Pennsylvania: Say Hello to Pennie!

Pennsylvania launches new state-based health insurance marketplace, Pennie

  • Pennie replaces Healthcare.Gov and will improve access to coverage and increase affordability

Harrisburg, PA – September 22, 2020 – Today, Pennsylvania announced, Pennie, the new state-based health insurance marketplace for 2021 coverage. Pennie is available to all Pennsylvanians and aims to improve the accessibility and affordability of individual market health coverage. It is also the only place that connects Pennsylvanians to financial assistance to reduce the cost of coverage and care.

Pennie was created by Act 42 of 2019, passed unanimously by both chambers of the General Assembly and signed into law by Governor Tom Wolf on July 2, 2019.

As I noted at the time, this was an extremely unusual thing to happen: A truly bipartisan vote to improve the ACA by making premiums more affordable as well as improving transparency and control over the experience and offerings to the state...spearheaded by the Republican legislative leadership and agreed to by the Democratic Governor. This is one of the only times I've seen a bipartisan government work the way it's supposed to on a significant statewide level project in years.

“My Administration has made it a priority to ensure all Pennsylvanians have health care that is accessible and affordable, and it is my hope that Pennie, as our state-based health insurance marketplace, works to make that priority a reality,” Governor Tom Wolf said. “I encourage Pennsylvanians to explore their health insurance options with Pennie.”

Pennsylvanians can begin shopping for health and dental coverage through Pennie at the start of Open Enrollment on November 1, 2020. This year, Pennie extended the 2021 Open Enrollment Period which will run from November 1, 2020 through January 15, 2021. Pennsylvanians currently enrolled through HealthCare.gov will be transitioned to Pennie for their 2021 coverage. Pennie’s goal is to make it easier for Pennsylvanians to access coverage through education, assistance, and improved customer service.

That's one major change right off the bat: The open enrollment period is being extended by an extra month from the official December 15th deadline.

Also noteworthy: Unlike Idaho and Nevada when they split off from the federal exchange, Pennsylvania has supposedly taken measures to port existing enrollee accounts over to their new platform:

How do I set up or access my account?

If you previously had an account with healthcare.gov, you already have an account with Pennie! 

“This is an exciting step forward for Pennsylvania. By transitioning from Healthcare.Gov to a state-based marketplace, Pennie will have the flexibility to react to changes and serve individuals and families in the way best suited for their needs. Through local control of our operations, outreach and customer service, we aim to simplify the purchasing process and enable shoppers to find the right plan,” says Zachary W. Sherman, Pennie Executive Director. Sherman came from Rhode Island’s marketplace, HealthSource RI, to serve as the first Executive Director of Pennie. “Affordability is one of the largest barriers prohibiting people from accessing quality coverage and through the Pennsylvania Reinsurance Program, Pennie will generate millions in premiums savings for individual market customers.”

This was the primary impetus for splitting off from HealthCare.Gov in the first place, just as it was for Nevada. At the time, CMS was charging Pennsylvania (and most other states) a 3.5% surcharge on premiums for all ACA exchange enrollees to cover the cost of operating the federal marketplace (even as the Trump Administration was slashing the marketing and outreach budgets by 90%). This was later reduced to 3.0%, but most of the other state-based marketplaces are operating on a much smaller fee (around 2% or so). By utilizing their own platform, PA is projected to save around $60 million/year.

Unlike Nevada, however, Pennsylvania is going one step further: Instead of simply knocking the 1-1.5% in savings off of the premiums for the enrollees directly, they're using that $60 million in savings to provide the funding in conjunction with federal funding for their portion of an ACA Section 1332 Reinsurance Waiver to knock unsubsidized premiums down by 5-10%.

Pennie will work closely with insurers to foster a competitive marketplace; with the Department of Human Services to support Pennsylvanians transitioning between Medical Assistance, CHIP and the marketplace; and with community and local leadership to promote and educate the public about the transition. Pennie has also significantly enhanced the state’s network of Exchange Assisters who provide multilingual support, in-person or by online appointment, across the Commonwealth. Pennie has also kicked off a streamlined, Pennsylvania-specific training for thousands of producers who will sell coverage as Pennie-Certified Producers during the 2021 Open Enrollment Period.

“We are excited and proud to bring Pennie to the citizens of Pennsylvania,” says Pennsylvania Insurance Commissioner Jessica Altman. “Our mission is to help Pennsylvanians access the health insurance they need to live a healthy life. This is now more important than ever. We strive to support all Pennsylvanians and understand many who lost employer-sponsored coverage as a result of COVID-19 may be new to the individual market and unaware our marketplace is a resource for assistance and financial help to pay for coverage.”

Pennsylvanians interested in learning more about Pennie can visit pennie.com to find information about the new marketplace and the transition from HealthCare.gov. Pennie will be communicating with transitioning customers in early October to ensure they are prepared for the 2021 Open Enrollment Period. During Open Enrollment, pennie.com will provide customers with the tools to learn, compare and shop for their health insurance coverage. Through Pennie only, customers can see if they are eligible for financial assistance that can help lower their monthly premiums or out-of-pocket costs in the form of Advanced Premium Tax Credits and/or Cost-Sharing Reductions.

Of course, if the Supreme Court strikes down the ACA, the reinsurance waiver would disappear. Along with HealthCare.Gov. And the federal funding. And the federal Advance Premium Tax Credits. And the Cost-Sharing Reductions. And the protections for pre-existing condition coverage on all the policies sold through Pennie...

In the meantime, however, Welcome to the Party, Pennie!