Be a Smart Shopper for ACA Health Insurance

(Northeastern PA Version)

The annual open enrollment period for the Affordable Care Act (ACA) marketplace has arrived. From November 1 through January 15, 2021, individuals and families across Pennsylvania can choose from a range of high-quality, affordable health insurance options that are tailored to meet their particular health needs.

If you don’t have health coverage through your employer or another government program, the ACA marketplace has a plan that’s just right for you. Bill Tuthill, vice president of federal markets for Highmark, offers his insights about the ACA and shares some tips to help you be a smart shopper during open enrollment.

What kinds of services are covered by ACA health insurance plans?

ACA plans offer comprehensive health coverage. All plans must cover certain “essential health benefits,” which include important items such as doctor’s visits, inpatient and outpatient hospital care, prescription drug coverage, mental health services, and pregnancy and childbirth. And, unlike many other plans, ACA plans cover a variety of preventive services – like vaccinations and annual wellness visits – for $0.

Is there financial help available to individuals and families?

Absolutely. The ACA marketplace provides a range of affordable coverage options for individuals and families. A couple making up to about $68,000 – or a family of four earning up to about $108,000 – will qualify for tax credits that significantly reduce the cost of ACA insurance.

For example, about three out of four of Highmark’s ACA members qualify for subsidies or tax credits that make coverage more affordable. We have nearly 9,000 members in Pennsylvania who receive a tax credit that reduces their premium to less than $5 per month. Highmark also offers ACA plans in Northeastern Pennsylvania with some of the lowest deductibles in the state, including options with $0 deductibles.

What can ACA shoppers expect from Highmark for 2021?

We realize that our ACA customers aren’t all looking for the same thing in a health plan, so we make a broad range of options available and help our customers make the right decision for them.

In all 13 counties of Northeastern Pennsylvania, consumers can choose Highmark ACA plans that provide broad access to doctors and hospitals across the region. Through the BlueCard® program, Highmark plans also include in-network coverage for services received from more than 95 percent of doctors and hospitals around the country, including in New York and New Jersey.

To help consumers manage their conditions and have more certainty about their out-of-pocket expenses, Highmark offers some of the lowest copays for specialist visits in the region (they are now the same cost as primary care visits). We also give members the freedom to choose what doctor or specialist they want to see in-network, with no referrals necessary. And, in response to positive feedback, we have expanded the number of ACA plans we offer with integrated adult dental and vision coverage.

When customers think about Highmark, I want them to think about convenience, access and choice.

What advice do you have for ACA shoppers?

The most important thing you can do is to make sure that you shop. If you already have coverage through the exchange, you are auto-enrolled into next year’s plan. But it’s important that you verify your eligibility and shop around because Highmark has new plans available this year. You might be able to find a new plan that saves you money while meeting your particular insurance and care needs.

And even though the enrollment period runs until January 15, you must enroll by December 15 to be sure you’re covered for the whole year.

Where can people go to learn more?

To learn more about our ACA plans, you can visit https://www.discoverhighmark.com/ or call 866-632-7209. We have an expert team available to help new and current shoppers sort through their options, and pick the right plan for them.