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Questions and answers

We know health insurance can be complicated. Here are answers to the most common questions we hear.

How can I get information about Geisinger Marketplace plans?

You can learn more about Geisinger Marketplace plans by clicking here or contacting one of our knowledgeable, friendly representatives at 800-223-1282, Monday through Friday, 8 a.m. to 5 p.m.
How do I enroll in a Geisinger Marketplace plan?

Options for 2021 coverage:

Open Enrollment began Sunday, Nov. 1, 2020, and ran through Friday, Jan. 15, 2021. If you enrolled between Nov. 1, 2020, and Dec. 22, 2020, your health coverage would have taken effect on Jan. 1, 2021. If you enrolled between Dec. 23, 2020, and Jan. 15, 2021, your coverage would have started Feb. 1, 2021. 

If you missed Open Enrollment, the COVID-19 Special Enrollment Period (SEP) began Feb. 15, 2021, and ends Aug. 15, 2021. 
This SEP is available to everyone, which means new and current enrollees are eligible to purchase coverage or switch plans, even if you already enrolled during the most recent Open Enrollment Period. The Qualifying Life Event (QLE) that you will select for this enrollment period will be whatever the current date is that you enroll on Pennie’s website yourself or with our team’s help. Your coverage effective date will be the first day of the next month, even if you apply on the last day of the month before.

Shop for and enroll in a Geisinger Marketplace plan by clicking here or contacting one of our knowledgeable, friendly representatives at 800-223-1282, Monday through Friday, 8 a.m. to 5 p.m.

What is the American Rescue Plan Act (ARPA)?

The American Rescue Plan, also known as the COVID-19 relief package, includes provisions specific to the Affordable Care Act (ACA) resulting in significant impacts, including huge, life-altering savings, for Pennsylvanians seeking individual market coverage and those already enrolled in coverage through Pennie.
 
This is the largest coverage expansion since the ACA passed in 2010. The eligibility enhancements under this law allow for money to be put back in the hands of people and provide potentially life-altering coverage and relief to many Pennsylvanians who may be struggling with the pandemic and its economic repercussions.
 
The plan includes an increase in the eligibility for, and the amount of, premium tax credits for Pennsylvanians at all income levels during the 2021 and 2022 plan years. Those earning more than the current cap of 400% of the federal poverty level — about $51,000 for an individual and $104,800 for a family of four in 2021 — will be newly eligible for APTC. Under this law, no one will pay more than 8.5% of their income in premiums for the second-lowest-cost silver plan (SLCSP or benchmark plan) in their county. In some cases, lower-income enrollees could have their premiums eliminated completely.
 
Find out how much you could save using Pennie’s savings calculator.
Do I need to use only Geisinger providers and facilities?

No! Geisinger Health Plan’s network offers access to more than 29,000 providers, including 100+ hospitals and more than 130 urgent and convenient care locations, along with access to emergency care anywhere in the world.  Click here to search our network and update location before you start your search. 
What is coinsurance?

Once you meet your deductible, GHP pays a percentage and you pay a percentage of the remaining costs. The percentage you pay is called coinsurance.

If you have a plan with 20 percent coinsurance, GHP will pay 80 percent of covered services after your deductible has been met and you pay the remaining 20 percent. Once you reach your maximum out-of-pocket you will no longer have to pay coinsurance.

What does maximum out-of-pocket mean?

The maximum out-of-pocket (MOOP) amount includes all member expenses, such as deductibles, coinsurance and copays, for all covered services within a plan period. Once your MOOP costs are met, your health insurance plan will pay 100 percent of costs for covered services.
What are metallic levels?

Under the Affordable Care Act (also known as the ACA, or healthcare reform), the below metallic tiered categories are based on how you and your plan splits your healthcare costs. There are four metallic levels (bronze, silver, gold and platinum).

  • Bronze: Your health plan pays 60% on average. You pay about 40%.
  • Silver: Your health plan pays 70% on average. You pay about 30%.
  • Gold: Your health plan pays 80% on average. You pay about 20%.
  • Platinum: Your health plan pays 90% on average. You pay about 10%.

As you go from bronze to platinum, the monthly premiums tend to go up. So, a bronze plan would generally have a lower premium than a platinum plan.

If your question isn’t answered here, call us at 800-223-1282.