HMO and PPO Plans With Network-Provider Discounts

Pennsylvania is the home to dozens of of the best PPO and HMO health insurance plans available to consumers. Not only do you receive lower rates, but the network of providers allows you to freely choose who handles your medical treatment and where you go to receive those services. And actually, there are very few Pa plans that don’t utilize this type of coverage. Managed care plans are designed to offer lower premiums and we can review the best options with you.

All of the new State Exchange plans utilize a provider network that gives you access to the finest doctors and hospitals in your area. Whether its UPMC or Highmark in Western Pa or Geisinger or Keystone in other parts of the state, the Pennsylvania Marketplace will allow you to choose among several options. If you need help understanding Obamacare in Pa, we wrote a separate article about it that should be helpful.

Our authoritative website explains in detail some of the differences between the two types of benefits. Which one is best for you? That depends on many factors including the type of medical expenses you typically incur in a year along with the availability of plans in your area. For example, most parts of Pennsylvania have several PPO plans to choose from. But the number of available HMO plans is growing, while PPO availability is decreasing.

The ACA Legislation And Its Effect

Obamacare, although passed in 2010, continues each year to cause reductions in the number of available policies, physicians, specialists, and other medical facilities. Not only are several companies no longer offering On-Marketplace plans, but HMOs are replacing PPOs in record numbers. There are approximately 40% less preferred-provider networks offered to Pa residents compared to pre-Obamacare years.

Thus, Keystone State residents often face out-of-network restrictions that can severely limit choices. Since most Exchange plans are subsidized, lower-income households often have fewer choices, especially if they seek out-of-the-area treatment. For example, the total number of PPO plans available countrywide is about 500 less than prior years, while there are more than 100 new HMO options offered.

HMO AND PPO Differences

With an HMO, you select a single doctor to coordinate all of your healthcare needs and treatment. For example, if you suddenly notice that your knee is swollen and hurts when you walk,  a visit to your primary care physician (pcp) is required. They will subsequently refer you to a specialist that will treat that specific condition.

Find The Best PPO PLans In Pennsylvania

Your Primary Care Physician Coordinates Your HMO Treatment

Conversely, with a PPO, assuming that same scenario, you can simply directly contact an orthopedic specialist for a consultation and possible treatment. You do not need a referral and you determine which type of treatment (or no treatment) that you receive. Flexibility of choosing who treats you and when you visit, are key features.

With many companies, your “network” extends countrywide and is much more extensive than an HMO. For example, Aetna offers the opportunity to utilize more doctors and facilities in nearby states (Ohio, New Jersey, New York, Delaware, and Maryland) along with the rest of the US. Conversely, Geisinger plans will be much more restrictive.

Impact Of Pre-Existing Conditions

Your existing medical conditions (if you have any)  play a vital role in your decision. If you are treated by multiple specialists, it may be critical to ensure that all of them  remain in the local provider network. With Open Enrollments occurring every November, it’s possible that you may have to change carriers or face the possibility that one (or more) of your physicians will no longer be available.

Comparing and reviewing new plans each year is highly encouraged. But equally important is to ensure your existing specialists (and physicians) are not dropping out of your carrier “approved provider” list. If your illness or disease requires multiple visits (especially pain management), changing providers can be challenging, especially if few options are available in your area that accept new patients.


If you live on the Western part of the state, UPC and Highmark have large coverage areas and  offer extremely competitive rates. Highmark, Capital Blue Cross and Geisinger are reliable carriers to consider if you live in Central Pa. And towards Philadelphia, Keystone (Independence Blue Cross) offers both HMO and PPO plans that are often priced lower than all competitors. Both high-deductible and comprehensive policies are easily purchased. Aetna also offers attractively-priced plans in most of the state.

UnitedHealthcare and Aetna have statewide coverage for their provider network and should be considered in all areas. Aetna is also a national carrier and is in the process of merging with CIGNA.

We’ll teach you the differences in Pa HMO plans and PPO plans. Both are comprehensive medical policies that are offered through the best insurers. You can view the best rates online from our website, and save money by utilizing our help.

Enrolling For Pennsylvania Health Insurance Online Made Easy

You currently live here in Pennsylvania and need health insurance benefits. Regardless if you are presently covered, or have been without a policy for many years, you are not looking forward to viewing, analyzing, and trying to understand the difference between hundreds of plans. Copays. Deductibles. Coinsurance. Subsidies. Maximum out-of-pocket expenses. On or off the Marketplace? Where do you begin?

It’s easy! OK.  We simplify the process for you by explaining in easy-to-understand language and terminology,  which plans are the most efficient and practical, based on your budget and medical condition needs. And, of course, we calculate and review the federal tax credit that may possibly reduce your rate. We determine your eligibility, and show you how much savings you will receive.

Online Enrollment Is Easy!

Online Pennsylvania health insurance quotes give you information about how much a policy costs, what benefits are provided, and how to apply to get coverage. We help you decipher the maze of hundreds of policies for single persons or families and make it easy to make the right decision regarding which option is your best choice. Since we are independent, and not captive, we shop multiple insurers, and give you the time and attention needed to secure the lowest personal prices.

If the carrier is licensed and approved to offer plans in the Keystone State, we will research and review all of their plans. NOTE: Not all companies or policies qualify for federal subsidies. We will specifically indicate which policies and/or carriers are ineligible for the Obamacare instant tax-credit. 

On-Marketplace And Off-Marketplace Policies Are Available

The Pa Health Insurance Exchange (via our website) is where you compare available plans and enroll for coverage. Applying takes about 15-25 minutes. No physicals are required and you won’t be denied benefits because of adverse medical conditions. If you are eligible for financial assistance, an “on-Marketplace” plan is the correct choice. Otherwise, an “off-Marketplace” plan should be utilized.

Best Pa Exchange Plans Online

Get Guaranteed Pa Healthcare During Open Enrollment

An experienced broker is perhaps more needed now than ever before. Calculating your subsidy (using the Federal Poverty Level ratio) and analyzing your projected medical expenses are two additional tasks that need to be performed before you apply for a policy. That’s one of the free services our website offers to Keystone residents.

There are many resources on the internet that provide online rates. We are a consumer-friendly site that saves you time and money without sacrificing any important benefits. If you need help with dental, vision or other ancillary  products, we will show you the top-rated choices for each type of coverage. Many carriers offer riders to add these types of benefits, and often the price is discounted.

Not All Coverage Has To Be With One Company

Often, it may be best to split your total package between more than one carrier. Individual Pa health rates, quite simply, are our specialty. If one member of the family has a chronic illness that requires expensive non-generic prescriptions, a separate policy should be considered, that reduces the out of pocket medication costs. The impact of meeting multiple deductibles, and subsidy-eligibility must always be considered.

For example, if a dependent covered on a family policy is treated with expensive non-generic medications, and requires specialized out-of-area care, in some situations, issuing a separate subsidized plan that includes needed network-providers may save a large amount of out-of-pocket costs. Each situation is unique, so we would thoroughly review all available options.

Only The Best Companies!

We eliminate “bad” options and select only high-quality companies and make the shopping process simple. By helping you learn about different medical coverage, you will save money. After you provide your zip code, you will be asked some basic questions. Moments later, you are finished. And all of the recommendations we provide are yours to keep and refer to at any time.

Find low cost Pennsylvania medical plans

Your Individual Pa Health Insurance Quote Is Free

As independent Pennsylvania health insurance brokers, we are able to offer direct rates from all  of the most reputable carriers, and not just one or two. For example, if you reside in Allegheny or Westmoreland county, we can choose between local options such as Highmark and UPMC along with statewide companies such as UnitedHealthOne and Aetna.

Or, if you live near the New Jersey border, we’ll strongly consider Independence Blue Cross/Keystone individual and group policies. Although  UnitedHealthcare or Coventry (Aetna) may also offer competitive pricing, in some situations, they may not be able to match the comprehensive IBX provider network.

More Than Free Emailed Quotes

But we don’t just find quality plans and email them to you. We know and understand the benefits and out-of-pocket costs that are likely to impact your decision. Not all plans will provide the benefits and price you want. But if that policy is offered, we will find it. You can also do all of the quoting, enrolling, and applying yourself. We understand that many consumers prefer that method.

We are experienced Pa brokers for affordable personal and family  plans and quotes. You can research, compare and apply for the very best  medical  plans. We value your privacy and take extreme caution to maintain a secure website. If you own a small business, there may be a low-cost plan that saves you and your employees money. If you employ more than 50 workers, you are  required to offer coverage.

If you only need a plan for a few months, then click here.  Temporary benefits are affordable, and provide a bridge that effectively covers a gap in coverage. You won’t be able to get “Cadillac” policies, but you can effectively protect your assets in case there is a large claim.

Most Modern Online Quote Engine

A state-of-the-art quoting system is used, allowing consumers to easily and quickly find the most affordable Pa  plans, but still receive personalized service from a broker with more than 35 years of experience. During the quoting process, we are happy to help you find the best policies that give you the coverage you want and with plenty of network providers.

Providing affordable options to individuals, families and businesses requires expertise and experience. Sometimes it may be a bit overwhelming trying to decipher terms and compare plans that seemingly look alike. We are always willing to help and are only a phone call or email away. And the best rates are only a click away.

Best High Deductible Health Plans In Pennsylvania

Pennsylvania High Deductible Health Plans (HSA) are an affordable medical option that can reduce your premiums, help you take advantage of tax deductions, and provide greater control over your healthcare.   Typically, these plans  save you approximately 25%-45% in premiums, when compared to more popular copay options. Each year, more Keystone State consumers purchase them, and they are eligible for federal subsidies, if you qualify.

Although Affordable Care Act legislation has created guaranteed benefits (with federal tax subsidies), medical plan prices continue to increase (sometimes substantially) for many consumers, especially those that earn middle and upper-level incomes. It is this group that can be most aided by the HDHP and HSA.

In 2016, the maximum out-of-pocket limits are $6,550 for single plans and $13,100 for families. The minimum annual deductibles remain at $1,300 for individuals and $2,600 for families. However, higher deductible options are generally more cost-effective. The maximum contributions are $3,350 per individual, and $6,750 per family. However, any person that has reached age 55, can contribute an extra $1,000. The “bonus” amount is also tax-deductible.

More Employers Offering HDHP Options

Many large and small employers are also switching to this concept, by adding HDHP options along with the traditional PPO and HMO plans. Because the cost is lower to the employer, contributions are made, often as much as $3,000. These funds can be used for medical, dental, or vision expenses. Employees can also contribute into the account. The National Bureau of Economic Research also gave its stamp of approval, by publicizing a study that verified that companies effectively reduced healthcare costs by offering HSA options.

Although  over-the-counter drugs are no longer deductible and the penalty for early withdraw has increased to 20% (from 10%), this type of plan is often a big money-saver for corporations. FedEx, with more than 400,000 workers, already converted to an HSA-style system. Workers are given a “credit” to deposit into their account while additional funds can be payroll-deducted. The combination of incentives and rewards, over time, has become very popular with workers.

You can view the policies that are the most competitive in your area, and easily understand coverage. You’ll be able to quickly compare the best HDHP policies and determine if its best to select a more traditional plan, or an HSA. We also make it easy for you to enroll, since missing a deadline may force you to keep a policy you don’t want. There are also many new available options each year that may become more cost-effective for you.

What is an “HDHP?”

Utilized with a Health Savings Account (HSA), it is an alternative to your traditional medical insurance.  Created in 2003, it is a savings policy that offers a different way for consumers to pay for their  expenses. Pennsylvania HSAs permit you to pay for current  expenses and also accumulate money on a tax-free basis. Qualified medical, dental and vision expenses are all eligible. Do you need new glasses or contact lenses? Or is it time for your six-month dental checkup? You can pay for these expenses with money from your account.

These types of policies remain very popular through the Pa State Marketplace thanks to IRS 2013-57 which states that HSA qualifications have been met (under IRC Section 223 (c) (2) despite preventive benefits covered at 100%. Previously, it was feared that since routine annual physicals (and other benefits) were covered in full, the tax deduction would be lost. This, thankfully, did not occur.

Pa HSA Plans

An HDHP Is One Of The Cheapest Medical Plans In Pa.

Often, you are issued a debit card to assist in the record keeping process. You can view statements online or receive a monthly statement in the mail. It becomes very simple to manage your account. And the healthier you are, the more your personal fund grows.

If you are self-employed, it’s a great way to handle your medical benefits. We have more information for the self-employed and small business owners. Depending on how you file your taxes, you may also be able to deduct the premiums for the actual policy (in addition to contributions).

You must have a “High Deductible Health Plan” (HDHP) to take advantage of an HSA. An HDHP costs less than a typical  policy. Ideally, the money you save on insurance can then be deposited into your account. As you manage the money in your HSA, you decide the type of investments you make into the account.

Although selecting the “fixed” account is your safest option, often a “variable” option will yield greater returns over a longer time period. However, since it involves investing in securities, and thus, a higher risk, potential rates of return are not guaranteed, and the possibility of losing money exists. Typically, it is advisable to avoid risks with funds

Don’t Lose It If You Don’t Use It

At the end of the year, you do not forfeit any of your funds that were not used. Often, you may make larger deposit amounts before April to take advantage of reducing your potential tax liability. If your actual medical expenses for the calendar year were significantly less than anticipated, you may have hundreds (or thousands) of dollars in the account by the end of December. Thankfully, these funds simply “roll” into the new year without consequence, tax liability or penalty.

You are not under an obligation to set up the account or make any deposits into the account. There are also many single and married persons that wait years before they make any deposits. Often, it is just prior to having a family and utilizing maternity coverage that may require significant out-of-pocket costs, if the existing policy is a Bronze-tier plan.

Actually, the high deductible portion is sometimes referred to as a “catastrophic” plan. Normally, this type of coverage does not cover the first several thousand dollars of  medical expenses (often known as “the deductible”). However, after the deductible, coverage is often 80%-100%…depending on the policy.

Find Cheapest Medical Plans With Pa HSA

Negotiate Lower Costs With An HSA

All Pennsylvania HSAs have “first dollar” coverage for preventative benefits and higher out-of-pocket expenses for non-network expenses. And a negotiated-network discount will reduce your expenses that are subject to the deductible. The savings is often hundreds or thousands of dollars on typical procedures. For example, a CT-Scan may originally be billed at the retail price of $950, and later repriced at $400. Or, a more complex scan might be repriced from $2,600 to $1,700. Those are big differences.

Normally, deductibles of $3,000-$6,000 are the most popular. However, there are a few carriers that offer deductible options as high as $8,000 or $11,000. Since you typically do not meet the deductible, many persons choose to pay the lowest available price by raising the deductible.

What is the cost of a policy?

Technically, an HSA is not a policy you buy. It is a savings account that allows you to deposit money on a tax-deferred basis. When you have coverage,  the only policy you purchase is the HDHP, which is an inexpensive plan that covers your medical expenses if they exceed the funds you have.

Monthly premiums  will vary, depending on the insurer. In some areas, a policy from Aetna may be the best option. Yet, in other areas, UnitedHealthCare, or another company such as Keystone may be the better choice. Highmark in Western Pennsylvania and Independence Blue Cross in Southeastern Pennsylvania offer very competitive rates. Geisinger is a great option in the Harrisburg area.

What is the best way to purchase coverage?

You can obtain free quotes (the quote section is near the top of the page) or if you would like to talk to a live person, simply call us at (888) 513 6446. We’ll review the options that are best for you and email you the specifics in writing.