In seventy-five days, over one-half million Pennsylvania residents can begin applying for medical insurance under the recently approved “Healthy Pennsylvania” program. Healthy PA is Pennsylvania’s version of the Medicaid expansion authorized under the federal Affordable Care Act, also known as “Obamacare.” Eligible Pennsylvania residents can begin to apply for Healthy PA beginning December 1, 2014. If they qualify, their coverage will become effective on January 1, 2015.

Healthy PA, which was approved in late August, will attempt to seal at least some of the “gaps” in the health care system. A large group of Pennsylvania’s most vulnerable residents failed to qualify for medical coverage in a bizarre twist of law and logic. Pennsylvania residents without access to an employer health care plan could qualify for subsidized medical insurance through the Health Care Exchange created by the Affordable Care Act if their income was over approximately 133% of the federal poverty level. Other needy Pennsylvanians between the ages of 22 and 64 could qualify for Medicaid if they were seriously disabled. Therefore, over one-half million Pennsylvania residents did not qualify for medical insurance because they were too old or too young, too healthy, or too poor.

Healthy PA is a program designed to cover those uninsured, non-disabled Pennsylvania residents between the ages of 22 and 64 whose income is less than 133% of the federal poverty level. A single individual with a yearly income less than $16,000.00 would meet the financial criteria for the Healthy PA as would a family of four with yearly income less than $32,000.00. Eligible residents will get to choose from at least two Private Coverage Options (PCOs) in their region. A PCO is a health plan offered by a participating private health insurance carrier. The PCO is similar to many of the HMO-type plans offered in Pennsylvania.

The question is: What should you do if you think you qualify for Healthy PA? We recommend that you apply on December 1, 2014. There are several different ways to apply for Healthy PA. Applications can be submitted on paper or in person to your local County Assistance Office. Applications for Healthy PA can also be submitted online at www.COMPASS.state.pa.us or through a phone call to the Consumer Service Center at 1-866-550-4355. There is no fee to apply for Healthy PA.

Finally, what should you do if you are not sure you qualify for Healthy PA? You should still apply for Healthy PA because you may find that you or members of your household are eligible for Medicaid or other government benefits. If you are not eligible you will receive an explanation of why you do not qualify for Healthy PA. There is no deadline to apply for Healthy PA. You can apply at any time after December 1, 2014. Of course, if you think you qualify for Medicaid you can and should apply immediately.

If you apply for Healthy PA and you qualify, you will be contacted by a state enrollment broker who will assist you in choosing a plan in you region. If you do not choose a plan, you will be assigned to a plan. If you do not like your plan you will have the opportunity to choose a new plan.

I enjoyed writing this brief article and I hope everyone found it informative. Next month I will write about the specific pitfalls and benefits of Healthy PA.