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Pennsylvania Affordable Care Act

Pennsylvania Affordable Care Act Comprehensive Guide

In this article, you will learn about the Affordable Care Act health care reform laws in Pennsylvania.  You will get an understanding of how the health care law impacts you as a citizen of the state.  Learn how to sign-up for the Affordable Care Act, learn about the Affordable Care Act penalty and subsidies, and much more.

What is Pennsylvania Affordable Care Act?

Affordable Care Act, also known as Obama Care, was signed into law in March 2010.  The goal of the Affordable Care Act is to provide US citizens with affordable health insurance and to reduce the cost of health care spending for families and in America.

The Key Points of the Affordable Care Act / Pennsylvania Obamacare:

How to Apply for Pennsylvania Affordable Care Act?

Pennsylvania Affordable Care Act marketplace is run by the Federal government.  Click on HealthCare.gov to access Pennsylvania Affordable Care Marketplace.  You can preview the different insurance plans and see participating doctors before selecting the final health insurance plan.

State Federal or State Marketplace  Website Medicaid Expansion?
Pennsylvania Federal www.HealthCare.gov Yes

When can I apply for Pennsylvania Affordable Care Act (Pennsylvania ACA)?

Pennsylvania  Affordable Care Act’s Open Enrollment starts on November 1 and ends on December 15.  To have health insurance coverage beginning in the following year, you must apply before the December 15 deadline.

In order to qualify for Tax Credit or Premium Tax Subsidies, you must purchase health insurance from the Affordable Care Act Marketplace during the Open Enrollment period.

If you qualify for Pennsylvania Medicaid health insurance, then you can sign-up for Medicaid any time of the year.

When is the deadline for Pennsylvania Affordable Care Act (PA ACA)?

Important dates for Pennsylvania Affordable Care Act deadlines:  The absolute last day to purchase health insurance from the Marketplace is December 15.

  • November 1: First day to enroll in or change plans for new insurance
  • December 15: Last day to enroll in or change plans for new coverage to start the new year

How much is Pennsylvania Affordable Care Act?

There are four different plans within the Pennsylvania Affordable Care Act.  The metal plans represent the various levels of coverage you receive and what the plan pays on average.  The plan levels DO NOT represent the quality of the health coverage/doctors you receive.

  • Bronze Plan: The plan pays 60% of the cost, you pay 40% of the cost
  • Silver Plan: The plan pays 70% of the cost, you pay 30% of the cost
  • Gold Plan: The plan pays 80% of the cost, you pay 20% of the cost
  • Platinum Plan: The plan pays 90% of the cost, you pay 10% of the cost

The cost of the Affordable Care Act in Pennsylvania depends on the metal plan you choose and the number of people in the household.   Platinum plans have the highest insurance premiums (monthly cost) and Bronze plans have the lowest insurance premiums.

What are the Pennsylvania Affordable Care Act Eligibility Requirements?

In order to get Pennsylvania Affordable Care Act, you must meet the following requirements:

  • Must live in Pennsylvania
  • Must be a US citizen, national, or lawfully present, immigrant
  • Cannot be currently incarcerated (be in jailed)
  • Have a valid Social Security Number
  • and few other requirements

Do I need to get Pennsylvania Affordable Care Act?

Yes, every individual in Pennsylvania needs to have health insurance.  The Individual Mandate of Affordable Care Act health care law requires US citizens to enroll in a health insurance plan or pay a penalty.  If you have Medicaid or company-sponsored health insurance, you have met the insurance coverage requirement.

You can choose not to have health insurance, but you have to pay the penalty in addition to the hospitals/doctor’s medical fee if you do get sick.

How much is the Affordable Care Act Penalty in Pennsylvania?

The penalty (or also called individual shared responsibility payment) is calculated in two ways.

Starting in the 2019 tax year, there is no longer a penalty for not having health insurance.

From 2016-2018, the ACA penalty is as follows:

  1. By percentage of income (2.5% of household income or a maximum of National Average Bronze plan premium)
  2. By number of people in the household ($695 per adult, $347.50 per child, or maximum $2085)

You’ll pay whichever penalty is higher. 

How much are Pennsylvania ACA Subsidies? What are the requirements?

Affordable Care Act Subsidies are also called, “Premium Tax Credits.”

ACA subsidy lowers your premium – the amount you pay each month to your insurance plan. The amount of your ACA Subsidy depends on the estimated household income that you put on your ACA Marketplace application.

In order to qualify for the Affordable Care Act Subsidy, your income must be between 100% to 400% of the Federal Poverty Level.

Affordable Care Act - Federal Poverty Level
Federal Poverty Level Insurance Premium After PTC Subsidy
Up to 133% FPL 2% of income
133-150% FPL 3%-4% of income
150-2000% FPL 4%-6.3% of income
200-250% FPL 6.3%-8.05% of income
250-300% FPL 8.05%-9.5% of income
300-400% FPL 9.5 of income
Over 400% FPL No Government Subsidy

Medicaid Expansion under the Affordable Care Act

With the new health care reform, the Federal government offered incentives for states to expand the Medicaid program.  30 states out of the 50 states plus Washington DC expanded Medicaid program while 20 states decided not to expand Medicaid due to expected future cut back funding from the Federal government.

Pennsylvania expanded the Medicaid program under the Affordable Care Act Health Care Reform.

State Medicaid Expansion
Pennsylvania yes

Insurance Companies that offer Affordable Care Act Health Insurance Plans in Pennsylvania:

The following insurance companies are offering Affordable Care Act Plans in the Marketplace.

  • Aetna (14)
  • Assurant Health (6)
  • Capital BlueCross (11)
  • Coventry (5)
  • Geisinger Choice (2)
  • Geisinger Health Plan (9)
  • Highmark (4)
  • Highmark Health Insurance Company (12)
  • Keystone Health Plan Central
  • Capital BlueCross (13)
  • Independence Blue Cross (15)
  • UnitedHealthcare (5)

Frequently Asked Questions (FAQ) on Pennsylvania Affordable Care Act:

  1. Who runs the Pennsylvania Affordable Care Act? Federal
  2. Where can I sign up for Pennsylvania Affordable Care Act? Click here
  3. Do I need to get health insurance or the Affordable Care Act? Yes, if not, you have to pay a penalty.
  4. How much is Pennsylvania Affordable Care Act? Click here for the average ACA premium
  5. Did Pennsylvania expand Medicaid under the Affordable Care Act? YES

Click here for more Frequently Asked Questions on Obamacare / Affordable Care Act.

For more information on Pennsylvania Obamacare / Affordable Care Act:

Federal HealthGov Marketplace
Toll-Free: 1-800-318-2596
Website: HealthCare.gov

Pennsylvania Insurance Department
Bureau of Consumer Services
1209 Strawberry Square
Harrisburg, PA 17111
(877) 881-6388


Pennsylvania’s five largest cities in terms of population: Philadelphia, Pittsburgh, Allentown, Erie, and Reading.  You can apply for Affordable Care Act Health Insurance in any city in Pennsylvania.

Pennsylvania Affordable Care Act

Health Insurance Marketplace in Pennsylvania

If you live in Pennsylvania, you’ll use HealthCare.gov website, to apply for coveragecompare plans, and enroll. Specific plans and prices will be available on October 1, 2013, when Marketplace open enrollment begins. Coverage can start as soon as January 1, 2014.

Beginning Oct 1, the Health Insurance Marketplace will make it easy for Pennsylvanians to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.

By the Numbers: Uninsured Pennsylvanians who are eligible for coverage through the Marketplace. 

  • 1,242,350 (12%) are uninsured and eligible
  • 928,243 (75%) have a full-time worker in the family
  • 491,258 (40%) are 19-34 years old
  • 864,180 (70%) are White
  • 201,028 (16%) are African American
  • 114,374 (9%) are Latino/Hispanic
  • 33,494 (3%) are Asian American or Pacific Islander
  • 707,872 (57%) are male

1,141,720 (92%) of Pennsylvania’s uninsured and eligible population may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Pennsylvania takes advantage of the new opportunity to expand Medicaid coverage under the Affordable Care Act.