Because of partisan games in Washington DC, Lancaster County has some of the highest costs for healthcare in the state, the highest in the state last year on the exchange marketplace. Premiums this year went up by an average of 31%. These costs eat up a large chunk of consumers paycheck keeping people from being able to spend their money in their community and forcing them to ship it off to major insurance companies instead.
High deductible plans force people to ration care and risk missing necessary treatment. This drives up costs for everyone by prioritizing emergency care and keeping people out of work making our economy less productive.
Changes in the economy mean more people find themselves in positions with less health coverage than they need. Healthcare uncertainty forces people to stay in jobs they no longer want instead of starting new small businesses in our area because they are too afraid to lose their coverage.
Pennsylvania can change this and put families first by offering KeystoneCare.
KeystoneCare would enable you to buy-in to an affordable health plan with manageable cost sharing so you don’t have to choose between healthcare and housing or sustainable employment. Plan cost would be anchored to the cost of Pennsylvania Medicaid coverage. This would be lower than competing exchange based plans and guarantee market competition as a downward force on premiums benefiting all exchange consumers.
KeystoneCare Frequently Asked Questions
Who can get KeystoneCare?
Any adult PA Resident that does not qualify for Medicaid will be able to purchase KeystoneCare on the Healthcare.gov exchange. Exchange consumers can purchase the coverage at-cost or use their Advance Premium Tax Credits towards the purchase.
What does KeystoneCare cover?
KeystoneCare will be a Qualified Health Plan with guaranteed issue (no limitations on pre-existing conditions) and cover the ten essential health benefits;
- Ambulatory patient services (outpatient services)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
What will it cost?
Premiums and total cost sharing will be lower than standard exchange based plans. They will need to be determined by each plan specifically but because they will piggyback on the medicaid provider network and rate structure it will be able to offer lower costs than standard exchange based plans while maintaining consumer choice.
How is it so affordable?
The ability for the Pennsylvania to work with Managed Care Organizations to negotiate lower rates pegged at those for Medicaid is what enables the low consumer cost. Because the MCOs already have a developed infrastructure plan development will be as efficient as possible.
How will the Commonwealth pay for this?
KeystoneCare is a market based product with premiums and cost sharing which will fund the program. Additionally PA will apply for a 1332 “innovation waiver” so that it can reinvest realized federal premium savings into the program.