Health insurance rates in Pennsylvania have declined for many persons. The combination of fewer submitted claims, the federal subsidy, and increased availability of low-cost plans has created many affordable policies that can be easily purchased. Regardless if you qualify for a Marketplace federal subsidy, or your household income is too high to qualify, you can easily and quickly view quality medical coverage that is budget-friendly. Many affordable Medicare options for Seniors are also available.
If you did not purchase coverage through Open Enrollment, you still may qualify for a "Special Enrollment Period," that allows you to qualify for a federal subsidy. You can also obtain benefits without using any federal help. NOTE: The SEP is not available for Medigap or Medicare Advantage plans. Senior plans have a separate OE period. Also, for low-income households, Pennsylvania Supplemental Nutrition Assistance Program (SNAP) provides food benefits, healthy food education, and help with nutrition.
For your convenience, we have separated the most affordable available policies into helpful categories. All options can be purchased as subsidized or unsubsidized plans. More detailed benefit information is always available by contacting us or requesting a quick free quote at the top of the page. You will be able to easily compare plans from all of the major carriers. We also provide specific pages for each carrier. For example, our UPMC Health Insurance For Individuals page helps Western Pa residents compare the best plans.
Cheap Pa Plans That Are Very Budget-Friendly
Catastrophic And Bronze Tier Plans - Cheapest Pa Health Insurance Plans
UPMC Advantage Catastrophic $7,350/$0 - $7,350 deductible with 100% coverage after deductible is met. Partner, Select, and Premium networks available.
Independence Blue Cross Personal Choice Catastrophic - $50 pcp office visit copay for first three visits. $7,350 deductible with 0% coinsurance.
Geisinger Marketplace Value - $7,350 deductible with 100% coverage after deductible is met.
Geisinger Marketplace HMO 30/60/6100 - $30 and $60 office visit copays with $6,100 deductible.
Highmark my Direct Blue Major Events EPO 7350 - $7,350 deductible with 100% coverage after deductible is met.
UPMC Advantage Bronze $6,950/$35 - $35 pcp office visit copay with $30 generic drug copay ($60 mail order). Deductible is $6,950.
Highmark my Direct Blue HMO 6950B - $50 pcp office visit copay and $6,950 deductible.
Highmark my Direct Blue HMO 7000B - $60 and $100 office visit copays with $120 Urgent Care copay. $7,000 deductible.
Independence Blue Cross Personal Choice Bronze Reserve - $6,650 deductible with 0% coinsurance.
Silver-Tier Plans Eligible For Cost-Sharing - UPMC (Pictured Above) Offers Very Attractive Options
UPMC Advantage Silver $3,500/$25 - $3,500 deductible with attractive $25 copay on pcp visits and $75 copay for specialist visits. $20 copay on generic drugs, and $65 on preferred brand drugs.
UPMC Advantage Silver $0/$50 - $0 deductible with $50 copay on pcp visits and $25 copay on generic drugs. Specialist visits ($100 copay) are also not subject to the deductible.
Capital BlueCross Silver PPO 4500/0/10 - $10 and $20 office visit copays with $75 Urgent Care copay. $4,500 deductible with $7,150 maximum out-of-pocket expenses. Generic, preferred brand, non-preferred brand and specialty drugs subject to $5, $25, $60, and $150 copays respectively.
Geisinger Marketplace HMO 30/60/3500 - $30 and $60 office visit copays with $30 Urgent Care copay. $3,500 deductible with $7,150 maximum out-of-pocket expenses and 20% coinsurance. All drugs must meet deductible.
Independence Blue Cross Keystone HMO Silver - $35 and $70 office visit copays. $2,500 deductible with $6,500 maximum out-of-pocket expenses. $15 generic drug copay.
Independence Blue Cross Keystone HMO Silver Proactive - $30 and $60 office visit copays and $0 deductible for Tier 1 preferred providers. $15 generic drug copay.
Highmark my Direct Blue HMO 7150S - $70 and $90 office visit copays with $110 Urgent Care copay. $7,150 deductible with $7,350 maximum out-of-pocket expenses. 15%, 25%, 35%, and 50% coinsurance on drugs.
Gold and Platinum-Tier Plans - The "Cadillac" Options
Aetna Leap Specialty - $3,000 deductible and $10 and $75 office visit copays. Maximum out-of-pocket expenses are also $3,000.
Keystone HMO Gold Proactive - No deductible with low office visit copays of $15 and $40. $15 generic drug copay and deductible is high ($6,850).
Keystone HMO Gold - Also no deductible with $25 and $60 office visit copays.
UnitedHealthcare Gold Compass 0 - No deductible with $30 and $60 copays for office visits.
UPMC Advantage Gold $750/$10 - $750 deductible with low $10 and $45 office visit copays.
Highmark Connect Blue EPO 250 - $250 deductible with $10 and $40 office visit copays.
Aetna PinnacleHealth $10 Copay - $1,400 deductible with $10 and $40 office visit copays.
Aetna Coventry Gold $10 Copay - $1,400 deductibles with $10 and $40 office visit copays.
UPMC Advantage Platinum $250/$20 - Low $250 deductible with $20 pcp office visit copay. Deductible applies to specialist visits.
Highmark Alliance Flex Blue PPO 1000 - $1,000 deducible with $10 and $20 office visit copays.
Keystone Healthy Benefits Value 1000.0 - $1,000 deductible with $20 and $50 office visit copays.
Keystone Healthy Benefits Value 0.0.10 - Platinum-tier option with no deductible and $10 and $25 office visit copays.
Geisinger Health Plan Marketplace Extra - $500 deductible with $10 and $30 office visit copays. $5,000 maximum out-of-pocket expenses.
Highmark Comprehensive Care Flex Blue PPO 500 - $500 deductible with 10% coinsurance and maximum out-of-pocket expenses of $1,650.
Important Note: Not all policies are available in all counties. Also, in Central Pennsylvania, many Keystone plans (Health Central) are underwritten through Capital Blue Cross.
Over Age 65 Senior Coverage
In Pennsylvania (and all other states), you should be eligible for Medicare benefits if you have reached age 65, or you meet specific disability guidelines. Your coverage includes Part A (inpatient outpatient hospitalization expenses), Part B (Additional medical services), Part C (Advantage plans that replace Parts A and B), and Part D (prescriptions). If you are under age 65, you still may be eligible if you have been diagnosed with permanent kidney failure (ESRD), are a US citizen, and have lived in the country for five years.
You are not required by any legislation (including The Affordable Care Act) to enroll in a supplemental plan. Although they reduce your out-of-pocket costs, and have specific Open Enrollment periods, you may select original Medicare benefits only. Advantage contracts provide an attractive alternative to original Medicare, and can also include prescription drug coverage. Also, Plans E, H, I, and J are no longer offered because of the Medicare Modernization Act. However, you may retain an existing plan if it is currently in-force.
Many companies are licensed to offer Supplement plans to Seniors in Pennsylvania, and although contracts are standardized, rates do vary. Shown below are some of the major carriers that underwrite coverage in Pa. Not all companies offer each of the 11 available plans.
Capital Blue Cross
Independence Blue Cross
Mutual Of Omaha
Western Catholic Union
Pa Medicare Advantage Plans
Offered by private insurers, Advantage contracts replace original Medicare benefits and provide you with Parts A and B coverage. Drug prescription coverage is also offered by many carriers and plans. If you live in the designated service area, have enrolled in Parts A and B, and do not have End-Stage Renal Disease (ESRD), you may be eligible to apply/enroll.
Listed below are highly-rated plans (US News And World Report) that include prescription drug coverage, and are available in many parts of the state. Of course, it is imperative to properly compare all policy options, and customize benefits and cost to meet your specific medical, prescription and budget needs. Other Pages on our website review Advantage contract options in greater detail.
AARP (UnitedHealthcare) MedicareComplete Choice, Keystone Focus, Preferred, and Select 65 Rx, Advantra Cares, Silver, and Gold, Aetna Medicare Standard, Humana Choice and GoldChoice, Personal Choice 65 Rx, Community Blue HMO Prestige and Signature, Freedom Blue PPO Classic, Select, and ValueRx, Security Blue HMO Deluxe, Standard, and ValueRx, and UPMC For Life HMO.
Often, the "best" Pennsylvania health insurance plans for one person, may not be the same for someone else. Differences in health, age, and budget must always be considered. By contacting us, we will custom-fit the options that provide you with the most appropriate benefits at the lowest available rate. Your overall health does not impact the rate. However, it helps us choose the options that will save you the most money.
Just as importantly are the maximum out-of-pocket expenses (MOP) on each plan. Although lower deductibles can save money on a large claim, the MOP can reach as much as $7,150 per person (maximum two persons per household). Therefore, in some situations, spending extra money for a smaller deductible may not be the best option.
Medicare Open Enrollment for Seniors begins on October 15th and ends on December 7th. Basic Medicare and drug coverage can be changed during this time. Pa Marketplace Open Enrollment begins on November 1st and ends on January 31st. Persons with or without coverage can purchase policies through our website.
There have been several plan and rate changes for both Medigap and Exchange (persons under age 65) policies. Most carriers have increased premiums while some minor changes have been made to preventative benefits. Also, business owners with 50-99 full-time (or equivalent) employees must now offer medical benefits to their employees or pay a penalty.