Open enrollment for subsidized health insurance is closed, but some Pennsylvanians can still qualify for coverage after they file their taxes this year.
By sharing their tax return information with Pennie, the state-run health insurance exchange, uninsured residents will get eligibility estimates for financial assistance. The Path to Pennie program also sets up accounts for tax filers who then have 60 days to sign up for coverage, provided they meet certain requirements.
For example, a 35-year-old in Pittsburgh making $30,000 a year qualifies for a plan that costs about $70 a month.
"Our overarching purpose is to maximize the number of Pennsylvanians with quality, affordable health coverage," said Pennie executive director Zach Sherman. "To achieve that, we really need to find and connect with the uninsured and make sure they understand their options and have tools and services available to them."
By opting into the program, tax filers trigger a so-called qualifying event that allows people to sign up for insurance outside the traditional enrollment period. Pennsylvania is one of at least five states to use the tax-filing process to connect uninsured residents to their state-run insurance exchanges; another four, including New Jersey, are in the process of standing up such programs.
Maryland pioneered this approach; in 2020, more than 4,000 tax filers enrolled in marketplace or Medicaid coverage. The program also pulled in a more diverse group of enrollees: Black Marylanders comprised 23% of the signups compared to just 17% during the regular open enrollment period.
Pennie's Zach Sherman estimates 2,000-5,000 Pennsylvanians will become insured through Path to Pennie in 2023. These projections are partly based on a pilot program launched in late March 2022. Despite going live less than a month before last year's filing deadline, 564 Pennsylvania households selected a marketplace plan during the pilot; another 211 signed up for medical assistance, such as Medicaid.
Enhanced health insurance subsidies, created in 2021 as a response to COVID-19, have also been extended through 2025. University of Pittsburgh’s Coleman Drake, a health care markets researcher, says now is a good time for states to expand outreach efforts and make the most of those federal dollars.
"We know health insurance coverage literally saves lives when it gives people access to health care," he said.
Targeted approach
One of the benefits of Path to Pennie's design is that it connects people who are missed through other channels to affordable health insurance, says Antoinette Kraus, executive director of the Pennsylvania Health Access Network. She notes that Pennsylvania's uninsured rate is at a historic low, meaning people who currently lack coverage are among the hardest to reach.
"We all file taxes, right? We all know we're filling out a bazillion forms. So what's one more?" said Kraus. "And that one form will then put you on the path to getting health coverage."
Often when performing outreach to uninsured residents, states are working off incomplete datasets — such as a list of people who submitted incomplete applications — says Georgetown University's Rachel Schwab. But Path to Pennie's approach is more targeted as it uses existing infrastructure via the tax filing system.
"Now you're getting their permission for the revenue department to share that information with the marketplace and Medicaid agencies to then reach out to them," said Schwab, who specializes in the impact of state and federal policy on coverage quality and access to health insurance. "It's sort of like making all the dots connect so that outreach can happen effectively."
