Pa health insurance companies offer a wide range of coverage. We teach you about these carriers, their prices, and provide a free guide and information so you can easily learn about different options before applying through the Exchange for a policy. No “discount” plans are ever used. Also, if a contract is not rated by A.M. Best Company, we will not offer coverage from them. Helpful hints and guidance is offered for the enrollment process, comparing Senior and under-65 plans, viewing network provider lists, and understanding how the federal subsidy works. Cigna began offering under-65 Marketplace plans two years ago to accompany their Senior Medicare portfolio.

When you view Under-65 quotes on our website, you’ll be able to easily review 2024 rates and benefits from the best plans in the state. Senior Medicare plans are available from most carriers, although not always in each county. HMO and PPO Medigap plans are the most popular contracts that are issued. Supplement plans generally allow consumers to utilize any available doctor or hospital. A separate Part D plan will need to be purchased to cover prescription drugs. Advantage plans (MA) utilize a specific provider network, but often include drug benefits along with vision, dental, and hearing coverage.

Several of the companies we represent include Highmark, Keystone, Aetna, UPMC, UnitedHealthcare, Capital Blue Cross, Independence Blue Cross, Cigna, Geisinger, Oscar, Ambetter, and Humana. We also provide rates, reviews, and information on companies that specialize in Senior Medigap, Medicare Supplement, and Advantage options. Part D prescription plans are offered for Seniors that need drug benefits. During Medicare Open Enrollment (October 15-December 7), consumers can terminate, switch, or join a new plan. The effective date of benefits is January 1. The initial enrollment period occurs when applicants become eligible for Medicare, and guaranteed coverage is also offered.

Aetna

Aetna is one of the largest US health insurance companies. They were founded in 1850 and provide coverage in all 50 states. Aetna was ranked number 2 in the healthcare category in Fortune Magazine’s “Most Admired Companies” lists. Five years ago, they merged with CVS, one of the largest US pharmacy chains. The $70 billion merger was approved by the US Justice Department. More affordable integrated medical coverage should become available within the next few years. Aetna also sold its Medicare prescription drug plan portfolio to WellCare Health Plans.

CVS walk-in MinuteClinics have increased in popularity. Most insurance is accepted, and covered services include allergies, sinus infections, urinary tract and bladder infections, screenings and monitoring, vaccinations and injections, annual physicals, sports physicals, TB testing, minor injuries, and women’s services. The cost of a visits is generally about 30%-40% less expensive than an Urgent Care visit. Appointments can be scheduled, although walk-in visits are also available. Pandemic (including COVID) vaccinations and testing are offered in most locations.

They have a wide portfolio of products including comprehensive Group HMO policies (in some states) and lower-cost Group HSA policies. Voluntary benefits, international coverage, retiree plans, and public sector options are also offered. Their individual Marketplace plans were previously very popular in Pennsylvania, including the Bronze $15 copay and Silver $10 copay. “Leap” plans were offered in the Philadelphia area. However, Aetna exited the private individual market four years ago, although there is a possibility they will return in several counties.

Aetna’s Pa Senior portfolio is very extensive, and includes Medicare Supplement, Advantage, and Part D prescription drug plans. Aetna Medicare MA Policy options include Advantra Cares, Advantra Credit Value, Advantra Eagle, Advantra Gold, Advantra Silver, Advantra Premier Plus, Advantra Value, Freedom Core, Gold, Longevity Plan, Philly Suburban Value, Premier, Premier Plus, Silver, SmartSaver Elite, Value, Value Plus, and Silver Back.

Also available is an extensive small group and large group business coverage portfolio.

Part D prescription drug plans are offered through SilverScript. The three offered plans are listed below:

SilverScript SmartSaver – $9.90 monthly cost with 3,634 formulary drugs. 90-day mail-order drug copays are $0 (Tier 1), $15 (Tier 2), 24% (Tier 3) and 50% (Tier 4). 91,543 plan members in Pennsylvania.

SilverScript Plus – $99.60 monthly cost with 3,585 formulary drugs. 90-day mail-order drug copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3) and 50% (Tier 4). 16,469 plan members in Pennsylvania.

SilverScript Choice – $40.70 monthly cost with 3,505 formulary drugs. 90-day mail-order drug copays are $6 (Tier 1), $21 (Tier 2), 16% (Tier 3) and 35% (Tier 4). 105,303 plan members in Pennsylvania.

They also made the decision (like many companies) to not offer policies on the Pa State Exchange (Pennie). Aetna’s PPO network is also utilized by Allstate in many states for their short-term coverage. Although not offered in the Keystone State, 12-month temporary plans provide low-cost options throughout the year. Allstate utilizes the Aetna PPO network, and offers $50 Urgent Care copays without a deductible requirement. It’s possible that in the future, Allstate (previously National General) short-term plans will return to Pennsylvania.

UnitedHealthcare

UnitedHealthcare serves more than 26 million clients. With 35 years of experience and 6,700 Network hospitals and 1.3 million physicians and healthcare professionals across the US, UnitedHealthcare is one of the biggest players in the industry. They write health or Medicare business in most states and every large city. However, single and family Exchange plans are not offered in Pa.UHC states that they are committed to diversity, equity, and inclusion. Employees must complete a harassment and discrimination training course.

Previously, UHC offered Marketplace plans in 23 states, including Bronze Compass HSA 5500, Bronze Compass 6500, and Silver Compass 4500. Last year they returned to several State Exchange programs, and will continue to expand their market share in 2024. However, the Keystone State is not on UHC’s list for current Exchange plan expansion, although neighbor Ohio now features UHC Marketplace options.

In Pennsylvania, Group (large and small), ancillary, and Senior Medicare plans are available along with “short-term” contracts. Available at all times throughout the year, temporary policies are very affordable and can be approved within 24 hours after completing a simple 15-minute online application. However, these options do not cover pre-existing conditions, or qualify for the Obamacare tax credit. Seniors can choose among many AARP-UnitedHealthcare options including Medigap Plans A, B, C, F, K, L, and N. A guide to all plan options is also found here. Plan G is the most comprehensive supplement plan option, although the Medicare Part B deductible is not covered.

AARP-UnitedHealthcare Senior plans are offered (Supplement, Advantage, and Part D). AARP membership is required for Supplement enrollment. UHC pays royalty fees to AARP, who is not an insurance carrier. Pa Advantage contracts include AARP Medicare Advantage from UHC PA-0003, AARP Medicare Advantage from UHC PA-0002, AARP Medicare Advantage from UHC PA-0012, AARP Medicare Advantage from UHC PA-0014, AARP Medicare Advantage from UHC PA-0017, and AARP Medicare Advantage Patriot No Rx.

UnitedHealthcare direct Advantage plans include: Care Advantage, Dual Complete, and Nursing Home Plan. Care Advantage and Nursing Home Plan have 5-Star ratings. Other supplemental and health coverage options include dental, vision, small and medium-size group, critical illness, accidental injury and death, fixed indemnity, vision, and term life. Since National General no longer offers temporary coverage (Bought out by Allstate), UHC’s temporary plans have become very popular.

UHC short-term plans are issued by Golden Rule Insurance. Policies can be purchased at all times throughout the year. Since contracts are not ACA-qualified, federal subsidies are not offered and pre-existing conditions are typically not covered.  Temporary plans available include: Medical Value, Medical Value Select, Medical Value Select A, Medical Plus, Medical Plus Select A, Medical Copay Value, and Medical Plus Select. Additional benefits that can be added are dental, vision, telehealth, and accidental injury.

Blue Cross

Blue Cross consists of four companies in Pennsylvania. Highmark Blue Cross Blue Shield serves 29 counties in the Western area. Highmark Blue Shield serves several areas. Independence Blue Cross (Keystone) serves the Southeastern (Philadelphia) area. And Capital Blue Cross serves 21 counties and the Lehigh Valley in the Central area. Blue Cross of Northeastern Pennsylvania merged with Highmark in 2015 and is no longer a separate company.

A wide selection of plans is available with many copay and deductible options. Plans and rates can vary sharply by area. HMOs and high deductible plans are very popular Pa Blue Cross choices, and rates are generally quite competitive when compared to other carriers. Group medical and dental benefits are provided to many small and large employers in the area. PPO options provide a large local network of providers. Marketplace plans are offered through independent websites (like ours) and the Pennie Exchange.

Highmark BCBS competes with UPMC for business in the Western portion of the state. In the Philadelphia area, only Ambetter can provide competitive prices when comparing to Keystone (Independence BC). Network providers also offer coverage in parts of Delaware and New Jersey. Popular under-65 Blue Cross policies throughout the state are: Capital Blue Cross Bronze Capital Advantage EPO 7450/0/50, Capital Blue Cross Silver Capital Advantage EPO 6000/20/40, Highmark my Direct Blue EPO Bronze 3800, Highmark my Direct Blue EPO Bronze 6900 HSA, Highmark Together Blue EPO Bronze 3800, Highmark Together Blue EPO Bronze 6900 HSA, Independence Blue Cross Personal Choice, EPO Bronze Basic, and Independence Blue Cross Personal choice PPO Silver.

Several Medicare Advantage (MA) plans available in the Keystone State include: Personal Choice 65 Elite Rx, Personal Choice 65 Medical Only, Personal Choice 65 Prime Rx, Personal Choice 65 Rx, Personal Choice 65 Saver Rx, Community Blue Medicare HMO Prestige, Community Blue Medicare HMO Signature, Complete Blue PPO Distinct, Complete Blue PPO Signature, Freedom Blue PPO Classic, Freedom Blue PPO Select, Freedom Blue PPO ValueRx, Security Blue HMO POS Classic, Security Blue HMO POS Deluxe, Security Blue HMO POS Standard, and Security Blue HMO POS ValueRx.

UPMC

UPMC offers many affordable options in the Western and Central portion of the state. Both comprehensive and high deductible policies are available to individuals and families. Rates for HSA and high-deductible options are very competitive. You can view their information on this page. Often, UPMC prices are more competitive than Highmark when comparing under-65 plans. If subsidy-eligible, catastrophic plans should not be considered.

President and CEO Diane P. Holder has reiterated that UPMC will continue to offer Exchange policies, despite many other carriers exiting the marketplace. J.D. Power also recognizes their plans as having the highest “customer satisfaction” of any Pa carrier.  Their main competitor Highmark has also indicated they will continue to participate in the Obamacare Exchange. No other carriers offer coverage in Western Pennsylvania through the Pennie Exchange.

Individual policies (under-65) utilize the Partner, Select, and Premier networks. Several “Advantage Gold” and “Advantage Silver” plan options offer copays on pcp office visits and are generally among the most affordable comprehensive plans offered. $1,000 deductible plans are also available. UPMC For Life plans offer Medigap (Medicare Advantage) coverage to Seniors. The 11 available policies are Complete Care, HMO Access Rx, HMO Deductible Rx, HMO No Rx, HMO Rx, HMO Choice, HMO Rx Enhanced, HMO Salute, PPO High Deductible Rx, and PPO Rx Enhanced.

UPMC Hospitals provide about $1 billion each year in community benefits. Currently, there are more than 30 hospitals and 700 physician offices and outpatient facilities to serve the Keystone State. The four divisions of the hospital are UPMC International, UPMC Enterprises, Provider Services, and Insurance Services.

Geisinger

Available in 41 Pa counties, Geisinger plans are very popular with consumers that prefer to stay in-network within their area. Currently, more than 500,000 persons are covered by single, family, or Group plans. Although service is typically personable and considered high-quality, treatment outside of the network results in much higher out-of-pocket costs, unless it is considered an emergency. However, with more than 25,000 physicians and 100 hospitals, generally, you don’t have to drive far to be treated.

A wide range of business, single, and family plans can be purchased with or without a federal subsidy and many comprehensive wellness programs help keep patients healthy. Many popular Marketplace plans for persons under age 65 and who are not Medicaid-eligible are available for easy enrollment. The least expensive Pennie Exchange plans are: Marketplace All-Access Value (POS), Marketplace All-Access HMO Pharmacy First (HMO), Marketplace All-Access HMO 40/80/8400 (HMO), Marketplace All-Access PPO 40/80/8400, and Marketplace All-Access QHDHP PPO 6850 – HSA Eligible.

Medicare Advantage plans offered include Gold Classic 360 Rx, Gold Classic Advantage, Gold Classic Advantage Rx, Gold Classic Complete Rx, Gold Classic Essential Rx, Gold Preferred Advantage Rx, Gold Preferred Complete Rx, Gold Preferred Enhanced Rx, and Gold Secure Rx. Most MA plans include preventative and/or comprehensive dental benefits, and additional ancillary coverage. A deductible may apply to prescription drug benefits.

Ambetter

Ambetter offers Marketplace plans in the Philadelphia area. It’s possible that in the future, additional areas of the state will be added. Currently, coverage is available in many other states, including nearby Ohio and Indiana. Popular copay plans are the Essential Care 10 (least expensive non-HSA option), Essential Care 2 (HSA), Essential Care 5 ($40 and $90 office visit copays), and Ambetter Secure Care 20 ($35 office visit copays). Optional dental and vision benefits are also offered at very affordable prices.

The parent company, Centene Corporation, is a Fortune 500 company that offers products and services in 32 states. More than 14 million persons are covered under managed care plans. Community investments in social services, arts, education, and health services are common in their service areas. Pa Health and Wellness issues policies in the state.