Pennsylvania Health Insurance

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Individual and family Pennsylvania health insurance plans will be issued through the PHIEA (Pennsylvania Health Insurance Exchange Authority) beginning in 2021. PA HB3 was the passed legislation that established the Exchange Fund. A state-based Exchange (SBE) often saves consumers money by reducing plan premiums, and increases access by making it easier for Keystone State residents to apply for coverage.

The Open Enrollment period is also extended by 45 days, beginning November 1 and ending January 15th. The Federal Marketplace OE period is from November 1 to December 15. More than 400,000 persons are expected to apply for coverage. The average savings should be approximately 5%-10% per consumer. The General Fund is not required to contribute any funds. An SEP (Special Enrollment Period) is granted throughout the year for a qualified life event.

The added flexibility of Pa’s SBE will provide increased coordination with state agencies and programs, outreach to enrollees and persons applying for coverage, better methods to handle consumer concerns and complaints, enhancing and improving the shopper’s experience, and making it easier to analyze application and enrollment data. It’s estimated that by operating the Exchange, the state will be able to lower premiums by approximately 5%-10%.

The new website Pennie will be utilized for 2021 enrollments instead of The comparison and application process should be quicker, easier, and more efficient. And we will continue to help consumers with that process and offer our free expert and unbiased service that continues for the 39th year. With the savings of utilizing a state-based Exchange, a reinsurance program will be created to reduce the cost of coverage for applicants that don’t qualify for a federal subsidy. Heading the Pa Exchange is the past-director of the Rhode Island Exchange, Zachary Sherman.

The reinsurance program saves insurers by providing reimbursement of 60% of the cost of claims between $60,000 and $100,000. By paying the medical expenses for many high-risk members, more affordable plans can be provided. It’s also possible that carriers will expand into additional counties in 2023 and beyond.

GetInsured created the Exchange platform and will be operating the call center. The Mountainview (California)-based company assisted more than one million consumers obtain medical benefits last year. They also created and operate other State-based Marketplaces including Nevada Silver State Health Insurance Exchange (SSHIX), Washington Health Benefit Exchange, Consumer Shopping Experience And Consumer Decision Tool (CDST), MNsure Individual State-Based Marketplace, Your Health Idaho Individual State-Based Marketplace, and Covered California Individual Shopping And Enrollment.


Pennsylvania Open Enrollment


Rate Filings For Pennsylvania Individual Health Plans

Carrier, Exchange-status, and requested increase (or decrease) are shown below:

Capital Advantage Assurance Company (On and off Exchange) – 14.3% decrease

Capital Advantage Insurance Company (Off Exchange) – 15.5% decrease

Keystone Health Plan Central (Off Exchange) – 1.7% decrease

First Priority Health HMO (Off Exchange) – 19.2% increase

Highmark (On and off Exchange) – 0.7% decrease

Highmark Benefits Group (On and off Exchange) – 3.96% decrease

Highmark Coverage Advantage (On and off Exchange) – 3.1% increase

Highmark Health Insurance Company (Off Exchange) – 15.6% decrease

Geisinger Health Plan (On and off Exchange) – 11.28% decrease

Geisinger Quality Options (On and off Exchange) – 13.57% decrease

Keystone Health Plan East (On and off Exchange) – 2.1% decrease

QCC Insurance Company (On and off Exchange) – 2.0% decrease

UPMC Health Options (On and off Exchange) – 1.3% increase

Pa Health And Wellness (On and off Exchange) – 6.6% increase

Oscar Health Plan Of Pa (On and off Exchange) – 6.86% increase


Plan Counts By County – Largest Number Of Policies Offered

Bronze Tier

17 – Centre

15 – Perry, Dauphin, Cumberland, York, Lancaster, York, and Adams.

14 – Columbia, Lehigh, Lebanon, Northampton, Northumberland, Schuylkill, Snyder, and Burks.

13 – Union

Silver Tier

68 – Cumberland and Dauphin

62 – Lehigh and Northampton

61 – Centre

60 – Perry and Schuylkill

59 – Columbia, Northumberland, Snyder, Adams, Lancaster, and York

55 – Clinton and Lycoming

Gold Tier

104 – Centre

98 – Dauphin and Cumberland

95 – Lehigh and Northampton

93 – Schuylkill

91 – Columbia, Northumberland, and Snyder

90 – Perry

Platinum Tier

25 – Carbon, Lackawanna, Luzerne, Monroe, and Wayne

23 – Clinton, Lycoming, Susquehanna, Wyoming, and Centre

22 – Columbia, Lehigh, Mifflin, Montour, Northampton, Northumberland, Schuylkill, Snyder, and Union

21 – Bradford, Pike, Sullivan, and Tioga

20 – Cumberland, Dauphin, and Juniata


Company Counts By County – Largest Number Of Carriers Offering Coverage

8 – Centre, Columbia, Lehigh, and Northampton

7 – Northumberland, Schuylkill, Snyder, Union, Berks, Adams, Lancaster, York, Cumberland, Dauphin, Lebanon, and Perry

6 – Cameron, Luzerne, Mifflin, Montour, Fulton, and Juniata

5 – Elk, Potter, Bradford, Lackawanna, Monroe, Sullivan, Wyoming, Blair, Cambria, Clearfield, Huntingdon, Jefferson, and Somerset