Pennsylvania Health Insurance

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Quality medical insurance typically means you’re going to pay a high premium. But you can find inexpensive Pennsylvania medical coverage policies that are budget-friendly and actually pay for the items you expect to be covered. Many Pa plans may surprise you with their low premium. We are highlighting seven low-cost policies that are provided by major companies, and also are very easy on your budget.

Comprehensive office visit, prescription drug, hospitalization, and major medical benefits are included. All qualified and approved preventative services are equally covered at 100% on these five plans, and you can enroll with or without a federal subsidy. Major companies Humana, UnitedHealthcare, Aetna, and Cigna, do not offer single or individual coverage in the state, although Group plans through employers, and Senior Medigap options are available. Many low-cost non-compliant options are also offered. Plan G (HD) is a popular low-cost Medicare Supplement option.

The cost of coverage for a single person is much less than coverage for a family. However, stand-alone dependent plans are offered with quality benefits and federal financial subsidies available. Child-only, single, and family plans provide guaranteed benefits with no waiting periods.

Seven Low-Cost Healthcare Options In Pa

UPMC Advantage Gold $1,000/$10  Available in the Pittsburgh area and other portions of Pennsylvania, this affordable plan features a low $1,000 deductible, although the maximum out-of-pocket expense is $7,000. The maximum allowed amount for 2021 is $8,550. Utilizing the Partner Network, which is an EPO (Exclusive Provider Organization), premiums are lower than many other policies, since you must stay within the network for your medical care. “Select” and “Premium” network options are also offered.  Pcp office visit copays are only $10, and specialist visits also receive a copay ($55). The Urgent Care copay is also $55.

The coinsurance is 10%. Substance use disorder, behavioral, and mental health disorders that are treated as an outpatient, require only a $10 copay. Inpatient services are subject to 20% coinsurance. Imaging expenses, such as an MRI, CT Scan, or PET Scan are subject to 10% coinsurance. However, negotiated network reductions will reduce the cost at many area facilities. Diagnostic tests require only a $50 copay per visit.

Rehabilitation and habilitative services receive a $90 copay while children’s eye exams, glasses, and an annual dental check-up is covered at 100%. Generic drugs receive a $25 copay, preferred brand drugs a $50 copay, and non-preferred brand drugs a $100 copay ($50, $125, and $300 mail order copays). The most expensive prescription specialty drugs are subject to a 50% coinsurance. NOTE: You can compare UPMC plans  on or off the Marketplace and quickly enroll through our website. Highmark BCBS is often the only other carrier that offers policies in Western Pa Counties that UPMC services.

Geisinger Marketplace All-Access HMO 30/60/4650 You’ll have to live in Central Pa or one of 42 counties to purchase this plan. Office visit copays are $30 and $60, and the Urgent Care copay is also $30. The ER copay is $350 (deductible applies). Diagnostic tests and imaging procedures also must meet the deductible and coinsurance. The policy deductible is $4,650 with maximum out-of-pocket expenses of $7,600 and 20% coinsurance. All prescription drugs must meet a $500 deductible.

Once the prescription drug deductible is met, the copay for preferred generic is $3, non-preferred generic is $20, preferred brand is $50, and non-preferred brand is $85. The mail-order copays are $6, $40, $100, and $170. Preferred specialty drugs have a 50% coinsurance. A drug formulary list is also available. Children’s eye exams are subject to a $60 copay, but a pediatric dental checkup is covered at 100%. A similar PPO plan is offered with out-of-network benefits.

With all Geisinger options, to take advantage of the low premiums and benefits, it’s important you utilize their network providers. Otherwise, you will pay more for services, and may lose most of the large discounts. Although they are not one of the big carriers in the industry, their providers enjoy working for them, and most policyholders are extremely satisfied. More than 20,000 physicians (primary care and specialist), 120 hospitals, and 220 urgent care facilities are in the network.

Geisinger has won many awards over the years, including “Fit Friendly Company,” Top 100 Best Places To Work In Health Care Business,” and “Top 100 Hospitals.” There are many more accolades and we are happy to provide a complete list (that seems to get bigger every year!). Several popular Senior products are also offered, including the following Medicare Supplement plans: Gold Plan A, Gold Plan F (High Deductible), Gold Plan N, Gold Plan B, Gold Plan M, Gold Plan C, and Gold Plan F.

Independence Blue Cross Personal Choice PPO Bronze If you live in the Philadelphia area (Chester, Montgomery, Bucks, Delaware, and Philadelphia Counties), there are only three companies that offer single and family medical coverage (Ambetter and Oscar are other carriers).  Independence Blue Cross (IBX) features a large network that extends into several additional states. The pcp office visits copay is $50, although specialist office visits are subject to 50% coinsurance. Diagnostic tests and imaging are also subject to 50% coinsurance.

ER and Urgent Care visits are subject to 50% coinsurance. The generic drug copay is $15 ($30 for 90-day mail order). Children’s eye exams, glasses, and dental checkups are covered at 100%. Eye exams and a pair of glasses are provided annually while dental checkups are provided every six months. The policy deductible is $6,000 and maximum out-of-pocket expenses are $8,150. IBX provides large network discounts in the Philadelphia area.

Highmark Blue Shield my Direct Blue EPO Bronze 3900 In many areas of Central Pennsylvania, UPMC, Geisinger, and Capital Blue Cross offer private coverage. Highmark also features several options, and this Highmark plan is typically the least-expensive policy. Other Highmark BS plans include my Direct Blue  EPO Bronze 7900, my Direct Blue  EPO Bronze 7800, my Direct Blue EPO Silver 3950 HSA Silver, and my Direct Blue EPO Silver 2900.

The office visit (pcp) copay is $60, but specialist visits must meet a deductible. Diagnostic tests, Urgent Care visits, ER visits, and prescriptions are subject to 40% coinsurance and policy deductible of $3,900. Substance abuse, behavioral health, and mental health outpatient services are covered at 100% for the first two visits. Thereafter, coinsurance and deductibles apply. Children’s eye exams, glasses, and dental checkups are coveted at 100%. Eye exams and a pair of glasses are provided annually while dental checkups are provided every six months.

Capital Blue Cross Bronze PPO 8000/0/60  Highmark and Geisinger aren’t the only options in Central Pennsylvania. Capital BC offers a wide variety of products to persons under age 65, and Seniors. This PPO plan features a copay on both pcp office visits ($60) and specialist office visits ($85). Diagnostic tests, including blood work and x-rays, receive a $25 copay at independent clinical labs. Facility-owned labs usage results in no copay.

Generic, preferred brand, and non-preferred brand drugs are covered at 100% after the deductible is met. Rehabilitation services and other mental health outpatient services are subject to an $85 copay. The deductible is $8,000. Additional  options to consider in the area include the UPMC Advantage Bronze $7,400/$50, Geisinger Marketplace HMO 30/60/7100, and Highmark my Direct Blue EPO Bronze 7900 plans.

Ambetter Balanced Care 12  Available in several counties in the Philadelphia area, this plan provides lower out-of-pocket expenses for many common benefits. Centene Corp. is the parent company of Ambetter. Office visit copays (pcp and specialist) are $35 and $70 with no limit on usage. Diagnostic tests (x-rays and blood work) also have a $35 copay. Urgent Care visits are subject to a $55 copay.

Generic and preferred brand drug copays are $25 and $60. Mail order copays are $62.50 and $150. Non-preferred brand and specialty drugs are subject to 50% coinsurance.

Oscar Classic Bronze Plan  Available in the Philadelphia area, Oscar is fairly new insurance company, but partners with more than half of the top-ranked health systems in the US. Most customer interactions are virtual, so response time tends to be quick. 50% coinsurance and the $6,000 deductible apply to office visits. However, telemedicine visits from network providers are 100% covered with no limit on usage. Urgent Care visits are subject to a $75 copay.

Generic drug copays are $3 ($7.50 mail order). All other drugs are subject to 50% coinsurance and the deductible.