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. We review all Pennie Exchange, Senior Medicare, and non-Obamacare options.
The top-rated contracts (under age 65) that are the least expensive, are typically plans that are not utilized very often. They typically have deductibles as high as $8,700, and place higher copays (or deductibles) on 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). Catastrophic-tier plans are offered to applicants under age 30, although federal subsidies are not offered. Catastrophic plans also rarely place a copay on specialist visits and Urgent Care visits.
On-Exchange Plans
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. Temporary plans provide a very affordable alternative, although pre-existing conditions are not covered.
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 several years ago for Marketplace plans.
Policy options include PPO plans, EPO 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. If a deductible applies to the claim, negotiated discounts will reduce out-of-pocket expenses. 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% until the deductible is met. Of course, there is a cap, so your risk is not unlimited. $8,700 is the maximum allowed out-of-pocket expenses for a single plan, and $17,400 for a family plan. Several plans offer reduced maximum amounts, although the deductible is still high, and copays may not be offered on specialty and ER visits.
Our favorite choices for Catastrophic and Bronze-tier benefits we have been describing include the following: Oscar Secure, Keystone HMO Bronze, Ambetter Essential Care 2 HSA, Ambetter Essential Care 10, Cigna Connect 8700, Cigna Connect 7800, Capitol Blue Cross Catastrophic PPO 8700/0/0, Highmark my Direct Blue Major Events EPO 8700, Highmark my Blue Access Major Events PPO 8700, Capitol Blue Cross Bronze Capital Advantage EPO 7450/0/50, Together Blue Major Events EPO 8700, and UPMC Advantage Catastrophic $8,700.
Each carrier provides a substantial cost-reduction when you utilize the large provider network. This applies to primary-care physicians (pcp), specialists, Urgent-Care facilities, the ER, hospitals, and other medical facilities. Although life-threatening treatment will qualify for the discount at non-network facilities, other services will result in higher out-of-pocket costs. It’s important to verify network status especially for diagnostic tests, inpatient and outpatient surgery, ER visits, and extended hospital stays.
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. In the last several years, additional companies began offering plan in the Philadelphia area, including Oscar, Cigna, and Ambetter (see below).
Ambetter offers plans in the Philadelphia area. Oscar has also begun to offer coverage in some Philadelphia-area counties. And of course, Aetna, Kaiser, UnitedHealthcare, and many other carriers are waiting for future legislative changes before they offer private plans in the Keystone State. UnitedHealthcare, one of the nation’s largest insurers, has re-entered many states, and is considering additional expansion. Cigna offers 2022 plans in selected Pa counties and features competitive rates and a large Medicare plan portfolio.
Specialized Needs
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. Coinsurance and deductibles vary, and copays on pcp and specialist visits typically range between $20 and $100. Virtual online visit copays typically cost less than $50 and unlimited usage is offered. Although not a substitute for an ER visit, virtual online visits can help diagnose and treat many common conditions and illnesses.
If you’re willing to pay a slightly higher premium for 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 Silver-tier policies that are a good value. “Cost-sharing,” if applicable, will provide low out-of-pocket expenses. Some of these options include: Oscar Silver Simple, Oscar Silver Classic, Ambetter Balanced Care 30, Ambetter Balanced Care 31, Ambetter Balanced Care 32, Independence Blue Cross Keystone HMO Silver Proactive Basic, Keystone HMO Silver Basic, UPMC Advantage Silver $3,500/$40, Highmark Together Blue EPO Silver 2900, Highmark my Direct Blue EPO Silver 2900, Capital Blue Cross Silver Capital Advantage EPO 6000/20/40, Cigna Connect 5500, and Geisinger Marketplace All-Access HMO 30/60/7000.
Pa Medicare Advantage Special Needs Plans (SNP) For Seniors
SNP contracts are coordinated care plans (CCP) designed to provide limited enrollment and specific care to persons with special needs. This includes persons living in nursing homes, persons requiring nursing care at their residence, applicants that are both Medicaid and Medicare-eligible, and persons that have specific disabling or chronic conditions. Several available SNP plans are listed below:
Aetna Medicare Advantra Cares
Allwell Dual Medicare
AmeriHealth Caritas VIP Care
Cigna Achieve Medicare
Cigna TotalCare
Cigna TotalCare Plus
Gateway Health Medicare Assured Diamond
Gateway Health Medicare Assured Ruby
Health Partners Medicare Special
HumanaChoice SNP
Keystone First VIP Choice
Provider Partners Pennsylvania Advantage Plan
Provider Partners Pennsylvania Community Plan
UnitedHealthcare Dual Complete
UnitedHealthcare Dual Complete Select
UnitedHealthcare Nursing Home Plan 2
UPMC For Life Complete Care
Most of the policies (non-Senior) 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 With $0 Premium
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 or 4.5 stars out of 5 stars rankings by Medicare (with $0 cost). Plan availability is determined by county of residence.
AARP Medicare Advantage Choice Plan 2
AARP Medicare Advantage Choice Plan 3
AARP Medicare Advantage Plan 1
Aetna Medicare Advantra Value
Aetna Medicare Advantra Premier
Aetna Medicare Advantra Silver
Aetna Medicare Value
Aetna Medicare Main Line Health Prime
Allwell Medicare
BlueJourney Essential
Cigna-HealthSpring True Choice
Community Blue Medicare HMO Signature
Community Blue Medicare PPO Signature
Geisinger Gold Classic Essential Rx
Geisinger Gold Classic 360 Rx
Geisinger Gold Preferred Complete Rx
Humana Gold Plus
Keystone 65 Basic Rx
Personal Choice 65 Prime Rx PPO
UPMC For Life HMO Deductible With Rx
UPMC For Life HMO Premier Rx
