Pennsylvania Affordable Healthcare Insurance Coverage
Pennsylvania residents with a drug addiction need to pay close attention to the affordable healthcare options. All policies are required to offer some benefits for this service, but the amount they pay varies based on the company and policy. The Affordable Healthcare Act set up several different rules and regulations that companies must follow and those that do offer what is known as “Obamacare” insurance. These policies are for those who can’t afford an employer insurance policy and there are a variety of these options to consider in Pennsylvania.
Aetna
The most well-known provider of Obamacare in Pennsylvania is probably Aetna. This national company currently provides four plans in PA:, two Bronze, one Silver, and one Gold. The Bronze plans both have high deductibles, so they are good choices if you have a health saving account. The two upper metal level plans have lower deductibles, but higher premiums. All the Aetna plans are HMOs, so you work with a primary care physician.
The level of coverage for substance abuse treatment per plan varies. Bronze plans provide full coverage for managed detox, inpatient, and outpatient treatment. While Silver requires e a $500 co-pay upon admission and then paying 30% of the total bill for inpatient care. Outpatient service requires a $75 per office visit payment with a waived deductible.
With the Gold plan, the office copay drops to $40 with the deductible waived and the co-insurance payment is just 20% of the total cost. There is no initial copay for inpatient service.
Geisinger
Geisinger offers two types of plans to PA residents. Geisinger Choice is a PPO program, so you can go to any doctor you like. There are two plans available under this brand name. The Silver Geisinger Choice Marketplace PPO 30/50/5000 policy has a deductible of $5,000 dollars and an out-of-pocket maximum of $6,000. The Gold plan, titled 25/50/1000, provides a lower deductible ($1,000) and a $4,000 out-of-pocket limit.
Both plans require you to make a copayment for substance abuse treatment. For the Gold program, you pay just $25 for an outpatient visit, whether it is individual or group and 20% after the deductible for inpatient care. As this is a PPO, you do have the option of going out of network for treatment and paying 30% after the deductible for both types of care plans.
The Silver plan is similar, but costs a little more, with a $30 fee for outpatient care and 30% after the deductible for inpatient treatment. If you go out of network, expect to pay 40% of the costs.
The Geisinger Health Plan program is the company’s HMO policy and one Point-of-Sale plan. POS plans work the same way as HMOs, but require higher payments for services but lower monthly premiums.
The deductibles vary on all the plans and range from $500 to $3,000. The lowest deductible plan is the Gold Extra 10/50/500 policy. With this program, you pay just a $500 yearly deductible and a maximum of $5,000. This plan also comes with a $250 copay on admission to an inpatient facility after the deductible is met and a $20 copay per outpatient visit. The highest deductible, $3,000, is also a Gold level plan and it offers the same substance abuse benefits.
With Geisinger’s POS plan and the two Silver HMOs, there is no initial copay for inpatient treatment, only the coinsurance payment, which varies by policy. You can expect to pay from 20 to 30%. None of the Geisinger Health Plan programs pay for out of network care and all require pre-authorization.
Aetna and Geisinger are just two of the companies offering affordable insurance to the people of Pennsylvania. Since there is such a wide range of programs and providers, you will need to investigate each one separately to determine which policy best suits your treatment needs.
