Consumer Alert: Information to prepare for changes in healthcare coverage this January
Commonwealth of Pennsylvania | 12.31.13
Harrisburg – Several key pieces of the federal Affordable Care Act (ACA) will go into effect on Jan. 1, 2014, and may include changes to your healthcare coverage. Pennsylvania wants to ensure that individuals who have applied, or are planning to apply, for healthcare know their status and where to go for assistance.
If you applied for healthcare coverage through the federal government’s website, HealthCare.gov, technical issues may impact your coverage on Jan. 1.
Thousands of low-income Pennsylvanians who applied through the federal government’s website and were determined eligible or potentially eligible for Medicaid or Children’s Health Insurance Program (CHIP) coverage may find out they were not enrolled as anticipated as of Jan. 1. This was due to a data transfer issue where states received incomplete records from the federal government.
The Department of Public Welfare (DPW) asks for patience from these customers, as they work to manually process the more than 25,000 applications affected by the file transfer issues. DPW will do everything possible to ensure these individuals receive the coverage they’ve applied for as quickly as possible.
If you applied on HealthCare.gov and were found eligible or potentially eligible for Medicaid:
- To date, the federal government has been unable to transfer your full application to Pennsylvania.
- You can expect to receive a call from the federal Health Insurance Marketplace Call Center within the next few days which will recommend you re-apply directly with DPW by calling 1-866-550-4355.
- If you applied between Oct. 1 and Dec. 24, 2013, and have not been enrolled due to these delays, your coverage will be retroactive to Jan. 1, 2014 upon your enrollment.
If you applied on HealthCare.gov and were found eligible for Private Coverage:
You should confirm your healthcare coverage through your new insurance company if you’ve not already received verification of enrollment.
If you applied through the state for Medicaid or CHIP and were found eligible:
You do not need to take any further action.
If you applied through the state for Medicaid or CHIP and were found ineligible:
- You should have been notified by the state that your application was referred to the Federally Facilitated Marketplace (FFM) for health insurance.
- If you haven’t already, you will be contacted by the FFM, also referred to as the Health Insurance Marketplace, with more information and next steps.
- You will also be advised that the quickest way to get your health coverage is to re-apply directly through the Health Insurance Marketplace by visiting HealthCare.gov.
If your family includes a current CHIP recipient:
- CHIP insurance companies are communicating with CHIP participants now, letting them know that all households with incomes between 100 and 133 percent of the federal poverty level will not be forced to move their children into the Medicaid program on Jan. 1, 2014.
- The state is instead diligently working with the federal government to secure approval for an option for Pennsylvania’s families to choose between Medicaid and CHIP. Additional details will be provided to CHIP families once an agreement is reached with the federal government.
If you received a discontinuation notice on a private insurance plan:
- The requirements of the ACA resulted in the cancellation of hundreds of thousands of private insurance plans in Pennsylvania this fall. President Obama later asked that all insurance companies be given the choice to allow these plans to continue.
- You should have received information from your insurance company allowing you to either keep your current plan or be enrolled in a new, comparable plan. If you have received a cancellation notice and have not heard from your insurance company about your options, contact your insurance company directly for assistance.
If you have employer-sponsored insurance:
Contact your employer directly with any questions.
If you did not complete Healthcare.gov enrollment, did not meet the deadline for Jan. 1 enrollment, or are uninsured:
- DPW encourages any Pennsylvanian who believes he or she may qualify for Medicaid coverage to contact DPW directly to apply at 1-866-550-4355. If found eligible, your coverage will be retroactive to the date of your application.
- If you wish to apply for private coverage, you may continue to try to enroll at Healthcare.gov until the end of the open enrollment period, which ends on March 31, 2014, or call a private insurance company directly to enroll (tax subsidies may not be available if you enroll directly through a private company).
- Learn more about your options at www.PaHealthOptions.com.
Governor Corbett’s Healthy Pennsylvania plan will increase access to quality, affordable healthcare coverage for more than 500,000 Pennsylvanians. The plan is currently in a public comment period and will be submitted to the federal government for approval following the review of the comments received. More information about the Healthy Pennsylvania plan is available at www.pa.gov.
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