What are exceptional circumstances for Pennie?
Asked by: Abdul Hackett | Last update: August 2, 2025Score: 4.2/5 (69 votes)
Which of the following is considered an exceptional condition for the special election period?
“Exceptional circumstances” can be personal – for example, a house fire or a serious medical condition that made it impossible for you to enroll – but they also include natural disasters that impact a large number of people.
Who qualifies for Pennie in PA?
Who can buy health insurance coverage through Pennie? Pennsylvania residents who are U.S. citizens or U.S. nationals, or those who have a qualified immigration status can get health care coverage through Pennie.
What is reasonable opportunity period for Pennie?
The Reasonable Opportunity Period (ROP) is a period of 90 days given to a consumer to provide proof of attested information submitted on an application when Pennie cannot electronically verify the attested information through trusted data sources.
Does Pennie check your income?
Pennie uses an income number called modified adjusted gross income (MAGI) to determine eligibility for financial assistance. The chart below shows common types of income and whether they count as part of MAGI.
Health Insurance Open Enrollment with Pennie | Cornerstone Care
Does Pennie cover pre existing conditions?
Pennie makes sure health plans will financially protect Pennsylvanians in the case of injury or illness and provide access to a wide range of medical care, including care for pre-existing conditions, free preventive services, hospitalization, prescription drugs, maternity care, mental health services, and much more.
What is the 50 30 rule Affordable Care Act?
Under the Shared Responsibility for Employers Regarding Health Coverage (PDF) final rule, applicable large employers (ALEs) - generally defined as employers with 50 or more full-time or full-time equivalent employees in the prior year - are required to offer to at least 95 percent of their full-time employees - ...
Can you enroll with Pennie at any time?
This is the yearly period when you can buy health insurance. If you don't enroll during this time, you can't sign up until the next one, except in limited instances, called special enrollment periods. Pennie's Open Enrollment Period runs yearly from November 1 to January 15.
What is the best plan on Pennie?
Platinum plans offer the highest level of coverage, meaning that your health insurer will pay a higher share of the cost when you access health care services.
Why did PA switch to Pennie?
By establishing Pennie, the state can offer access to health insurance products from private insurers. As of 2022 – the most recent year such statistics were available – Pennsylvania ranked ninth in the country for the lowest uninsured rate, with 5.4% of its population lacking health insurance.
How do I know if I qualify for the Affordable Care Act?
Must live in the United States. Must be a U.S. citizen or national (or be lawfully present). Learn about eligible immigration statuses. Cannot be incarcerated in prison or jail.
Which of the following individuals are likely to qualify for a special election period?
A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you've had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child, or if your household income is below a certain amount.
Why are people leaving Medicare Advantage plans?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
Who qualifies for Medicare special needs plans?
To be eligible for a special needs plan, an individual must fit into one of the following groups: People who live in certain institutions (like nursing homes) or who require nursing care at home. People who are eligible for both Medicare and Medicaid.
What is the 9.5 rule in Obamacare?
The 9.5% threshold for health insurance costs
The Health Reform bill established 9.5% as the amount of income used for health insurance beyond which, it would not be an affordable. This means that if you make $40K annually, the bill subsidizes health insurance premiums beyond just short of $4K.
What counts as full-time?
The standard definition of full-time hours in California is between 32 and 40 hours per week. However, it's important to note that after the implementation of the ACA, workers are considered part-time if they work less than 30 hours per week, and full-time if they work 30 hours a week or more.
What is the 13 week rule for ACA?
Classifying Rehires under the ACA
An employee will be considered to be a terminated and rehired employee if the employee has a period of 13 consecutive weeks during which the employee is not credited with an hour of service.
How does Pennie verify income?
Proof of Household Income. Paycheck stubs showing employee information, pay date or pay period, and gross amount of pay, for the 4 weeks prior to the date listed on your notice. 1040 federal or state tax return from the previous year if representative of attested income.
What pre-existing conditions are not covered?
Is there health insurance for pre-existing conditions? Choosing a health plan is no longer based on the concept of a pre-existing condition. A health insurer cannot deny you coverage or raise rates for plans if you have a medical condition at the time of enrollment.
What is the income limit for Pennie PA?
Learn more at Path to Pennie | Pennie. Pennsylvanians at certain income levels can enroll year-round in free, comprehensive health plans through Pennie. Households that qualify have an annual income at or below 150% federal poverty level, which is $21,870 for 1 person and $45,000 for a family of 4.
What disqualifies you from the premium tax credit?
For tax years other than 2021 and 2022, if your household income on your tax return is more than 400 percent of the federal poverty line for your family size, you are not allowed a premium tax credit and will have to repay all of the advance credit payments made on behalf of you and your tax family members.
What happens if I underestimate my income for Obamacare in 2024?
For the 2024 tax year, if you underestimated your income and received a larger tax credit than you were eligible for, you must repay the difference between the amount of premium tax credit you received and the amount you were eligible for.
Can I refuse health insurance from my employer and get Obamacare?
Obamacare is available to everyone, whether or not their employers offer insurance. From a practical standpoint, though, there are financial consequences to doing this. Often, an employer subsidizes part or all of their employees' coverage.