Affordable low-cost Pennsylvania family health insurance plans cover you, your spouse and dependents under one policy. Private and Group coverage is offered by many top-rated carriers such as UnitedHealthcare, Ambetter, Independence Blue Cross, Keystone, UPMC, Highmark Blue Cross Blue Shield, Capital Blue Cross, Geisinger, Aetna, Ambetter, Cigna, and Oscar. Plans for self-employed and lower-income households are also offered.
Family policies typically feature comprehensive benefits such as copays on covered office visits and prescriptions, maternity and delivery, preventative and wellness coverage, specialist and therapy sessions, and unlimited lifetime limits on catastrophic claims. These policies are specifically designed for households with children that may require numerous well-check visits, and additional unexpected visits to primary-care physicians and specialists.
Online telemed visits are often covered with a $0 or small copay. You can speak to your healthcare provider live, and easily send or receive messages. Remote monitoring may also be available. Most prescriptions (especially preferred generic and generic) are provided with very small copays. Specialty drugs have the highest out-of-pocket costs. However, most other prescriptions can be obtained through telemedicine benefits.
Online office visits have become increasingly popular after the COVID-19 epidemic impacted so many Keystone State residents. Physicians can quickly and effectively diagnose many medical issues and also prescribe prescription drugs. Virtual visits may also allow doctors to monitor existing conditions and discuss with patients ongoing or new treatment. Mobile medical equipment can also be used very effectively. Mental health visits can also sometimes utilize mobile capability. Emergency situations, however, should be treated in-person at a hospital or medical facility.
CHIP may be offered to households that meet income requirements. It’s fairly common when parents are covered through a Marketplace plan, and their children are covered through CHIP. Preventative benefits are paid at 100% for all family members, and the adults can continue to qualify for a federal subsidy. If household income changes throughout the year, it is possible that CHIP eligibility and the amount of federal subsidy can change. If Marketplace eligibility occurs, a Special Enrollment Period may be available after the OE period has ended (January 15th through Pennie Exchange).
Current Plans
Available again this year is a higher federal subsidy assistance that could substantially reduce prices on all available policies offered through the Pa Health Exchange (Our website quoting system shows you the plans). Households that have income less than 400% of the Federal Poverty Level will qualify for help. This link provides specific FPL numbers and annual guidelines. Generally, each year, individual and household income levels change. HHS poverty guidelines for 2024 plans are $14,580 for one household member, $19,720 for two members, $24,860 for three members, and $30,000 for four members.
Eight years ago, Medicaid eligibility expanded in the Keystone State, so that adults with FPL income up to 138% could qualify. “Healthy Pennsylvania” was introduced by Governor Tom Corbett. However, after Corbett lost the election to Tom Wolf, “HealthChoices,” a more conventional form of Medicaid became effective. This Pa DOI article explains the transition. Households eligible for Medicaid do not qualify for federal subsidies on Marketplace plans. These policies can still be purchased, but at substantially higher premiums. Benefits are identical although copays and deductibles may be higher on Silver-tier plans.
Note: If you have current individual coverage, your policy may be “grandfathered,” so that you don’t have to apply for a new contract. Even though certain provisions of your coverage may be different, the cost of coverage may be quite competitive. During Open Enrollment, you can terminate these plans and select a new plan without answering medical questions. Newer carriers may be offered in your area with several deductible and out-of-pocket expense options. Cigna, for example, began offering plans in selected areas last year. UnitedHealthcare offers Exchange plans in several states, but not yet in Pa.
Federal Subsidies For Families
Shown below are some specific examples of the 2024 monthly dollars amounts of federal aid offered to pay premiums. The instant tax credit is immediately applied, which creates low-cost options for households with several dependents. One-dependent families also will notice the savings. NOTE: Philadelphia County and Southeastern Pa were used for each scenario. Other counties may have minor, but not substantial differences.
$537 – Family Of Three (44,38,14) with household income of $80,000.
$521 – Family Of Three (42,42,15) with household income of $83,000.
$602 – Family Of Three (45,45,20) with household income of $85,000.
$1,492 – Family Of Four (48,45,21,19) with household income of $70,000. (Ages used in plan examples below)
$1,380 – Family Of Four (55,53,18,15) with household income of $100,000.
$1,598 – Family Of Five (50,50,22.21,19) with household income of $85,000.
$1,852 – Family Of Five (55,55,22.21,19) with household income of $85,000.
Popular Low-Cost Plans For Families With Children
UPMC Advantage Bronze $6,700/$0 – 40% coinsurance with $30 generic drug copay ($60 mail order).
UPMC Advantage Gold $1,000 – $20 and $50 pcp and specialist office visit copays. $10, $50, and $100 copays for generic, preferred brand, and non-preferred brand drugs ($20, $100, and $200 mail order). $50 Urgent Care copay. $50 diagnostic test copay. $1,000 policy deductible.
Highmark Together Blue EPO Bronze 3800 – Inexpensive premium. $65 office visit copays. Prescriptions are subject to deductible and copay. $100 Urgent Care copay with $150 and $65 copays for x-rays and blood work. $3,800 policy deductible.
Highmark Together Blue EPO Gold 0 – $20 pcp and specialist office visit copays. $0, $30/$60/$90, and $150/$300/$450 copays for Tier 1, Tier 2, and Tier 3 drugs. $40 Urgent Care copay. $35 diagnostic test copay. $400 imaging copay. $0 policy deductible.
Highmark Together Blue EPO Silver 7000 – $55 pcp and specialist office visit copays. $0, $30/$60/$90, and $150/$300/$450 copays for Tier 1, Tier 2, and Tier 3 drugs. $100 Urgent Care copay. $75 diagnostic test copay. $600 imaging copay. $7,000 policy deductible.
Capital Blue Cross Gold PPO 2400/10/20 – $25 and $45 office visit copays. $10 and $25 generic drug copays. 40% coinsurance (and deductible) applies to all other drugs. $75 Urgent Care copay. Most other non-preventative benefits are subject to the $2,400 deductible. $25 copay at facility-owned and independent labs for diagnostic tests. No charge for children’s eye exam. No charge for children’s standard frames and lenses. $8,550 maximum out-of-pocket expenses.
Capital Blue Cross Gold PPO 18000/10/20 – $20 and $45 office visit copays. $10 and $25 generic drug copays. $25 and $75 preferred brand and non-preferred brand drug copays (subject to deductible). $75 Urgent Care copay. Most other non-preventative benefits are subject to the $1,800 deductible. $25 copay at facility-owned and independent labs for diagnostic tests. No charge for children’s eye exam. No charge for children’s standard frames and lenses. $8,550 maximum out-of-pocket expenses.
Cigna Connect Bronze 7800 – $50 and $100 pcp and specialist office visit copays. Preferred generic drug copay is $3 ($9 mail order). $75 Urgent Care copay. $7,800 policy deductible. $9,100 maximum out-of-pocket expenses.
Cigna Connect Gold 2500 – $10 and $45 pcp and specialist office visit copays. Preferred generic drug copay is $3 ($9 mail order). Generic and preferred brand drug copays are $20 and $50 ($60 and $150 mail order). $35 Urgent Care copay. $2,500 policy deductible.
Keystone HMO Silver Proactive Basic – $50 and $100 pcp and specialist office visit copays. Generic drug copay is $20 ($40 mail order). $100 Urgent Care copay. $2,500 policy deductible. $150 x-ray copay.
Important Note: “Silver-tier” plans are offered to individuals and families between 100% and 250% of the Federal Poverty Level, and special “cost-sharing” applies. For example, for a family of four, income of up to about $63,000 qualifies for this feature. If only two family members, the cap is about $41,000.
If you qualify, deductibles, copays, and maximum out-of-pocket costs could substantially reduce, resulting in thousands of dollars of savings. In many situations, the Silver-tier policy becomes a better option than a Gold-tier option. Please ask us about additional details.
Grandfathered Plans (No Longer Offered But Still Active For Many Households)
UnitedHealthcare’s Copay policies from previous years were the most comprehensive family Pennsylvania health plans in their portfolio. There was no limit on the number of covered office visits ($35 copay) and prescription coverage was very good ($15 generic copay and higher copays on non-generic). UnitedHealthcare offered dozens of riders including enhanced accidental death benefits. A “reducing deductible” feature slowly lowered the deductible after the first year if it was not met.
For these plans, rates were more competitive in Eastern Pennsylvania. Preventative coverage was very comprehensive and not subject to any waiting period or deductible. You can still use your policy anywhere in the US, and basic vision and dental benefits are included. “Golden Rule” is occasionally the brand name you see on ID cards or advertising campaigns. Short-term plans are also issued through Golden Rule.
The Highmark Blue Blue Shield DirectBlue plan (available in the 29 Western Pa counties) featured preventive benefits (routine physical, mammogram, gynecological exam, pap test and pediatric immunization) that were also paid completely by the insurer. Most other coverages were paid at 90% after the selected deductible had been met. Some of these items include office visits, hospital facility expenses (including maternity), medical/surgical expenses and diagnostic services.
The Highmark AdvancedBlue policy did not require a deductible to be met for most office visits. Additionally, the RX out of pocket costs were only $8 or $40 (for brand name). This policy was suited for families that expected to have many office visit and specialist expenses.
UPMC Value contracts were often considered in the Pittsburgh area. There are many participating doctors and hospitals and their price on these plans was very competitive. Although both UPMC and Highmark often wage battles in the local media, they are both very trustworthy companies. NOTE: UPMC offers very competitive rates and policy options are very popular in Western Pa counties.
HealthAmerica’s Copay and Choice1 PPO plans are no longer offered. Rates were very attractive in most parts of the state and their $1,250 deductible option was a great “buy.” Currently there are “no deductible” policies available, although the maximum out-of-pocket expenses limit is high.
These Aetna, United HealthCare, HealthAmerica and Highmark BC BS policies are just three examples of many Pennsylvania family health insurance plans that are no longer available. If you would like to compare or apply for the highest quality options in Pa, please use the “Quote” area at the top of this page. Your rates are mandated by the state, so the premium will be the lowest allowable by each insurer. If applying outside of the Open Enrollment period, non-ACA plans may be the best option.
