Get Help with Health Insurance!

Uninsured? Need to change your plan? Not sure what your options are? PHAN can help!

As a nonprofit, we provide free assistance in understanding, applying for, and enrolling in health coverage, as well as troubleshooting problems. Review our frequently asked questions below or contact our helpline for help.

To get help, call or text PHAN’s helpline at (877) 570-3642 or fill out the form below: 

Frequently Asked Questions about Health Insurance

If you need health coverage or do not receive it from your employer, you may be eligible for one of the following types of coverage:

  • Free health coverage for low-income Pennsylvanians (Known as Medicaid, ACCESS, or Medical Assistance)
  • Free or low cost health coverage for children under 19 (The Children’s Health Insurance Program or CHIP)
  • Healthcare you can purchase on your own. 9 out of 10 people qualify for financial assistance! (Known as Pennie, Obamacare, or Marketplace Coverage)
  • Healthcare programs for people with disabilities, such as Medical Assistance for Workers with Disabilities (MAWD), Home- and Community-Based Services (HCBS), or Medicare
  • Health coverage for people over 65 (Medicare)

If you are purchasing your own insurance through Pennie (also known as Marketplace or Obamacare) for the following year, you must enroll during the Open Enrollment Period from November 1st-January 15th unless you are eligible for a Special Enrollment Period.

If you apply during Open Enrollment in 2023, your coverage will begin in January or February of 2024.

If you are applying for free health coverage benefits through Medical Assistance, you can apply at any time.

You can enroll in health coverage when it is not Open Enrollment if you are low-income or if you have had one of the following “qualifying life events” happen in the last 60 days. This is called a “Special Enrollment Period.” PHAN can help you determine if you qualify - just give us a call!

  • Losing existing health coverage of any kind, including Medicaid or CHIP
  • Change in immigration status
  • Getting married or divorced
  • A change in the number of dependents using your coverage
  • Moving from another state to Pennsylvania
  • Moving to a different zip code within Pennsylvania
  • If you are low-income.

That depends on a lot of factors! The good news is that 9 out of 10 Pennsylvanians will qualify for financial assistance that lowers the cost of their plan, and people with lower incomes may be eligible for a $0 premium plan through Pennie.

New legislation passed by Congress will save Pennsylvanians an average of over $1,000 a year through 2025, so it’s important to take a look at your options this year. To get an estimate of how much a Pennie plan will cost for you or your family, check out Pennie’s savings calculator.

For people with lower incomes, choosing a silver plan means you can save even more on copays and deductibles. If your income is below $20,385 for a household of 1, or $41,625 for a household of 4, then you qualify for this extra assistance. To receive this extra assistance, you must enroll in a Silver plan.

Starting in 2022, everyone enrolled in a Pennie plan will automatically have their coverage renewed.

If you previously agreed to give Pennie permission to verify your income, you will automatically see financial assistance similar to what you previously received. If you did not give Pennie permission to do this, you will see the full-cost plan. Don’t worry! All you need to do is contact Pennie or re-submit your application to get the financial assistance again.

It is always a good idea to check your application and the plan you were re-enrolled in. You may have changes within your household to report, such as expected income or address, and you may want to shop around for a new plan.

There are four levels of coverage available through Pennie. The levels are based on how much you pay when you get care and your monthly payment (called a premium). Lower level plans, like Bronze and Silver, typically have lower monthly premiums with higher yearly deductibles and copays. Higher level plans, like Gold and Platinum, typically have higher monthly premiums and lower yearly deductibles and copays. The different levels do not have to do with quality of care, only the cost.

  • Bronze: Lowest monthly premium, highest costs when you need care
  • Silver: Moderate monthly premium, moderate costs when you need care
  • Gold: High monthly premium, lower costs when you need care
  • Platinum: Highest monthly premium, lowest costs when you need care

All of these are terms for costs that you will have to pay out-of-pocket. Out of pocket means costs you are responsible for paying.

Premiums are what you have to pay monthly for your health coverage, whether or not you need care.

A deductible is the amount you have to pay before your plan starts paying for certain types of care.

A co-pay is a fixed amount you pay when you go to the doctor or seek care.

Coinsurance is the percentage you pay for services when you seek care.

It can be confusing, but this blog post lays out all of the types of income that count when you’re applying for health insurance.

It depends! Your health coverage may kick in right away or it could take up to a month and a half to be active. If you know you’ll need coverage soon, it’s best to apply as early as you can. Our helpline staff can help you understand when your coverage is likely to kick in, based on when and what type of coverage you’re applying for.

For example, if you apply for Pennie coverage on April 7th, coverage will start on May 1st. If you apply for Pennie coverage at any point between April 16th-April 30th, coverage will not start until June 1st. If you are losing other coverage, such as coverage through an employer or through Medicaid, then Pennie coverage will start the first day of the month after the loss of coverage regardless of when in the month you apply.

If you are losing your employer coverage, or are turning 26 and losing parental coverage, you may be eligible to enroll in Pennie using a Special Enrollment Period.

Depending on your income or age, you may also be eligible to enroll in Medicaid or CHIP at no cost.

If you are over 65, you are most likely eligible for Medicare. If you need assistance with your Medicare coverage, or choosing a Medicare supplemental plan, you can reach out to PA MEDI for assistance (1-800-783-7067).

If you already have Medicare, you might also be eligible for Medicaid or programs to help lower your Medicare premiums. Call our helpline to see if you’re eligible.

Depending on the family’s income, children may qualify for Medicaid (also known as Medical Assistance) or the Children’s Health Insurance Program (CHIP).

CHIP is available to children under 19, and costs vary depending on the ages of the children, household size, and income. There are three categories of CHIP: free, low-cost, and full cost.

Children with certain disabilities or health conditions may also be eligible for a special Medicaid program, PH95, even if they already have insurance. There are no income limits on this program. Call PHAN’s helpline to see if your child qualifies.

Depending on your income, you may be eligible for free coverage through Medicaid (also known as ACCESS or Medical Assistance).

If you are not eligible for free coverage, you may still be able to purchase coverage through Pennie. You will only be eligible to enroll in Pennie if the cost of your employer insurance is over 8.39% of your monthly income. Please call our helpline if you have any questions about this.

You may also be eligible for Medical Assistance for Workers with Disabilities (MAWD). This is a Medicaid program for people who are working at least one hour a week and have a chronic health condition. Call PHAN’s helpline to see if you qualify!

Even if Pennie (Marketplace/Obamacare) coverage has been too expensive for you in the past because someone in your family had coverage through work, check out this year's plans! Changes to the rules mean that plans for people in this situation may be much less expensive than they have been in the past.

You will need:

  • Income information for anyone included on your taxes
  • Names and dates of birth for anyone included on your taxes
  • Social Security Numbers for everyone applying, if they have one
  • Proof of immigration status for everyone applying
  • Names of doctors and prescriptions for everyone applying

You may have options for disputing a bill, filing a complaint, or appealing to your insurer. Call our helpline, and we can give you information about your individual situation.

You can search your plan’s provider directory to find doctors near you who are taking new patients. The provider directory is available on the plan’s website, or you can also call their Member Services to request a list of doctors covered by your plan. If you are having trouble finding a doctor in your plan’s network, reach out to PHAN for assistance.

Doctors or facilities that are “in-network” are ones that participate in your plan. You will usually have to pay less to see an in-network doctor. “Out-of-network” doctors or other providers do not participate with your plan, and you will likely have to spend more if you choose to see them for care. Depending on your plan, some “out-of-network” services may not be covered at all.

Many immigrants may qualify for coverage and financial assistance. Persons who have had permanent residence for at least 5 years, asylum, refugees, and children with documented statuses may qualify for Medicaid coverage.

Persons with other immigrations statuses, such as permanent residents for less than 5 years, persons with work visa, student visas, and others may qualify for coverage through Pennie with financial aid.

Also, different family members may qualify for different programs! Applying for coverage will not affect your immigration status in any way. Call our helpline for help checking your household’s options.

If you have had Medicaid throughout the COVID-19 pandemic, you may be aware that most people have not been terminated from their Medicaid coverage, even if you are technically over the income limit to qualify. This is because of the Public Health Emergency (PHE) that has been in place throughout the pandemic. Once the PHE ends, people will start to be terminated from their Medicaid benefits if they no longer qualify. To prevent being terminated from your Medicaid coverage, you should make sure the state has the most updated information for you. Here are some steps you can take:

  1. If you have moved throughout the pandemic make sure your County Assistance Office has the most up-to-date address for you.
  2. If you receive a renewal in the mail, submit it as soon as possible.
  3. If you income has gone down throughout the pandemic, make sure the CAO or your case worker has your most up-to-date income information.
If your yearly income is below this amount you may qualify for free insurance through Medicaid. If it is above this amount you may qualify for financial assistance to purchase a plan through the Marketplace. 9 out of 10 people qualify. [table id=4 responsive=scroll /]