Pennsylvania Health Insurance

Affordable Pennsylvania Health Insurance Quotes

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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 with our comparison tools.

Many affordable Medicare options for Seniors are also available. Persons that have reached age 65 can review several Medigap options that can be customized to match their specific medical needs. A high deductible Supplement plan (F-HD) offers 100% coverage after the deductible has been met. Coverage for older adults is available for many additional products, including dental, vision, long term healthcare, and property and casualty.

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 (October 15th to December 7th). If the 65th birthday occurs before the OE period, applying for coverage may be possible.

Government-assisted programs including Medicare and Medicaid provide comprehensive benefits for many persons. 35% of Keystone State individuals and families are covered by government programs while employer-provided plans cover more than half of eligible residents. These programs provide complete healthcare benefits with low copays and deductibles. Out-of-pocket costs are substantially lower than most private and employer-sponsored plans.

SNAP

For low-income households, Pennsylvania Supplemental Nutrition Assistance Program (SNAP) provides food benefits, healthy food education, and help with nutrition. An electronic card is provided for convenient purchases. If any person is physically not able to travel to the nearest office, a waiver can be obtained. A personal interview will be replaced by a phone interview. The FNS Food and Nutrition Service) helps eligible members make informed decisions.

SNAP was formerly the food stamps program and has maximum household income requirements. Maximum monthly limits are $1,354 for one person, $1,832 for two persons, $2,311 for three persons, 2,790 for four persons, $3,269 for five persons, and $3,748 for six persons.  A pre-screening tool is offered to help determine eligibility. Free summer meals are also provided to children 18 years-old or younger during non-school months. During the school year, these are no longer offered.

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 major carriers. We also provide specific pages for each carrier. For example, our UPMC Health Insurance For Individuals page helps Western and Central Pa residents compare the best plans. Highmark also offers attractive rates in Western and Central Pa.

Cheap Pa Plans That Are Very Budget-Friendly (Under Age-65)

Catastrophic And Bronze Tier Plans – Cheapest Pa Health Insurance Plans

UPMC Advantage Catastrophic $8,150/$0 – $8,150 deductible with 100% coverage after deductible is met. Partner, Select, and Premium networks available.

Highmark Together Blue Major Events EPO $8,150 – $8,150 deductible with 100% coverage after deductible is met. Three pcp visits are covered with a $0 copay.

Independence Blue Cross Personal Choice EPO Catastrophic – $50 pcp office visit copay for first three visits. $8,150 deductible with 0% coinsurance.

Geisinger Marketplace All-Access Value – $8,150 deductible with 100% coverage after deductible is met. Three pcp visits are covered with a $0 copay.

Geisinger Marketplace All-Access HMO 30/60/7100 – $30 and $60 office visit copays with $7,100 deductible. Urgent Care visits also receive $30 copay.

UPMC Advantage Bronze $7,400/$50 – $35 pcp office visit copay with $30 generic drug copay ($60 mail order).  Deductible is $7,400.

UPMC Advantage Silver $2,000/$80 – $80 and $90 office visit copays with $2,000 deductible. Generic drug copays are $25 and $50. Preferred brand drug copays are $50 and $125. Non-preferred brand drug copays are $100 and $300. $90 Urgent Care copay.

Highmark Together Blue EPO Bronze 7900 – $7,900 deductible with 100% coverage after deductible is met.

Highmark my Direct Blue HMO Bronze 3900 – $60 pcp office visit copay with $3,900 deductible. Specialist visits must meet deductible. 40% coinsurance.

Independence Blue Cross Personal Choice EPO Bronze Reserve – $6,900 deductible with 0% coinsurance.

Independence Blue Cross Personal Choice EPO Bronze Basic – $8,150 deductible with 0% coinsurance. Three pcp visits are covered with a $40 copay.

Ambetter Essential Care 1 – $8,150 deductible with 0% coinsurance. $20 ($50 mail order) generic drug copay.

Oscar Classic Bronze – $6,000 deductible with 50% coinsurance. Telemedicine visits fully covered. $3 ($7.50 mail order) generic drug copay.

Oscar Simple Bronze – $8,150 deductible with 0% coinsurance. Telemedicine visits fully covered. $3 ($7.50 mail order) generic drug copay

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 $100 copay for specialist visits. $25 copay on generic drugs, and $50 on preferred brand drugs. Mail order copays are $50 and $125.

UPMC Advantage Silver $2000/$80 – $2,000 deductible with $80 copay on pcp visits and $90 copay for specialist visits. $25 copay on generic drugs, and $50 on preferred brand drugs. Mail order copays are $50 and $125.

Capital BlueCross Silver PPO 6000/20/40 – $40 and $85 office visit copays with $100 Urgent Care copay. $6,000 deductible with $8,150 maximum out-of-pocket expenses. Generic, preferred brand, and non-preferred brand drugs are subject to $10, $50, and $100 copays respectively ($20, $100 and $200 mail order).

Geisinger Marketplace Extra HMO 10/50/4500 – $50 office visit copays with $50 Urgent Care copay. $4,500 deductible with $7,350 maximum out-of-pocket expenses and 30% coinsurance. Generic and non-preferred generic drug copays are $3 and $20 ($6 and $40 mail order).

Independence Blue Cross Keystone HMO Silver Proactive Lite – $50 and $100 office visit copays. $0 deductible for Tier 1 preferred providers ($6,000 tiers 2 and 3). $15 generic drug copay ($30 mail order).

Independence Blue Cross Keystone HMO Silver Proactive $40 and $80 office visit copays and $2,000 deductible for Tier 1 preferred providers ($6,500 tiers 2 and 3). $100 Urgent Care copay. $20 generic drug copay ($40 mail order).

Oscar Classic Silver Next Plan – $25 pcp office visit copay. $100 Urgent Care copay. $7,000 deductible with $8,150 maximum out-of-pocket expenses. Generic and preferred brand drug copays are $3 and $100 ($7.50 and $250 mail order).

Highmark my Direct Blue HMO Silver 3950 HSA – HSA-compatible plan with $3,950 deductible and maximum out-of-pocket expenses of $6,750. Coinsurance is 10%.

Highmark Togerther Blue EPO Silver 3950 HSA – HSA-compatible plan with $3,950 deductible and maximum out-of-pocket expenses of $6,750. Coinsurance is 10%.

Highmark my Direct Blue HMO Silver 2900 – Two Free PCP Visits – $40 (first two are $0) and $90 office visit copays with $90 Urgent Care copay. $2,900 deductible with $7,800 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 prescription drug copays are $0 and $30. Mail order copays are $0 and $60.

Highmark Together Blue EPO Silver 2900 – Two Free PCP Visits – $40 (first two are $0) and $90 office visit copays with $90 Urgent Care copay. $2,900 deductible with $7,800 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 prescription drug copays are $25 and $50. Mail order copays are $50 and $100.

Ambetter Balanced Care 11 – $30 and $60 office visit copays. $6,000 deductible with $8,100 maximum out-of-pocket expenses. $20 copay on generic drugs, and $50 on preferred brand drugs ($50 and $125 mail order copays).

Ambetter Balanced Care 12 – $35 and $70 office visit copays. $55 Urgent Care copay. $6,500 deductible with $8,150 maximum out-of-pocket expenses. $25 copay on generic drugs, and $60 on preferred brand drugs ($62.50 and $150 mail order copays).

 

Gold and Platinum-Tier Plans – The “Cadillac” Options

UPMC Advantage Gold $800/$20 – $800 deductible with attractive $25 copay on pcp visits and $50 copay for specialist visits. $20 copay on generic drugs, and $50 on preferred brand drugs. $100 copay for non-preferred brand drugs. Mail order copays are $50, $125, and $300. Diagnostic tests receive a $40 copay.

Highmark my Direct Blue HMO Gold 1000 – Two Free PCP Visits – $20 (first two are $0) and $45 office visit copays with $45 Urgent Care copay. $1,000 deductible with $7,000 maximum out-of-pocket expenses and 20% coinsurance. Tier 1 and Tier 2 prescription drug copays are $5 and $30. Mail order copays are $10 and $60. Diagnostic tests receive a $20 copay.

Independence Blue Cross Keystone HMO Gold Proactive – $15 and $40 office visit copays with $100 Urgent Care copay. ER copay is $400. $0 deductible with $8,150 maximum out-of-pocket expenses and 20% coinsurance. Diagnostic tests and x-rays subject to $60 copay. Imaging subject to $120 copay. Generic drug copay is $20 ($40 mail order).

Independence Blue Cross Keystone HMO Gold – $35 and $65 office visit copays with $100 Urgent Care copay and $350 ER copay. $0 deductible with $7,000 maximum out-of-pocket expenses and 20% coinsurance. Diagnostic tests and x-rays subject to $60 copay. Generic drug copay is $15 ($30 mail order).

Independence Blue Cross Personal Choice PPO Gold – $30 and $65 office visit copays with $100 Urgent Care copay. ER copay is $350. $0 deductible with $6,500 maximum out-of-pocket expenses and 20% coinsurance. Diagnostic tests and x-rays subject to $60 copay. Generic drug copay is $15 ($30 mail order).

Geisinger Marketplace All-Access HMO 20/40/3000 – $20 and $40 office visit copays with $20 Urgent Care and $250 ER copays. $3,000 deductible with $7,350 maximum out-of-pocket expenses and 20% coinsurance. CT and PET scans, and MRIs covered at 100%. Generic, preferred brand, and non-preferred brand drug copays are $3, $35, and $55 ($6, $70, and $110 mail order).

Ambetter Secure Care 5 – $15 and $35 office visit copays.  $35 Urgent Care copay. $1,250 deductible with $5,900 maximum out-of-pocket expenses. $15 copay on generic drugs, and $30 on preferred brand drugs ($37.50 and $75 mail order copays).  Non-preferred brand drugs are subject to coinsurance and deductible.

Oscar Classic Gold – $25 and $50 office visit copays with $75 Urgent Care copay. $1,700 deductible with $8,150 maximum out-of-pocket expenses and 20% coinsurance. Lab work subject to $50 copay. Generic and preferred brand drug copays are $3 and $50 ($7.50 and $125 mail order).

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 many of the major carriers that underwrite coverage in Pa. Not all companies offer each of the 11 available plans. Prices can fluctuate when the policy renews.

Aetna

American Republic

Capital Blue Cross

Colonial Penn

Companion Life

Equitable

Everence

Geisinger

Gerber

Globe

Highmark BCBS

Highmark BS

Humana

Independence Blue Cross

Medico

Mutual Of Omaha

Oxford Life

Reserve National

State Farm

Sterling Life

Thrivent

Transamerica

United American

UnitedHealthcare

UPMC

USAA

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 several available plans 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. Not all plans are offered in all counties.

Aetna Medicare Advantra Silver, Value, Elite, and Credit Value, AARP Medicare Advantage Plan 2, and Plan 1, AllWell Medicare, BlueJourney Essential, Cigna-HealthSpring Alliance and True Choice, Clover Health Choice, Community Blue Medicare HMO Signature, PPO Distinct, and PPO Signature, Geisinger Gold Classic 360 Rx, Complete Rx,  and Essential Rx, HumanaChoice,  Humana Value Plus, Keystone Basic Rx, Personal Choice Prime Rx PPO, Vibra Health Plan Essential and Health Plan Enhanced Complete,  UPMC For Life HMO Deductible With Rx and UPMC For Life HMO Premier Rx.

Pennsylvania Part D Prescription Drug coverage is offered by the following carriers: Envision, WellCare, Aetna, Blue Cross, Cigna, Express Scripts, Mutual Of Omaha, AARP (UnitedHealthcare), Humana, Clear Spring, SilverScript, and SecureRx. Deductibles, copays, drug formulary lists, and rates vary.

Short-Term Medical Plans

Temporary medical coverage is ideal for individuals or families that prefer a low-cost plan with limited major medical benefits. Mental health and maternity are typically not covered. Coverage is available from 1-12 months with made-to-order benefits offered by many carriers. Companies that offer competitive prices include UnitedHealthcare, Companion Life, Everest, Independence American, and LifeShield National. National General previously offered plans utilizing the Aetna PPO Network. However, the Pa DOI no longer allows their temporary plans to be offered.

By bridging a gap with these types of plans, you drastically reduce the risk of paying huge amounts of out-of-pocket expenses for a major medical claim. There are no penalties or enrollment restrictions, and indemnity plans are offered, which allow you to use any doctor or hospital. Deductibles are available as high as $10,000. Lower deductibles of $250 and $500 can also be purchased. Additional riders can be added, and all family members can be included under one policy. If a spouse becomes eligible for Medicare or Medicaid, other family members can continue to be covered under the policy.

Ancillary Plans

Many carriers offer non-healthcare coverage to applicants under age 65 and Seniors. These policies can be offered privately, with no other existing in force policies required, or through an employer. Common examples are life, dental, vision, disability, accidental, and long-term health care. Property and casualty products (auto, home, boat, motor home, mobile home, rental property, and ATV) are occasionally offered by employers.

Non-insurance products are sometimes offered, including pre-paid legal assistance products. Pet insurance is also offered from selected carriers. Although financial planning, banking, and investment products are sometimes offered, obtaining these products through a large financial institution often provides more competitive options.

Summary

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 $8,150 per person (maximum two persons per household). Therefore, in some situations, spending extra money for a smaller deductible may not be the best option. Each year, during Open Enrollment, all available plans should be reviewed, and household income should be projected to determine the amount of the subsidy.

Additional Information

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 December 15th. 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.