Pennsylvania Health Services FAQs
- How do I get health insurance in Pennsylvania?
- Are there insurance plans specifically for people with certain health care needs?
- When can I enroll in a health insurance policy?
- Which companies provide private health insurance policies in Pennsylvania?
- What is COBRA insurance?
- Do I have to pay for insurance if I do not use it?
- How are health insurance rates determined in Pennsylvania?
- How do I ask my health insurance company to appeal a decision?
- How do I submit a complaint about a health insurance company in Pennsylvania?
- Who can I ask for help when I have Medicare questions in Pennsylvania?
- Who do I ask for help with Medicaid in Pennsylvania?
- Where can I find help with the Children’s Health Insurance Program in Pennsylvania?
- Where can I get medical treatment in Pennsylvania?
- I am a veteran. Where can I use VA health insurance in Pennsylvania?
- Are there any transportation resources in Pennsylvania for veterans?
- What do I do if I have a complaint about a hospital or nursing facility?
- How is my personal medical information protected in Pennsylvania?
- What health care procedures should be done regularly?
- Are any immunizations required for kids in Pennsylvania?
- What procedures are not usually covered by health insurance?
Pennsylvania has a variety of health insurance options. Most people who are employed full-time find it convenient to use the health insurance provider through their workplace. Pennsylvania also uses the federal health insurance marketplace. Furthermore, there are public health insurance plans available for children, older adults, people with disabilities and individuals with low income.
Pennsylvania participates in the federal Medicare program, which is aimed at older adults, people with disabilities and individuals with specific diseases. Many of these individuals are eligible for other types of public assistance as well, such as Medicaid.
You can only sign up during specific times no matter which type of coverage you want. When you have learned which types of health insurance you qualify for, find out when the enrollment period is for your plan. Under special circumstances, you can qualify to enroll during special periods. These will vary based on the qualifying life event and the type of coverage you need.
Insurance providers in Pennsylvania change each year. Plans are available from Aetna, Capital BlueCross, First Priority Health, Geisinger Health, Highmark Health Insurance, Keystone Health, Independence Blue Cross, UnitedHealthcare and UPMC Health Plan, among others. Plans from these companies can be found on the health insurance marketplace.
COBRA, also known as the Consolidated Omnibus Budget Reconciliation Act, allows people with employer-based insurance to keep their coverage for a limited period after quitting or being let go. Usually, COBRA is only available at businesses that employ more than 20 people. However, Pennsylvania has a Mini-COBRA law that allows people who worked for smaller employers to continue their coverage for nine months after leaving their job.
You will not pay towards your deductible or make copayments if you do not receive medical treatment or take prescription medications during a benefit period. However, when you have an insurance policy, you may need to pay a monthly premium to keep your coverage. The only exception would be if you qualify for free health coverage from a public assistance program. Download our comprehensive guide to learn about the eligibility requirements for health care assistance in PA.
All health insurance rates in Pennsylvania are submitted to the Insurance Department for approval. Rates vary based on individuals’ age, tobacco use and geographic area. There are nine different rating areas in the state. Gender, health status and preexisting conditions do not affect one’s rates.
Health insurance companies are required by law to let you submit appeals when you disagree with a coverage decision. If you are billed for a benefit that you think should be covered, then start by reading your explanation of benefits handbook. Contact your provider to begin the appeals process if a service indeed should have been paid for by your insurance.
Health insurance companies are regulated by the Pennsylvania Insurance Department. If you are treated unfairly or your insurance rights are violated, then file a complaint with the department.
If you are enrolled in Medicare or will become eligible soon, then Pennsylvania offers a free counseling service called APPRISE. This program helps you understand Medicare coverage options.
The Pennsylvania Department of Human Services provides Medicaid coverage. Contact DHS for all of the resources you need to understand your coverage options. You can also log into your Pennsylvania COMPASS account to find Medicaid resources.
CHIP is administered by the DHS. Contact DHS or log into your COMPASS account to find resources for CHIP.
There are hundreds of medical facilities in Pennsylvania, including hospitals, hospice centers, outpatient clinics, nursing homes, home health agencies and extended care centers. For those who do not live near a hospital, Pennsylvania also has Rural Health Clinics that provide many medical services on-site.
There are nine VA medical centers, 12 Vet Centers and more than 30 community-based outpatient clinics throughout Pennsylvania.
Veterans who need help getting to medical appointments can utilize the Veterans Transportation Service. The Coatesville VA Medical Center and hospitals in the VA Pittsburgh Healthcare System participate in this program. Former military personnel can learn about the services available for PA veterans at their local VA office.
When you are unsatisfied with the quality of your treatment at a medical facility, you should contact the management to resolve the issue. If this does not fix the issue, then register a formal complaint with the Pennsylvania Department of Health, which regulates these facilities.
Under the Health Insurance Portability and Accountability Act, your information cannot be disclosed without your consent. Insurance companies and the Pennsylvania Insurance Department are not allowed to share your personal information. If your information needs to be given to others, then you will receive a form that allows you to give or deny your consent.
The procedures you need on a regular basis will vary based on your age, gender and health status. Everyone should get an annual check-up or physical regardless of age. Preventative screenings for common cancers, diabetes and heart disease are usually covered by insurance policies.
If you have children attending school, then they need to receive certain vaccinations unless a medical or religious exemption applies. For any grade, children need four doses of the vaccination for tetanus, diphtheria, polio and whooping cough; three doses for hepatitis B; and two doses for measles, mumps, rubella and chickenpox (unless immune). Additional vaccinations are required when children enter seventh and 12th grade. Immunizations are usually covered by insurance.
In most cases, insurance companies only pay for procedures that are medically necessary. Providers have different definitions for what counts as a medically necessary procedure, medication or treatment. For comprehensive information about the services covered and not covered by PA health care assistance programs like Medicaid, Medicare and CHIP, download our free guide.
What Health Services Are Available in Pennsylvania?
From Obamacare health insurance plans to Medicaid and Medicare, there are various types of health coverage available in Pennsylvania. Each type of insurance can be accessed through a different application method. To learn about the easiest ways to apply for affordable health care in GA, download our comprehensive guide on health services.
Who Is Eligible for Affordable Health Services in Pennsylvania?
Affordable and free health services are often limited to Pennsylvania residents who meet all established eligibility requirements. Income, age and household size are often key factors taken into consideration when determining an applicant’s qualifications. Discover if you qualify for free or reduced-cost health insurance by reviewing the in-depth information on all program eligibility requirements within our comprehensive guide.