Pennsylvania to insure 40,000 adults of low income; However 300,000 meet eligiblity

[NRSKarenRN, BSN, RN]

Pennsylvania to insure 40,000 adults of low income

Starting in July, 40,000 low-income uninsured Pennsylvanians will be able to receive physician, hospital and emergency medical coverage under a new state program for a modest monthly fee.

Philadelphia Inquirer, April 25, 2002

http://www.philly.com/mld/inquirer/business/3134561.htm

Starting in July, 40,000 low-income Pennsylvanians without health insurance will be able to receive physician, hospital and emergency medical coverage under a new state program, for an average $30 monthly fee.

Those 40,000 are a fraction of the estimated 300,000 adults in the state who are uninsured.

The plan, called "adultBasic," will be funded with $76 million in its first year from Pennsylvania's share of the nationwide tobacco settlement.

Gov. Schweiker announced on Tuesday that the funding would insure 40,000 Pennsylvanians ages 19 to 64 who have no health insurance, have lived in the state for at least 90 days, and have annual incomes below $17,720 for a single adult and $23,880 for two adults in the same household.

Philadelphia-area residents who sign up for adultBasic will receive their benefits through Keystone Health Plan East, a plan owned by Independence Blue Cross. Keystone was selected as the provider for this region by the Pennsylvania Insurance Department, which is administering the plan.

"While coverage is scheduled to start on July 1, we are accepting applications, and we can begin the process of evaluating potential enrollees," said Stephen Fera, Keystone's senior director of government programs.

Plan participants will pay a monthly "premium" of about $30 a month, and a co-payment per visit to the doctor or hospital. The co-pays will be $5 for a physician visit, $10 to see a medical specialist, and $25 for an emergency-room visit. If the emergency-room visit results in a hospital admission, the co-pay will be waived.

"I think it's important for Pennsylvanians to understand that this is real insurance," Schweiker said. "This isn't some government-run program that is long on promises and short on coverage."

Statewide, 300,000 low-income Pennsylvanians meet the eligibility requirements for the plan, but the $76 million allocated for the first year will pay to insure only up to 40,000 of them, said Melissa Fox, spokeswoman for the Pennsylvania Insurance Department.

Applicants will be enrolled on a "first come, first served" basis, she said.

In the Philadelphia area, adultBasic participants will receive Keystone Health Plan East identification cards, enabling them to use all doctors and hospitals in the Keystone network, Fera said.

Doctors, in turn, will be paid by the insurance provider. The Insurance Department will reimburse insurance companies based on a per-patient monthly rate.

Fox said the "statewide average" rate to insurance companies would be "about $200 per patient a month."

The Insurance Department selected the insurance companies participating in the program after a bidding process.

Besides Keystone, those selected were Capital Blue Cross/Pennsylvania Blue Shield in Central Pennsylvania, Highmark/Western Caring Foundation in Western Pennsylvania, and First Priority Health in Northeast Pennsylvania.

AdultBasic is modeled after the Children's Health Insurance Program, or CHIP, which provides insurance to more than 121,000 children. The program, in its ninth year, is run by the state Insurance Department.

"CHIP has been tremendously successful in helping working parents obtain free or low-cost insurance for their children," Insurance Commissioner Diane Koken said. "We will apply those lessons learned to serving Pennsylvania adults."

Keystone also has the contract for CHIP in Southeastern Pennsylvania. "Now the entire family will have access to health insurance," Fera said. "It offers one-stop shopping and real health insurance to help the entire family, not just kids."

Contact Linda Loyd at 215-854-4822 or [email protected].

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