Pa catastrophic (high deductible) health insurance plans are an affordable low-cost option to reduce rates, and still maintain major medical benefits. We specialize in helping Keystone State residents find the least expensive catastrophic coverage with top-ranked companies, that cover emergencies, and offer 100% preventative benefits. The combination of higher deductible plans and supplemental coverage is often a popular cost-saving option and saves money when compared t0 other QHPs (Qualified Health Plans). After Open Enrollment ends, you can continue to buy qualified plans with an approved SEP exception.
Seniors can consider a Plan F (HD) or Plan G (HD) Medicare Supplement plan option that features a $2,800 deductible. Plan G (HD) was introduced four years ago and is available to new and existing applicants. Plan F (HD) is not offered as a new-enrollment plan. The deducible is the annual out-of-pocket expenses (not including the policy premium) that a beneficiary pays before benefits begin. Annually, the deductible changes, based on the Consumer Price Index (CPI). The new deductible is typically calculated in mid-September.
What Is Catastrophic Health Insurance? This type of benefit provides quality high-deductible medical coverage for individuals, families, and Seniors. HSAs and Medicare Part D plans for Seniors are popular options, along with catastrophic-tier Marketplace plans. Short-term contracts are non-compliant (ACA), but provide budget plan options. Low premiums and affordable plans are common when comparing these types of policies. However, chronic conditions may not be suitably covered.
Both options are typically the least-expensive standardized supplement contract, and are often suitable for applicants that are comfortable paying a higher deductible with their lower monthly premium. Although the Part B deductible is not covered, most other expenses are paid after the initial plan deductible has been met. United American, Medico, New Era Life, Bankers Fidelity, Great Southern Life, Humana, Ace Property And Casualty, Elips Life, and United States Fire often offer the most attractive rates.
Open Enrollment (Under Age 65)
During Open Enrollment, “Catastrophic-tier” plans are often the cheapest policies offered to Pa residents. To be able to purchase these types of plans, you must be under age 30, or qualify for “economic hardship.” If the cost of coverage is more than 8% of the household income, the “economic hardship” rule will apply. This will allow you to save money by selecting a cheap plan, and utilize negotiated network discounts offered by each carrier. However, in many situations, selecting a Bronze-tier plan will be more cost-effective, since a federal subsidy may apply, and unlimited primary care physician office visits (with a cop) may be offered.
Expanded Bronze-tier benefits may also be offered, including copays for an unlimited number of specialty physician visits. Often, the least-expensive plans limit the number of primary-care physician (pcp) visits that are subject to only a copay. ER and Urgent Care visits also have deductibles to meet on most Bronze-tier plans. Non-generic prescription drugs are covered, although a deductible may have to be met. All Exchange plans offer unlimited coverage without annual limits or waiting periods. Pediatric dental and vision benefits are often included. Comprehensive dental plans may also be available.
If you forgot to sign up during the OE period, you can apply for several economical options that concentrate on paying larger claims, instead of routine office visits and medications. Since these policies are not designated for long-term use, it’s best to utilize them only until the next Open Enrollment, which typically occurs in November (October for Seniors). However, in the future, eligibility dates may change if future legislation creates more low-cost options.
By 2024, several newer plans may be offered outside of the Pennie Exchange, that eliminate many benefits that most consumers do not utilize. A “Public Option” offered by the federal government has never been available but could possible be offered, depending upon the national election. If available, the network would be extremely large, similar to Medicare Supplement plans.
Many Companies Offer Plans
Individual and family plans are offered through large insurers such as Highmark Blue Cross Blue Shield, Capital Blue Cross, UPMC, Keystone, Independence Blue Cross, Cigna, Ambetter, Oscar, and Geisinger. The rates you view on this website are always the lowest issued by the carriers, and the exact rate that you would pay by going directly to the carrier. Therefore, by utilizing our 40 years of experience, you are always viewing the lowest offered premium. Note: HealthAmerica was purchased by Coventry, which was subsequently bought by Aetna. Northeastern Blue Cross also merged with Highmark.
Aetna, UnitedHealthcare, and other newer carriers may return to the under age-65 market in 2025 (private individual coverage). Additional carriers, such as Humana, offer Senior products, but not private (non-Group) plans to persons under age 65. Ambetter specializes in Medicare products and offers affordable private plans in three Philadelphia-area counties. Oscar and Cigna also recently began offering coverage in that area. Independence Blue Cross continues as the market share leader in the Philadelphia area.
Pa Seniors covered by Medicare can also select an inexpensive option for Medigap benefits. After reaching $7,400 (out-of-pocket threshold or TrOOP) in out-of-pocket prescription drug expenses, a catastrophic benefit begins, and generally only a small copay or coinsurance applies. Plan F is the most comprehensive Medigap option, but high-deductible Plans (HD) F and G are offered that feature the same standard benefits, although a $2,800 deductible must be met. Despite the high deductible, foreign travel and emergency care, hospice care, and a skilled nursing facility copay are included. Plan G (HD) is offered in all counties by several carriers, including Aetna, Mutual Of Omaha, United American, Humana, and New Era Life.
Catastrophic health insurance policies for persons under age 65, will insure major claims, such as hospital expenses (including semi-private room charges, surgery and fees charged by doctors, surgeons and nurses), outpatient surgery, and emergency room and facility charges. Also referred to as “high deductible” plans, this type of coverage typically has a high deductible (up to $9,450 for individuals and $18,900 for a family) that must be met before most non-preventative benefits are paid. Several $0 deductible plans are offered, but the maximum out-of-pocket expenses on these plans is generally high. Many Silver-tier plans may also feature a $0 deductible if cost-sharing is eligible.
Out-of-pocket expenses will depend on which deductible is selected, along with the coinsurance option that you choose. Since high-deductible of options are the cheapest health insurance plans in Pennsylvania, they are extremely popular with healthier applicants or persons with a limited budget. Bronze-tier plans are eligible for financial subsidies, and can often be purchased for less than $50 per month with a subsidy. Bronze-tier contracts are the most popular individual plan issued, and all participating Marketplace carriers offer at least one Bronze-tier contract. ER and special visits are often subject to the policy deductible.
Whether you are one person, a family, uninsured, self employed or on Cobra, this type of plan is always worth considering. The concept is simple: In the event of an emergency, protect yourself against unexpected illness, disease or an accident. Supplemental options are available for persons that already have existing benefits, but simply want to cover some of the “gaps” in their policy. A Medigap plan works the same way. Medicare covers most expenses and a secondary policy fills in the “gaps.” Plans are designed to help Seniors, while special supplemental options can help persons under age 65 cover many out-of-pocket expenses.
During Open Enrollment (Under Age 65), if you are in reasonably good health (or if you have chronic conditions), you can apply and get approved for a policy with more coverage, such as office visits and lower out-of-pocket charges. You should, however, consider what effect that will have on your current and future situation. Having office visit copay benefits is always a great feature. But it’s important to determine if you are paying thousands of dollars per year for a coverage that only provides a few hundred dollars of coverage in return.
Catastrophic Health Insurance Plans In Pennsylvania (Marketplace)
UPMC Advantage Catastrophic $9,450 – Available in Partner, Select, and Premium Networks. $9,450 deductible with 0% coinsurance. Deductible must be met before non-preventative expenses are covered. Available in Western Pa, and other counties. One pair of children’s glasses, an eye exam, and one children’s dental checkup fully covered each year. $55-$75 reimbursement for non-participating provider (children’s glasses only).
Highmark my Direct Blue Major Events EPO Catastrophic 9450 – One of the least expensive plans available, it features a $9,450 deductible with no coinsurance. First three pcp office visits are covered at 100%. Each year, full coverage is provided for one children’s eye exam (to age 19), a pair of children’s lenses/glasses, and two children’s dental checkups.
Highmark Together Blue Major Events EPO Catastrophic 9450 – Also one of the least expensive plans available, it features a $9,450 deductible with no coinsurance. First three pcp office visits are covered at 100%. Each year, full coverage is provided for one children’s eye exam (to age 19), a pair of children’s lenses/glasses, and two children’s dental checkups.
Highmark My Blue Access Major Events PPO Catastrophic 9450 – Also one of the least expensive plans available, it features a $9,450 deductible with no coinsurance. First three pcp office visits are covered at 100%. Each year, full coverage is provided for one children’s eye exam (to age 19), a pair of children’s lenses/glasses, and two children’s dental checkups.
Geisinger Marketplace All-Acess Value – $9,450 deductible with 0% coinsurance. Only available in Central Pennsylvania and various surrounding counties. POS plan that utilizes the Geisinger network.
Capital Blue Cross Catastrophic PPO 9450/0/0 – $9,100 deductible with 0% coinsurance. Only available in Central Pennsylvania and various surrounding counties. This is a PPO plan. First four pcp office visits have a $0 copay. Capital Blue Cross network is utilized.
Oscar Secure – $9,450 deductible with 0% coinsurance. First three pcp office visits are covered at 100%. The plan utilizes the Oscar EPO network, which expanded in many areas last year. One children’s dental checkup covered every six months.
Independence Blue Cross Personal Choice EPO Catastrophic – $9,450 deductible with 0% coinsurance. Similar to other plans although first three pcp office visits are subject to $50 copay. Available in the Philadelphia area (Montgomery, Philadelphia, Chester, Delaware, and Bucks Counties). Telemedicine visits are provided with no charge. Each year, full coverage is provided for one children’s eye exam a pair of children’s lenses/glasses, and two children’s dental checkups.
Not Recommended are low-priced “limited benefit” medical plans. Generally, a large non-refundable enrollment fee ($75-$200) is required, benefits are vague, out-of-pocket expenses are high, and the provider network is significantly smaller than most major carriers. Often, policies are quickly canceled, and obtaining alternative coverage may be difficult if the Open Enrollment period has ended. The Better Business Bureau (BBB) often issues unfavorable ratings for these companies because of a high volume of complaints and unsatisfied customers.
Specific coverage is capped, with large benefit gaps if a chronic condition or major medical condition occurs. Non-generic medications are generally not fully-covered, and ongoing therapy or chronic conditions are not fully covered. Instead of maximum out-of-pocket expenses capped at $5,000 or $9,450, a significant health condition could result in hundreds of thousands of dollars in expenses. Although hospitals may be willing to negotiate a portion of the outstanding bill, it could still take decades to pay off the balance. Accrued interest may also increase the outstanding debt.
Medicare Supplement Plans G And F (High Deductible) For Seniors
A common option for Seniors is choosing the Medigap Plan F and Plan G (HD) plan. Covered benefits include Part A coinsurance and hospital expenses, Part B coinsurance and copays, the first three pints of blood, Part A Hospice Care coinsurance and copay, skilled nursing facility coinsurance, Part A and Part B deductibles, Part B excess charges, and foreign travel emergency expenses. However, unlike standard Plan F, you must meet an annual $2,700 deductible before expenses begin to be covered. Once the deductible has been met, the benefits of the high-deductible Plan F is the same as the standard Plan F.
Plans F and G can be sold with the high-deductible option. Previously, Plan J could be used as a high deductible. Plan G became available two years ago to newly-eligible Medicare applicants. Plan F is no longer available to new beneficiaries, although the plan will remain active if already purchased. The only major difference in coverage is that Plan B will not cover the 2024 Part B deductible ($240), which decreased from last year. Once the deductible is met, Medicare and Plan G pay 100% of Medicare-approved expenses.
Premiums, however, are much lower with the “HD” option. Thus, if you rarely have covered medical expenses to submit, it may be a very cost-effective option to consider. Benefits are standardized, so comparison of premiums is fairly simple. You are generally not permitted to enroll in a Supplement and an Advantage plan. Although prices for the HD coverage are less than most other options (A, B, C, D, F, etc…), often the rates on an Advantage plan are less expensive than the high-deductible option. Advantage contracts also may include prescription drug benefits, along with dental, vision, and hearing coverage.
2024 Plan F (HD) And Plan G (HD) Monthly Rates (Male Age 65) In Pennsylvania
Pittsburgh Area Plan F (HD)
$37 – United American
$41 – Allstate
$42 – Medico
$42 – New Era Life
$114 – Highmark
Pittsburgh Area Plan G (HD)
$37 – United American
$40 – Medico
$42 – New Era Life
$42 – Bankers Fidelity
$49- Ace Property And Casualty
$50 – Humana
$50 – United States Fire
$50 – Aetna
$52 – United Of Omaha
$52 – Elips Life
Harrisburg, Williamsport, Chambersburg, and York Areas Plan F (HD)
$32 – United American
$36 – New Era Life
$39 – Allstate
$51 – Medico
$84 – Highmark BS
Harrisburg, Williamsport, Chambersburg, and York Areas Plan G (HD)
$32 – United American
$36 – New Era Life
$36 – Bankers Fidelity
$43 – Humana
$44 – United States Fire
$44 – Aetna
$44 – Ace Property And Casualty
$45 – Elips Life
$45 – United Of Omaha
$48 – Medico
Philadelphia Area Plan F (HD)
$37 – United American
$46 – Medico
$50 – Great Southern Life
$52 – New Era Life
$65 – Allstate
Philadelphia Area Plan G (HD)
$37 – United American
$44 – Medico
$46 – Bankers Fidelity
$51 – Humana
$54 – Aetna
$54 – Ace Property And Casualty
$55 – Elips Life
$55 – United States Fire
$56 – United Of Omaha
Allentown, State College, Hazleton, and Scranton Areas Part F (HD)
$37 – United American
$46 – Medico
$50 – Great Southern Life
$52 – New Era Life
$65 – Allstate
Allentown, State College, Hazleton, and Scranton Areas Part G (HD)
$37 – United American
$44 – Medico
$46 – Bankers Fidelity
$51 – Humana
$54 – Aetna
$54 – Ace Property And Casualty
$55 – Elips Life
$55 – United States Fire
$56 – United Of Omaha
Erie and Johnstown Areas Part F (HD)
$36 – New Era Life
$37 – United American
$40 – Great Southern Life
$51 – Medico
$52 – National Health
$90 – Highmark BCBS
Erie and Johnstown Areas Part G (HD)
$36 – New Era Life
$36 – Bankers Fidelity
$37 – United American
$44 – Elips Life
$44 – United States Fire
$44 – Aetna
$45 – Humana
$45 – United Of Omaha
$46 – Medico
Reading, Wilkes-Barre, Easton, and Bethlehem Areas Part F (HD)
$36 – New Era Life
$37 – United American
$40 – Great Southern Life
$41 – Humana
$51 – Medico
$52 – Allstate
$90 – Highmark BS
Reading, Wilkes-Barre, Easton, and Bethlehem Areas Part G (HD)
$36 – Bankers Fidelity
$36 – New Era Life
$37 – United American
$41 – Humana
$43 – Elips Life
$44 – United States Fire
$44 – Aetna
$45 – United Of Omaha
$48 – Medico
Lancaster, Lebanon, and State College Areas Part F (HD)
$32 – United American
$36 – New Era Life
$51 – Medico
$52 – Allstate
$36 – Bankers Fidelity
$83 – Highmark BS
Lancaster, Lebanon, and State College Areas Part G (HD)
$32 – United American
$36 – New Era Life
$36 – Bankers Fidelity
$41 – Humana
$43 – Ace Property And Casualty
$43 – Elips Life
$44 – United States Fire
$44 – Aetna
$45 – United Of Omaha
$48 – Medico
Altoona Area Part F (HD)
$36 – New Era Life
$37 – United American
$51 – Medico
$52 – Allstate
$90 – Highmark BS
Altoona Area Part G (HD)
$36 – New Era Life
$36 – Bankers Fidelity
$37 – United American
$41 – Humana
$43 – Ace Property And Casualty
$43 – Elips Life
$44 – United States Fire
$44 – Aetna
$45 – United Of Omaha
$48 – Medico
Pottstown Area Part F (HD)
$37 – United American
$42 – New Era Life
$48 – Medico
$65 – Allstate
Pottstown Area Part G (HD)
$37 – United American
$42 – New Era Life
$46 – Bankers Fidelity
$46 – Medico
$51 – Humana
$53 – Ace Property And Casualty
$54 – Aetna
$55 – Elips Life
$55 – United States Fire
$56 – United Of Omaha
Summary
We’re committed to finding the plan that best matches your specific budget and needs. You can apply online for coverage or we can assist you. Please feel free to email or call or email us. There are no fees or charges, and our free services continue after you have enrolled in a plan.
Updates From The Past:
Catastrophic coverage is available as Exchange plans. To qualify to purchase this type of policy, you must be under age 30 or have special “hardship” exemptions. Typically, major medical expenses are covered, and a deductible applies to most non-preventive expenses. Most deductibles are high.
Previously, some of the most popular catastrophic options for the Pa Exchange (you can get free quotes at the top of the page) include Highmark Major Events Blue, HealthAmerica HMO, UPMC Advantage Secure Select, Keystone Healthy Benefits Value HMO, Geisinger Marketplace Value, Aetna Basic, Independence Personal Choice and Blue Cross of NE Pa MyBlue.
The government is now allowing policyholders that have had their plan cancelled due to the implementation of Obamacare, to purchase catastrophic plans on the Exchange. Prior to this announcement (see above), only applicants under age 30 could qualify. A copy of the cancellation letter will be required by most companies to obtain this special low-cost policy.
If you qualify for an exception, you can still buy a plan that receives subsidies. There are about 10 situations that allow you to qualify for financial help after Open Enrollment has ended. Otherwise, there are additional low-cost options that we can discuss with you. Simply contact us with your information.
