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.
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, 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. Also, for low-income households, Pennsylvania Supplemental Nutrition Assistance Program (SNAP) provides food benefits, healthy food education, and help with nutrition.
SNAP was formerly the food stamps program and has maximum household income requirements. Maximum annual incomes are $16,237 for one person, $21,983 for two persons, $27,729 for three persons, and $33,475 for four persons. A pre-screening tool is offered to help determine eligibility.
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 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 $7,900/$0 - $7,900 deductible with 100% coverage after deductible is met. Partner, Select, and Premium networks available.
Independence Blue Cross Personal Choice Catastrophic - $50 pcp office visit copay for first three visits. $7,900 deductible with 0% coinsurance. Telemedicine visits are provided free.
Geisinger Marketplace Value - $7,900 deductible with 100% coverage after deductible is met.
Geisinger Marketplace HMO 30/60/6600 - $30 and $60 office visit copays with $6,600 deductible. Urgent Care visits also receive $30 copay.
UPMC Advantage Bronze $6,950/$35 - $35 pcp office visit copay with $30 generic drug copay ($60 mail order). Deductible is $6,950.
UPMC Advantage Silver $3,500/$25 - $25 and $75 office visit copays with $3,500 deductible. Generic drug copays are $25 and $50. Preferred brand drug copays are $50 and $125.
Highmark my Direct Blue HMO 7900 - $7,900 deductible with 100% coverage after deductible is met.
Highmark my Direct Blue HMO 4000 - $60 pcp office visit copay with $4,000 deductible. Specialist visits must meet deductible.
Independence Blue Cross Personal Choice Bronze Reserve - $6,750 deductible with 0% coinsurance.
Ambetter Essential Care 1 - $7,900 deductible with 0% coinsurance. $20 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 $75 copay for specialist visits. $20 copay on generic drugs, and $50 on preferred brand drugs. Mail order copays are $50 and $125.
UPMC Advantage Silver $0/$50 - $0 deductible with $50 copay on pcp visits (first five visits are $0 copay) and $100 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 5000/10/30 - $30 and $75 office visit copays with $75 Urgent Care copay. $5,000 deductible with $7,350 maximum out-of-pocket expenses. Generic, preferred brand, and non-preferred brand drugs are subject to $10, $50, and $100 copays respectively.
Geisinger Marketplace HMO 30/60/4650 - $30 and $60 office visit copays with $30 Urgent Care copay. $4,650 deductible with $7,350 maximum out-of-pocket expenses and 20% coinsurance. Preferred and non-preferred drug copays are $3 and $20 ($6 and $40 mail order).
Independence Blue Cross Personal Choice PPO Silver - $30 and $70 office visit copays. $2,500 deductible with $7,000 maximum out-of-pocket expenses. $15 generic drug copay ($30 mail order).
Independence Blue Cross Keystone HMO Silver Proactive - $40 and $80 office visit copays and $0 deductible for Tier 1 preferred providers ($6,000 tiers 2 and 3). $20 generic drug copay ($40 mail order).
Highmark my Direct Blue HMO Silver 4450 HSA - HSA-compatible plan with $4,450 deductible and maximum out-of-pocket expenses of $6,650. Coinsurance is 10%.
Highmark my Direct Blue HMO Silver 2400 - Two Free PCP Visits - $40 (first two are $0) and $90 office visit copays with $90 Urgent Care copay. $2,400 deductible with $7,800 maximum out-of-pocket expenses and 30% coinsurance. Tier 1 and Tier 2 prescription drug copays are $5 and $30.Mail order copays are $10 and $60.
Ambetter Balanced Care 11 - $30 and $60 office visit copays. $6,000 deductible with $7,900 maximum out-of-pocket expenses. $20 copay on generic drugs, and $50 on preferred brand drugs ($60 and $150 mail order copays).
Ambetter Balanced Care 5 - $40 and $80 office visit copays. $7,350 deductible with $7,350 maximum out-of-pocket expenses. $20 copay on generic drugs, and $60 on preferred brand drugs ($60 and $180 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 $7,900 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 $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).
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 HMO 20/40/3000 - $20 and $40 office visit copays with $20 Urgent Care and $250 ER copays. $3,000 deductible with $6,000 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 1 - Three free pcp office visits. $1,000 deductible with $6,350 maximum out-of-pocket expenses. $10 copay on generic drugs, and $25 on preferred brand drugs ($30 and $75 mail order copays). Non-preferred brand drug copays are $75 and $225.
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 some 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.
Capital Blue Cross
Independence Blue Cross
Mutual Of Omaha
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.
Advantra Northern Pennsylvania Gold, Silver, Silver Plus, Gold, and AdvantraOne, Aetna Medicare Silver, Medicare Gold, Allwell Medicare, Geisinger Gold Classic Essential Rx, Gold Preferred Enhanced Rx, Preferred Advantage Rx, Gold Classic Advantage, and Gold Complete Preferred Rx, UPMC for Life HMO Premier Rx, PPO High Deductible with Rx, HMO Rx, PPO Rx Enhanced, HMO Rx Enhanced, and HMO Deductible with Rx, Humana Value Plus, Security Blue HMO-POS ValueRx, HMO-POS Standard, and HMO-POS Deluxe, Freedom Blue PPO Value Rx, Classic, and Select.
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, SilverScript, Aetna, 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, National General, Companion Life, Everest, Independence American, and LifeShield National.
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 are also available. Additional riders can be added, and all family members can be included under one policy.
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.
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 $7,900 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.
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.