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Living with Diabetes
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Pennsylvania
The following information details health insurance and assistance programs available to uninsured people in Pennsylvania.
Pennsylvania Insurance Department: Consumer Guide to Health Insurance - (877) 881-6388
Pennsylvania Guaranteed Issue through Blue Cross and Blue Shield information-
New Pennsylvania law makes it easier to get individual insurance under certain situations, including if you left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 63 days. Specifically, if you meet certain criteria, you are considered an eligible individual and guaranteed the right to buy individual health coverage from Blue Cross and Blue Shield plans in Pennsylvania without a pre-existing condition exclusion period.
To be an eligible individual, you must:
1) have had 18 months of continuous credible coverage, at least the last day of which was under a
group health plan;
2) have used up any COBRA continuation coverage for which you were eligible;
3) not be eligible for Medicare, Medicaid or a group health plan;
4) not have other health insurance.
You must apply for health insurance for which you are an eligible individual within 63 days of losing your prior coverage.
Highmark Blue Cross Blue Shield - (800) 544-6679
Blue Cross of Northeastern Pennsylvania - (800) 829-8599
Capital Blue Cross and Blue Shield - (800) 958-5558
Independence Blue Cross and Blue Shield - (800) 453-2566
Please remember that even though insurers other than Blue Cross Blue Shield can turn you down for an individual health insurance policy in Pennsylvania, you can never be turned down for health insurance that is offered through an employer.
If you are having a problem with your state-regulated health plan and you are unable to resolve it with the plan directly, file a complaint with the Department of Insurance. They may be able to provide you with assistance in reaching a conclusion.
Pennsylvania Medicaid - (866) 542-3015
Medicaid is available to anyone who meets income and eligibility criteria. Even if your income meets the criteria, you must fall into one of the eligibility categories in order to qualify. Contact your state Medicaid program for more information.
Pennsylvania Children’s Health Insurance Program (PaCHIP) - State Children’s Health Insurance Program - (800) 986-KIDS
PaCHIP is the health coverage program designed to provide health coverage to children and families who have too great an income or assets to qualify for Medicaid, but who may not be able to access or afford other health coverage. Visit the Web site to find out if you or your child meets the income guidelines.
Adult Basic Health Insurance program - (800) GO-BASIC (462-2742)
Adult Basic is the health insurance program available to Pennsylvania residents aged 19-64 who meet certain eligibility criteria. While the program has a modest monthly premium, this program currently has a waiting list. In addition, it does not cover prescription drugs. Contact Adult Basic for more information, and to be placed on the waiting list.
Pennsylvania Health Law Project - 1-800-274-3258
Free legal and advocacy services are available to Pennsylvanians having trouble accessing publicly funded health care coverage or services. Contact the phone number mentioned above, or e-mail staff@phlp.org
Pre-Existing Condition Insurance Plan (PCIP)
Through the Affordable Care Act, uninsured people with diabetes who have been continually uninsured for six months or more will be able to access insurance through a new program called the Pre-Existing Condition Insurance Plan (PCIP). PCIP, which is administered by either your state or the U.S. Department of Health and Human Services, will be available until the provisions banning discrimination based on pre-existing conditions are fully implemented in 2014.
PCIP will be available in every state, but the program may vary depending on the state. Currently, many states run programs, often called “high risk pools,” to offer insurance for those with pre-existing conditions. To build on what states are already doing, states can either run a new program with resources from the Affordable Care Act or rely on the U.S. Department of Health and Human Services to provide coverage. Please check out the State Plans page to learn more about how PCIP works in your state. http://www.pcip.gov/StatePlans.html
Local Community Health Clinics
If you or your loved one is unable to see a physician due to the cost of care, there may be a local community health clinic in your area. These clinics generally are free to patients or require a very small fee. Find a clinic in your area.
