Mother with child talking with doctor

Selecting Health Coverage

Everyone needs health insurance. Even though you may not plan on getting sick or hurt, chances are that you will need medical care at some point.

And despite what you may read or hear, health insurance coverage is still available to everyone, regardless of a medical condition, sex, or age.

There are many plans available to meet your needs and budget; and financial assistance may be available.

Whether you need health insurance for the first time, or already have health insurance and are comparing your options, it’s important to get covered and stay covered.

How Can I Get Health Coverage?

There are several ways you can obtain health insurance.

  • Through HealthCare.gov—If you buy insurance for you or your family, the HealthCare.gov website provides an easy way to see the plans available to you, and determine whether you qualify for financial help. Using this website also helps you learn if you qualify for free or low-cost coverage through Medicaid or the Children’s Health Insurance Program (CHIP). You may buy insurance through Healthcare.gov during the “open enrollment period” (typically early November through mid-December) unless you qualify for a “special enrollment period” due to a life event like losing coverage, getting married, or having a baby. You also can buy insurance through a licensed insurance agent.
  • Through Your Employer—If your employer offers health insurance, you may choose to purchase insurance for you or your family from your employer. If your employer does not offer coverage or you decide to not purchase coverage from your employer, you may be able to buy insurance from HealthCare.gov or from a licensed insurance agent.
  • For Older Pennsylvanians—If you are age 65 or older and qualify, you may be eligible for Medicare. There are several choices, including traditional Medicare Part A and Part B plans, Medicare Advantage plans, prescription drug coverage, and Medicare Supplement Insurance (Medigap). There are specific times when you can sign up for these plans or make changes to the coverage you already have.  
  • Other Programs—For those who qualify, coverage may be available through Pennsylvania’s Medical Assistance program (Medicaid) or Pennsylvania’s CHIP.

Importance of Insurance

There are many benefits of having health insurance. Some of the major benefits include access to “everyday” care, access to emergency care, and preventive care.

Key Benefits of Health Insurance

  • Immediate, “everyday” care—such as primary care, children’s health and dental care, specialty care, mental health care, and prescriptions
  • Emergency, inpatient, and follow-up care—such as when you receive emergency medical care, are admitted to the hospital, and after you leave the hospital
  • Preventive care and chronic care management—such as vaccinations, health screenings, and care to manage conditions like diabetes and asthma

Need Assistance?   

If you need personal assistance applying for health insurance coverage or have more questions, there is help available close to home. These individuals are known by different names, depending on who provides the service and where they are located, but all of them can help you with your choices and application.

  • Your Local Hospital—Your local hospital is taking an active role in helping individuals enroll in health insurance coverage. Contact your local hospital
  • In Person Help and Enrollment Events—You can find free, in-person assistance and enrollment events near you via Healthcare.gov or contact your local library
  • Phone Assistance—You can call (800) 318-2596 (TTY: 1-855-889-4325), 24 hours-a-day, 7 days-a-week for assistance
  • The Pennsylvania Department of Insurance—The department’s website has helpful information. If you still have questions, you can call the department’s Customer Service Line at (877) 881-6388 (TTY/TDD: 717-783-3898)

 

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