Pennie, the state’s health insurance marketplace, has reopened its health insurance marketplace for a special enrollment period, February 15th through May 15th, to allow people affected by the coronavirus pandemic to select a new plan. The enrollment period is open to anyone who wants coverage. During this four-month window, consumers may submit a new application for coverage or update their existing coverage.
Readers may recall that the fall of 2020 was Pennie’s inaugural enrollment season. Previously, Pennsylvania participated in the federal marketplace (healthcare.gov). Nearly 338,000 Pennsylvania residents signed up for coverage during Pennie regular enrollment (November 2020 to January 2021). Of those, 75,000 were new consumers, a 9.7% increase compared to last year. Nearly nine of ten consumers received financial assistance.
During this special enrollment period, coverage will begin on the first of the following month regardless of when an individual has enrolled. For example, if a plan is selected on March 23rd coverage would begin on April 1st.
PHLP has answered some of the most asked Pennie questions:
Q. Who can enroll in Pennie?
A: Pennie was designed for state residents who are U.S. citizens or legal U.S. residents, and do not have access to health insurance through a private company, their workplace, a family member’s employer, or a government program, such as Medicare or Medical Assistance (Medicaid).
Q. What is a special enrollment period?
A: Typically, people can buy a marketplace plan only during the annual open enrollment period in the fall or if a major life event gives them another opportunity to sign up, called a special enrollment period. Losing job-based health coverage is one event that creates a special sign-up opportunity; so is getting married or having a baby. But usually, people must sign up with the marketplace within 60 days of the event.
With the new special enrollment period, how long someone has been uninsured isn’t relevant, nor do people have to provide documentation that they’ve lost job-based coverage. This special enrollment is open to anyone who wants coverage. During this four-month window, consumers may submit a new application for coverage or consumers who have coverage can update/change their existing plan. The message is quite simple: Come and apply.
Q. What if I cannot afford the health insurance premiums or other costs?
A: Financial assistance is available for households whose annual income is below 400% of federal poverty— about $51,500 for one person or $106,000 for a family of four. The size of the tax credit depends on household size and income. Those earning less than 200% of federal poverty may qualify for additional assistance to reduce out-of-pocket expenses like copayments. More than 45% of the households using Pennie coverage reported incomes below 200% of poverty; 87% reported incomes below 400% of poverty.
Q. I am enrolled in a Pennie plan; can I add a household member through the COVID-19 enrollment period?
A: YES. You can add a new household member to your application and then add them to your existing coverage.
Q. Do I have to test positive for COVID-19 to be eligible for Pennie’s COVID-19 enrollment period?
A: NO. You do not have to test positive for COVID-19. An individual’s medical history is not a factor at all.
Q. When will my coverage start during this special enrollment period?
A: If an individual enrolls in a plan during this special enrollment period their coverage will begin on the 1st of the following month, regardless of how late an individual applies the month before. For example, if an individual were to select a plan March 24th their coverage would begin April 1st.
Q. Do I need to report one-time stimulus payments my household received?
A: No. Federal stimulus payments during the pandemic do not count as income coverage for the purpose of calculating marketplace tax credits from Pennie.
Noteworthy Enrollment Data From Pennie
These two charts recently released by Pennie summarize who enrolled in marketplace coverage by income and age during Pennie’s regular open enrollment period (Nov. 2020 to Jan. 2021)