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 five 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.
Five Low-Cost Healthcare Options
UPMC Advantage Silver $1,750/$30 Available in the Pittsburgh area and other portions of Pennsylvania, this affordable plan features a low $1,750 deductible, although the maximum out-of-pocket expense is $7,900. 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 $50, and specialist visits also receive a copay ($80).
The coinsurance is 20%. Substance use disorder, behavioral, and mental health disorders that are treated as an outpatient, require only a $50 copay. Inpatient services are subject to 20% coinsurance. Imaging expenses, such as an MRI, CT Scan, or PET Scan are subject to 20% coinsurance. However, negotiated network reductions will reduce the cost at many area facilities.
Rehabilitation and habilitative services receive a $45 copay while 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. 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 counties that UPMC services.
Geisinger HMO Plan 30/60/3500 You'll have to live in Central Pa and some surrounding counties (like Jefferson, Somerset, Cambria and Clearfield) to purchase this plan. Office visit copays are $30 and $60, and the Urgent Care copay is also $30. Diagnostic tests and imaging procedures, however, must meet deductible and coinsurance. The policy deductible is $3,150 with maximum out-of-pocket expenses of $7,150 and 20% coinsurance. All prescription drugs must meet the deductible.
Once the deductible is met the copay for generic preferred is $3, non-preferred generic is $20, preferred brand is $45, and non-preferred brand is $80. Preferred specialty drugs have a 50% coinsurance. A drug formulary list is also available.
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. No, they are not one of the big players in the industry. However, their providers enjoy working for them, and most policyholders are extremely satisfied.
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 Bronze Basic If you live in the Philadelphia area (Chester, Montgomery, Bucks, Delaware, and Philadelphia Counties), there is only one company that offers single and family medical coverage. Independence Blue Cross (IBX) features a large network that extends into several additional states. This plan has a $40 pcp office visit copay for the first three visits. All specialist visits, however, must meet the policy deductible of $7,150. The maximum out-of-pocket expenses are also $7,150 with 0% coinsurance.
Once the deductible has been met, 100% of all covered medical expenses are paid, including an annual eye exam and one pair of glasses. It is expected that in 2020, additional companies will offer plans in the area.
Highmark BCBS my Priority Blue Flex HMO 6800B In many areas (Carbon, Luzerne, Monroe, Pike, Wayne, Lackawanna, Susquehanna, Wyoming, Bradford, and Sullivan Counties), only Geisinger and Highmark offer private coverage. And often, the only Bronze-tier option (and least-expensive) is this Highmark policy.
Office visit copays are available bu they are quite high ($95 for pcp visits and $130 for specialist visits). Diagnostic tests, x-rays, and blood work are also subject to a $95 copay. The Urgent Care copay is $150. The policy deductible is $6,800 with maximum out-of-pocket expenses of $7,150 and 30% coinsurance. The four Tiers of prescription drigs are subject to 15%, 25%, 35%, and 50% coinsurance.
Capital Blue Cross Silver PPO 4500/0/10 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 very low office visit copays of $10 and $20, along with a $75 Urgent Care copay. Chiropractic visits also receive a $20 copay. The deductible is $4,500 with maximum out-of-pocket expenses of $7,150 and 50% coinsurance.
The generic drug and preferred brand drug copays are $5 and $25 for retail prescriptions. Mail-order copays are $13 and $63. Non-preferred brand drug and specialty drug copays are $60 and $150 ($150 and $450 mail-order). Additional options to consider in the area include the Capital Blue Cross Gold PPO 1000/0/20, Highmark Alliance Flex Blue PPO 2300, and Geisinger Marketplace HMO 20/40/3000 plans.