Private Exchange

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Pennsylvania Health Insurance Exchange Technology

In December Pennsylvania Gov. Tom Corbett announced that the state would default to the federally run exchange, because it had yet to receive enough information from the federal government to implement its own exchange. The Republican governor cited the unknown costs of the law as the main reason why he did not want the state to control the exchange. His decision however went against the state’s insurance department which had already started planning the exchange. This decision means that Pennsylvania residents will rely on the federal exchange for their insurance options and their planning with healthcare subsidies.

Essential Health Benefits

Every state in the union had the option of making a recommendation of what should be covered in their essential health benefits. These benefits help set up a standard of care for Pennsylvania residents. Pennsylvania did not submit a recommendation so they will default to the federal regulations. The federal regulations offer Pennsylvania residents benefits in the following categories: rehabilitative and habilitative services, mental health and substance abuse aid, pediatric services, chronic disease management, preventative care, emergency services, laboratory services and more. Pennsylvania will have its essential health benefits plan default to its largest small group plan, Aetna POS.

Pennsylvania Health Insurance Exchange Stats:

  • Total Residents: 12,621,000
  • Total Health Expenditures (in millions): $97,414
  • Exchange Decision: Default to Federal Exchange
  • Total Health Insurance Exchange Grant: $33,832,212
  • EHB Benchmark Plan Status: Aetna POS small group plan supplemented by the federal employee dental and vision insurance program


Although the Pennsylvania Insurance Department was ready to take on the burden of implementing an exchange and planned a site similar to a travel purchase site, the governor decided against the plan. This means that there is an opportunity for expanded coverage in Pennsylvania employers, associations, and groups. To learn more information about setting up an exchange in Pennsylvania contact a representative of Exchange.GoHealth today!

For more information about setting up a private exchange solution in Pennsylvania, contact a representative at GoHealth today.