Pennsylvania health insurance providers offer comprehensive, catastrophic, student and short-term temporary coverage to Pa residents. Many plans are available at very low rates. As one of the state’s leading authorities for providing affordable healthcare coverage, we represent all of the large companies. Our unbiased information, advice and online quotes are free, and allow you to view the best prices in minutes. Both Senior and under age-65 plans are available.
We help you find the carriers that offer the least expensive prices, while maintaining the services you need most. The most important factors include the type of benefits you need, your budget, the networks of your personal physicians, and what level of subsidy you are likely to receive from the federal Exchange. We have listed below details and important information about many of these carriers. If the ACA Legislation is possibly changed or altered by current Administartions, additional plans will be offered by many of the companies listed below. Any changes, if approved, may be completed by 2021.
Aetna (a CVS company) offers an extensive combination of PPO and HMO Pennsylvania insurance plans. As the first national, full-service health insurer to offer individual consumer contracts, Aetna also features various competitively-priced Senior Medigap plans for applicants receiving Part A and Part B benefits. Advantage contracts often include prescription drug benefits, dental, and vision coverage. Private options for persons under age 65 consist of employer-sponsored coverage (see below) and various ancillary products.
Many retirees have converted their group products and continue to maintain benefits. Note: Aetna purchased Coventry, which had previously purchased HealthAmerica. Although private individual plans are not offered, in other states, National General utilizes Aetna’s PPO network for their short-term coverage.
Policies are available for Group benefits and “off-Exchange” since individual Marketplace plans are no longer offered. Three years ago, Aetna made the decision to offer plans in only four states – Virginia, Delaware, Iowa, and Nebraska. Heavy underwriting losses contributed to the decision. It’s possible a return to the Keystone State will occur in 2021. HSA plans would likely be offered, along with several comprehensive options.
Also, Aetna’s dental rates, if added to a policy, typically cost only $18-$30 per person (per month). That cost is substantially lower than most other full-service rates. A stand-alone policy can also be purchased. Disability, supplemental, vision, and life coverage can often be purchased through employer group plans. Property and casualty (auto and home) products are not offered, although auto, home, rental property, RV, motorcycle, and RV policies are widely available from other carriers.
Medicare Supplement plans offered are A, B, F, G, and N contracts. Advantage plans include Advantra Core, Advantra Credit Value (PPO), Advantra Silver (HMO), Aetna Medicare Value (PPO), Aetna Medicare Advantra Cares (HMO D-SNP), Avantra Premier (HMO), Advantra Gold (HMO), Advantra Premier Plus (PPO), Aetna Medicare Silver (PPO), and Aetna Medicare Gold Plan (PPO).
UnitedHealthcare (UHC) is one of the largest US insurers, and provides plans through UnitedHealthOne and Golden Rule. Private Pa individual comprehensive Exchange coverage is not currently available, although small and large group plans are offered in the Keystone State. Senior Medigap products are also available (specific details below), and are typically very affordable.
Individual private plans previously available include Compass HSA Bronze 6550, Compass Bronze 7100, Compass Silver 5200, and Compass HSA Silver 2800. UHC also offered many popular limited copay plans before the Affordable Care Act. It’s possible that UHC will offer Pa single and family private Exchange plans again in the future. Currently, dental, vision, and other ancillary products can be purchased. Office visit and prescription drug coverage can be added to short-term plans.
UHC temporary rates are also extremely competitive. Short-term contracts can be bought throughout the entire year, regardless of Open Enrollment periods. Currently, they do not offer options through the Marketplace. Thus, if you qualify for an Obamacare tax credit subsidy, you can not apply the funds towards a UHC plan. Short-term temporary plans available are: Medical Copay Value, Medical Value, Medical Copay, and Medical Plus.
Policies are marketed under the “Golden Rule” brand. “FACT” membership is required, which provides discount eye and dental benefits. Up to six months of coverage is available. Many additional riders ae offered, including term life, dental, and vision benefits. Enrollment is streamlined, and applications can be completedin less than 20 minutes.
Senior Medigap coverage includes Medicare Supplement, Advantage, and prescription drug plans. Available Supplement options are Plans A, B, C, F, G, K, L, and N. The least expensive policies are plans A and K. The most expensive are plans F and C, which offer more benefits. The offered Advantage contracts AARP Medicare Advantage Choice Plans 1, 2, 3, AARP Medicare Advantage Essential, and Medicare Advantage.
Prescription drug plans (Part D) are AARP MedicareRx Walgreens, AARP MedicareRx Preferred, and AARP MedicareRx Saver Plus. The first two options do not have a deductible for Tiers 1 and 2.
Highmark Blue Cross Blue Shield (BCBS) services Pittsburgh (see photo below) and the 29 counties of Western Pennsylvania, and features one of the largest provider Networks in the region. Including all subsidiaries, they are the fourth largest BCBS organization in the US. Coverage is also available in West Virginia, Delaware and additional states that honor the BlueCard. BCNEPA merged with Highmark three years ago. Supplemental dental, vision, and accidental coverage is also available to individuals and small and large businesses. Fertility treatment and travel coverage are also provided, along with HIPAA conversion contracts.
Both federally-subsidized and “off-Exchange” private plans are offered. The least expensive policy is my Direct Blue HMO Bronze, which has a $7,900 deductible. The my Direct Blue HMO Bronze 4000 has the same deductible, but with a copay for pcp office visits. The my Direct Blue HMO Silver 2400 plan offers two free pcp office visits with a copay for specialist visits. UPMC is Highmark’s only other competitor for under-65 non-Group coverage in the Pittsburgh and Western Pa area. Capital Blue Cross and Geisinger compete with Highmark in many other counties, especially in the Central Pa area.
Community Blue plans provide quality coverage with an extensive physician network, and access to 90% of US hospitals. Connect Blue options provide local network access at reduced rates, and Community Flex plans provide two levels of coverage for customers. Conemaugh Region Flex Blue, Blue Edge Dental, and Blue Edge Vision plans are also offered.
Senior Medicare Supplement contracts offered are Plans A, N, B, C, F, and F (High-Deductible). Plan F (HD) is the least expensive option while C and F are the most expensive. Two Part D prescription drug plans (Blue Rx PDP Plus and Blue Rx PDP Complete) are also offered. Several of the most popular Advantage contracts include Community Blue HMO Signature, Community Blue Medicare HMO Prestige, Community Blue Medicare PPO Distinct, Security Blue HMO-POS Basic, Security Blue HMO-POS Deluxe, Security Blue HMO-POS ValueRx, Freedom Blue PPO Select, Freedom Blue PPO Classic, and Freedom Blue PPO ValueRx. Online tools are provided to help applicants estimate their healthcare expenses. The “SilverSneakers” free fitness program is available, and includes fitness classes, memberships, and many additional Senior benefits.
Capital Blue Cross services 21 counties in the Central part of the state, and the Lehigh Valley. Since 1938, individual coverage has been offered at very competitive rates. Based in Harrisburg, Capital BC employs almost 2,000 workers and owns several subsidiaries, including Geneia, Consolidated Benefits, Keystone Health Plan Central, Capital Advantage Assurance, Avalon, and Dominion National.
Non-Group private plans available are Bronze PPO 7350/0/60, Gold PPO 2000/10/20, and Silver PPO 5000/10/30. Dental plans offered are Dental Select Basic, and Dental PPO Plans 1, 2, 3, and 4. A single vision plan is also available. International health, CHIP, trip cancellation, and pet coverage, are offered as stand-alone products. “Petplan” is a separate company that offers policies in North America.
“Blue365” members receive discounted gym memberships and many other services. Medicare supplement plans offered are A, B, C, F, G, and N. Three HMO Advantage options are BlueJourney Premier, BlueJourney Value, and BlueJourney Essential. Two available PPO Avantage options are BlueJourney Prime, and BlueJourney Classic. BlueJourney HMO is offered through Keystone Health Plan, while BlueJoutney PPO is offered through Capital Advantage Insurance Company.
In the Harrisburg, Lancaster and Lebanon areas, they are very well-positioned on price. Geisinger and Highmark, however also must be included in comparisons in those areas. All three offer small business options that are very popular if the number of employees is less than 50.
Affordable Philadelphia area medical coverage is offered by IBX.
Independence Blue Cross (IBC and IBX) is Southeastern Pennsylvania’s largest health insurer, and covers individuals, families, and businesses in 25 states. More than two million persons are covered in just the Philadelphia area (and surrounding counties). The five-county service area is Philadelphia, Montgomery, Bucks, Chester and Delaware. As part of the Blue Cross Blue Shield association, the Blue Card provides comprehensive provider network benefits inside and outside of the area. Third party benefits administration and workman’s compensation are provided by subsidiary companies.
The Personal Choice and Keystone policies offer a wide variety private coverage with flexible benefit options. Both federally-subsidized and non-subsidized plans are offered. Available plans include Personal Choice Bronze Basic, Personal Choice PPO Bronze Reserve, Personal Choice PPO Bronze, Keystone HMO Silver Proactive, Keystone HMO Silver, Personal Choice PPO Silver, Keystone HMO Gold Proactive, Keystone HMO Gold, Personal Choice PPO Gold, Keystone HMO Platinum, and Personal Choice PPO Platinum.
Seniors have many competitive Pa IBX products to consider. Available Supplement plans are Plans are A, B, C, and F (HD). Advantage plans are the Keystone 65 Select Medical Only HMO, Keystone 65 Preferred Medical Only HMO, and Personal Choice 65 Medical Only PPO. Prescription drug plan options are Keystone 65 Focus RX HMO, Keystone 65 Select RX HMO, Keystone 65 Preferred RX HMO, and Personal Choice 65 RX PPO. Low-income subsidies are generally available.
Dental plans provide 100% coverage for cleanings, exams and x-rays. The “Preferred” option provides 50% coverage for fillings, root canals, and extractions, but does not include benefits for major services. The “Premier” option offers lower out-of-pocket expenses for many benefits, and includes 50% coverage for many major services, including inlays, onlays, and crowns. Two vision options are also offered (Adult Vision Care 100 and Adult Vision Care 180). An international travel plan (GeoBlue) is also available outside the US.
Geisinger is one of the largest health service organizations in the US, and provides assistance to millions of patients in Pennsylvania and New Jersey. In addition to a School of Medicine, and several research facilities, more than 30,000 employees (including about 1,500 doctors) are employed at various facilities and campuses. Since they are non-profit, more than $500 million was re-invested back into local communities last year. The Commonwealth School of Medicine is one of the most recent additions that aid the community.
The Under-65 health insurance service area covers Northeastern, Central, and South Central Pennsylvania. More than 40 counties are part of the Under-65 Marketplace network, including Adams, Berks, Dauphin, Lancaster, Lebanon, Lehigh, Luzerne, Perry, Pike, Somerset, Union, Wayne, and York. HMO, PPO, and “Value” options are offered. Principal competition is provided by Capital Blue Cross and Highmark. Available plans that are eligible for federal subsidies are Marketplace HMO 30/60/3500 and Marketplace HMO 20/40/3000. The Off-Exchange plan is the Marketplace PPO 30/50/5000. The catastrophic option is the “Value” plan.
Three Medicare Advantage plans are also available. Geisinger Gold Classic is an HMO that allows you to select a doctor to coordinate your healthcare treatment. A PPO Gold Preferred option is also offered. Gold Secure Rx is a special needs plan that may be offered, depending on household income and medical conditions. “GHP Kids” is the CHIP option that provides comprehensive benefits at a very low cost. GHP Family medical assistance plans aid applicants that are eligible for Medicaid. Enrollment through the Department of Human Services is required.
Group business coverage is also provided for small and large (50 or more employees) businesses, along with self-funded plans. When self-funding, substantial discounts, experienced customer-service, and a large provider network are available. Geisinger also provides excellent third-party administration. Medicaid plans are offered to lower-income households.
UPMC is the highest ranked Pennsylvania health plan for customer satisfaction, according to J.D. Power. Based in Pittsburgh, coverage is offered in parts of Pennsylvania, Ohio, West Virginia, and Maryland. As a non-profit company, they are the biggest non-government employer in the Keystone State. Patients can be treated at more than 25 hospitals, and 600 physician offices and facilities. More than 3 million persons are covered by a UPMC insurance product. Expansion to the central portion of the state has expanded market share.
Along with Highmark, they are the only carrier to offer private individual medical coverage in Western Pa. More than three million members are covered through individual, group, and CHIP, Senior, Special Needs, and workman’s compensation products. Affiliated companies and divisions include UPMC WorkPartners, Askesis, UPMC For You, UPMC For Life, UPMC For Kids, and LifeSolutions.
Individual UPMC Advantage plans are issued through the Partner, Select, or Premium Networks. The Premium option includes out-of-network coverage. Private Marketplace (on and off-Exchange) plans offered are: Catastrophic $7,150/$0, Bronze $6,950/$35, Silver $3,250/$10, Silver $1,750/$30, Silver HSA $2,600/20%, Silver $0/$50, Silver $3,500/$30, Gold $750/$10, and Platinum $250/$20.
UPMC Medicare Advantage coverage provides an attractive option for Seniors that prefer an alternative to original Medicare benefits. Six plans are available (listed below), although not all plans are offered in each county.
UPMC For Life HMO – No deductible with $4 and $45 office visit copays. UPMC For Life HMO Deductible With RX – $750 deductible with $5 and $50 office visit copays. UPMC For Life PPO High Deductible With RX – $1,250 deductible with $10 and $50 office visit copays. UPMC For Life HMO RX – $0 deductible with $5 and $40 office visit copays. UPMC For Life PPO Rx Enhanced – $500 deductible (out of network) with $5 and $50 office visit copays. UPMC For Life HMO Rx Enhanced – $0 deductible with $5 and $25 office visit copays.
Cigna has offered coverage for more than 200 years, and transformed into one of the nation’s biggest carriers when Connecticut General and INA merged in 1982. Last year, an attempted merger with Anthem was denied. In Pennsylvania, although private individual coverage is not offered, a robust portfolio of Senior, Group, dental, and vision benefits give consumers a wide choice of products to compare. Employer-provided disability, life, and accident plans are also available. Lump sum cancer, and whole life coverage are offered. These policies are medically-underwritten, and rates depend on many factors, including age and health.
Medicare Advantage contracts offered include Cigna-HealthSpring Achieve, Preferred, Preferred Plus, PreventiveCare, TotalCare, and Traditions. Each plan is offered in multiple counties, including the Philadelphia area. Additional counties where at least plans are available, include Cumberland, Lancaster, York, Lehigh, Northampton, and Berks.
Two Part D prescription drug plans are available – Rx Secure and Rx Secure-Extra. The Rx Secure plan is about $8-$10 per month cheaper, and has a $400 deductible with maximum out-of-pocket expenses of $3,700. The 90-day supply preferred cost-sharing copays are $6 for Tier 1, $21 for Tier 2, $120 for Tier 3, and 46% for Tier 4. The Rx Secure-Extra plan has a $50 deductible with maximum out-of-pocket expenses of $3,700. The 90-day supply preferred cost-sharing copays are $15 for Tier 1, $30 for Tier 2, $126 for Tier 3, and 50% for Tier 4.
Supplement plans offered are A, B, F, F (HD), G, and N. Three international plans (Silver, Gold, and Platinum) can be purchased by applicants with international destinations. The Platinum option features an unlimited benefit period.
Humana is one of the most diversified insurers in the US. Although they no longer offer individual medical coverage (all states), they have earned significant market share with many of their products. In Pennsylvania, their Senior plans are very popular. The eight Medicare Supplement plans offered are Plans A, B, C, F, F (HD), K, L, and N. The three Part D prescription drug plans available are Walmart Rx Plan PDP ($400 deductible and least expensive plan), Preferred Rx Plan PDP ($400 deductible), and Enhanced PDP ($0 dedutible and most expensive plan).
Four Advantage plans are available. HumanaChoice PPO features a $500 deductible with $10 and $35 office visit copays. The maximum out-of-pocket expenses are $4,500. Another HumanaChoice PPO features a $0 deductible with $15 and $45 office visit copays. The maximum out-of-pocket expenses are $6,700. A third HumanaChoice PPO features a $500 deductible with $15 and $45 office visit copays. The maximum out-of-pocket expenses are $6,700, and this plans is more expensive than the prior two plans. Finally, the Humana Gold Choice PFFS features a $0 deductible with $15 and $40 office visit copays. The maximum out-of-pocket expenses are $6,700.There is no drug deductible on this plan.
Group coverage is provided to small and large employers, The standard medical, dental, vision, and wellness benefits are offered, along with life, disability, pharmacy, Medicare, workplace voluntary, and behavioral health options. Plans with spending accounts are available (Group) and have become increasingly popular. A proposed merger with Aetna fell through several years ago when regulatory approval was not received.
For additional information on any Pennsylvania health insurance company, please contact us. We’ll review which plans are most suitable for you, and provide an easy method to apply for coverage. Your free quote takes only a few minutes and can be found in the quote boxes at the top of the page. Both Senior Medicare and under-65 plans are offered.