Health insurance is like your taxes. It always seems to change, and usually the changes seem to cost you more each year. Pennsylvania healthcare plans are no different than other states. But there are several insurance policies that have held costs down in recent years and are still affordable. Our mission has always been to find the policies that pay your claims and keep most of your money in your pocket.
The top-rated contracts that are the least expensive, are typically plans that are not utilized very often. They will have deductibles of $7,900 or higher (sometimes as much as $15,800 per family) and often omit comprehensive benefits on items likely to be used, such as office visits and prescriptions. Since maintenance and underwriting costs are minimal, this type of coverage usually will be cheap. An HSA can be used if the policy is considered an HDHP (High Deductible Health Plan).
Since mandatory Obamacare benefits are included in these choices, an instant tax-credit subsidy, courtesy of the Federal Government, may help you pay for the plan. Household size and income determines eligibility and amount. Although not all major companies offer these options, you will not have to pay a penalty if you purchase an off-Exchange policy, short-term plan, or another type of contract that does not include all required Essential Health Benefits.
Thus, if your household income was $50,000, the penalty was $1,250 (2.5% of household income). If you did not qualify for new government tax credits, you might pay thousands of dollars less in premiums, which easily would offset the $1,000 in this example. But the loss of specific benefits (sometimes maternity and mental illness) should be discussed before enrolling in these cost-saving contracts. NOTE: This penalty (actually a tax) was eliminated for Marketplace plans by the Trump administration.
These options include PPO plans (or HMOs) since a "Preferred Provider Organization" allows you to be treated by a primary care physician or a specialist at a discounted cost. Also, additional x-rays, diagnostic tests and other procedures will cost less if you stay "in-Network." All of the policies discussed have large Networks that allow you to choose where you will be treated. EPO options are also offered in many counties.
Reduced Costs Of Some Policies
How cheap are they? Regardless of whether you are buying an individual or family policy, you'll pay about half the cost of a traditional plan. And the cost to the insurer to maintain and administer the plans is low, so rate increases tend to be in the single digits instead of double digits. But despite the basic structure of the policies, they provide superior benefits if you have large claims, and of course, there is no annual or lifetime limit on the number of claim dollars that are paid.
These policies are often found in the "Catastrophic" or "Bronze" category of Exchange options. Although the cost is low, the cost-sharing ratio is high, meaning that you would be required to pay a larger portion of the claim. Instead of 10% or 20% of the hospital bill, you might have to pay 40%. Of course, there is a cap, so your risk is not unlimited. Typically, $7,900 is the maximum allowed out-of-pocket expenses for a single plan, and $15,800 for a family plan. Several plans offer reduced maximum amounts, although the deductible is still high.
Our favorite choices for the type of benefits we have been describing include the following: UPMC Advantage Bronze $6,950/$35, Highmark my Direct Blue HMO Bronze 7900, Highmark my Direct Blue HMO Bronze 4000, Geisinger Marketplace HMO 30/60/6600, Geisinger Marketplace PPO 30/60/6600, Highmark my Direct Blue EPO Bronze 7900, Independence Blue Cross Personal Choice EPO Bronze Reserve, and Ambetter Essential Care 1.
Compare All Pa Plans Online
You can view specific details of each policy listed above on our quote engine or by simply requesting to view your personal rates. All of these plans offer superior major medical coverage while costing less than most other available options. However, it is important to note that not all of these plans are offered in every part of the state (see below). Also, we have a separate page devoted to COBRA options in Pa. COBRA premiums are usually quite high and should only be considered if all other policies have been reviewed. Also, you can utilize additional resources, such as Consumer Reports, and other reputable publications.
The Capital Blue Cross contract is available in Harrisburg and Central Pa, but not in many other areas. Independence Blue Cross offers policies to individuals and families in the Southeastern part of the state (Philadelphia). But the Network will not extend to many other parts of Pa. UPMC and Highmark BCBS (despite their recent battles with each other) offer very low prices in Pittsburgh, Erie, Altoona, Johnstown, and Washington, but not in Reading or Scranton. Ambetter offers plans in the Philadelphia area. And of course, Aetna, Cigna, Kaiser, UnitedHealthcare, and many other carriers are waiting for future legislative changes before they offer private plans in the Keystone State.
If you have a specific and specialized need, the best policy may not be on the previously mentioned list. For example, if maternity coverage is extremely important, and you live in Lancaster, one of the Geisinger, Highmark, or Capital BC options will provide a low rate with maternity included. Typical expenses covered include hospital charges for mother and baby, routine obstetric care, lab tests, prescription drugs, radiology, vaccines, and anesthesia. Selecting a low-deductible and low out-of-pocket expenses plan should be considered if you are currently pregnant or expect to be pregnant shortly. Several plans are offered with maximum out-of-pocket expenses of $5,000 or less.
If you're willing to pay a slightly higher premium for some office visit and prescription benefits, but you still want to keep rates below the cost of a high-end comprehensive plan, there are affordable choices. Pennsylvania features many policies that are a good value. Some of these options include: Capital Advantage Silver PPO 4500, First Priority Health my Priority Blue Flex HMO 6800B, Geisinger Marketplace HMO 30/60/3500, Highmark Alliance Flex Blue PPO 2300, Highmark my Community Blue Flex PPO 2100S, Independence Blue Cross Personal Choice PPO Silver, Keystone HMO Silver, and UPMC Advantage Bronze $6,950/$35.
Most of the policies listed above continue to cost less than group options through an employer and many popular individual health insurance plans in Pennsylvania. Any existing medical conditions (including height and weight) will not change eligibility and premium. And as previously mentioned, certain options are only available in specific counties. By providing your zip code and some basic information, you can view the best policies in your part of the state. Each year, new plans become available and occasionally, existing plans are replaced.
Popular Senior Medicare Advantage Plans In Pennsylvania
For applicants that are Medicare-eligible and prefer "Advantage" contracts with prescription drug benefits, rather than conventional Medicare coverage, there are many options with monthly premiums of $0. Listed below are several plans with 4.0 stars (or higher) out of 5 stars rankings by Medicare (with $0 cost). Plan availability is determined by county of residence.
AARP MedicareComplete Plan 1
UPMC For Life HMO Premier Rx
Community Blue Medicare HMO Signature
Aetna Medicare Silver
Humana Gold Plus
Geisinger Gold Classic Essential Rx