Key Takeaways
- Pennsylvania expanded Medicaid under the ACA, covering adults up to 138% of the federal poverty level
- Pennie is Pennsylvania's state-based health insurance marketplace
- Pennsylvania CHIP covers children in families above Medicaid limits
- Pennsylvania has a Life and Health Insurance Guaranty Association protecting policyholders
- adultBasic was replaced by Medicaid expansion for uninsured adults
Pennsylvania State Health Programs
Pennsylvania provides various programs to ensure residents have access to health insurance coverage.
Pennsylvania Medicaid (MA)
Pennsylvania's Medical Assistance (MA) program covers low-income individuals:
Eligibility Categories
| Category | Income Limit |
|---|---|
| Children (0-18) | Up to 215% FPL |
| Pregnant Women | Up to 215% FPL |
| Parents/Caretakers | Up to 138% FPL |
| Adults (Expansion) | Up to 138% FPL |
| Aged/Disabled | Various limits |
Medicaid Expansion
Pennsylvania expanded Medicaid under the ACA:
- Covers adults ages 19-64
- Income up to 138% of Federal Poverty Level
- Comprehensive benefits package
- No asset test for expansion population
Exam Tip: Pennsylvania is a Medicaid expansion state. Adults up to 138% FPL qualify.
Pennie (Pennsylvania Marketplace)
Pennsylvania operates its own state-based marketplace called Pennie:
Pennie Features
| Feature | Description |
|---|---|
| Website | Pennie.com |
| Open Enrollment | November 1 - January 15 |
| Premium Tax Credits | Available for qualified applicants |
| Plan Tiers | Bronze, Silver, Gold, Platinum |
| Special Enrollment | Qualifying life events |
Who Uses Pennie
- Individuals without employer coverage
- Self-employed individuals
- Small businesses (SHOP)
- Those losing other coverage
Children's Health Insurance Program (CHIP)
Pennsylvania CHIP covers children above Medicaid limits:
CHIP Eligibility
| Factor | Requirement |
|---|---|
| Age | Under 19 years old |
| Income | Above Medicaid, up to approximately 300% FPL |
| Residency | Pennsylvania resident |
| Citizenship | U.S. citizen or qualified immigrant |
CHIP Benefits
- Comprehensive health coverage
- Dental and vision included
- Mental health services
- Low or no cost to families
Pennsylvania Life and Health Insurance Guaranty Association
Protects policyholders when insurers become insolvent:
Coverage Limits
| Coverage Type | Maximum Limit |
|---|---|
| Life Insurance Death Benefit | $300,000 |
| Cash Surrender Value | $100,000 |
| Health Insurance | $500,000 |
| Annuity Present Value | $250,000 |
| Disability Income | $300,000 |
| Long-Term Care | $300,000 |
Key Points
| Rule | Description |
|---|---|
| Advertising | Cannot use as selling point |
| Eligibility | PA residents with covered policies |
| Funding | Assessments on member insurers |
| Coverage | Policies from licensed PA insurers |
What Is NOT Covered
- Policies from unlicensed insurers
- Self-funded employer plans
- Variable product investment portions
- Government programs
- HMOs (separate guaranty fund)
Exam Tip: Remember that producers CANNOT use the Guaranty Association as a selling point. This is frequently tested.
What is the name of Pennsylvania's state-based health insurance marketplace?
What income level qualifies Pennsylvania adults for Medicaid expansion?
What is the maximum life insurance death benefit coverage under Pennsylvania's Guaranty Association?
Can Pennsylvania producers use the Guaranty Association as a selling point?
Pennsylvania CHIP covers children up to approximately what income level?
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