PA Fair Care - Pennsylvania High Risk Insurance Plan

Product Review

The details of this coverage have not yet been reviewed by Freedom Benefits. If you wish to submit comments to be incorporated into the review, please e-mail us. We appreciate your feedback.

Pros

This insurance is available at the same price as other similar insurance despite the higher expected cost of medical treatment for its mambers. Premiums are subsidized by the federal government so that maximum premium is expected to be about $283 per month regardless of age. This is one of the few government-sponsored pre-existing insurance plans plans that does not charge older applicants more than younger applicants.

Does not consider prior medical history in determining eligibility.

May be combined with other supplemental insurance to reduce financial risk due to deductibles, out-of-network charges, lost income and out-of-pocket expenses. Supplemental insurance during the six month period prior to application does not affect eligibility.

Cons

Requires applicants to be uninsured for at least six months. This could cause serious financial risk or a gap in medical care.

Eligibility is determined by the state based on a review of each individual application.

Does not offer spousal or family coverage unless the dependent(s) also meet the eligibility criteria.

This plan may require a recent decline letter or exclusion rider letter from a commercial insurance. If you do not have a decline letter, see the Pennsylvana low cost insurance exchange page listings for companies that can issue this documentation.

The policy has high out-of-pocket costs including deductible and co-payments. These uncovered expenses could be up to $5,000 per year before the insurance takes full responsibility for payment. Since medical providers typically require these out of pocket costs at the time of treatment (or on the next visit after the insurance claim is processed) this can pose a threat to ongoing treatment.

In-network providers are limited and may not be available in all locations.

Out-of-network expenses may not be capped.

Forms in PDF format for download

The enrollment forms can be found by following enrollment link above.