Western Pennsylvania health insurance rates are very affordable compared to other parts of the state. Catastrophic, copay, short-term, and HSA plans are provided from most of the major health insurance companies (Highmark BCBS and UPMC are two of the largest) in the Pittsburgh area either on or off the Exchange. Regardless what type of policy you need to purchase, there are many low-cost options to consider. Applying and enrolling for coverage is quick and easy. Additional companies offer Senior Medicare plans (Supplement, Advantage, and Part D prescription drug).
Finding The Best Pa Health Marketplace Rates (Under Age 65)
We research and find the most affordable Western Pa plans and make it easy for you to compare and apply for top-notch coverage at rates that are guaranteed to be the lowest offered by all of the medical providers. We compare all carriers so you can find a Marketplace policy (or policy without a federal subsidy) that meets your budget needs and gives you quality benefits. We only investigate top-ranked companies and never use any type of “discounted-benefit” plan. Short-term plans offered by UnitedHealthcare are an economical option for applicants that missed Open Enrollment, or prefer to consider less-expensive options than Obamacare plans.
Typically, prices in this part of the state are often lower than most other sections, especially the Philadelphia and surrounding area. Some of the cities (other than Pittsburgh) that feature very attractive rates include New Castle, McKeesport, Washington, Monroeville, Bethel Park, Mt. Lebanon, Plum, and Penn Hills. In addition to Allegheny County, other nearby counties with affordable private options include Beaver, Washington, Lawrence, Mercer, Westmoreland, Armstrong, Clarion, Vernango, Crawford, and Erie. Provider networks typically extend their service area to Ohio, West Virginia, Maryland, and New York.
NOTE: The streamlined method of enrolling for 2021 typically takes about 10-15 minutes. This is a major improvement from previous years, when glitches and delays often caused loss of information. You can use our direct enrollment link and easily review the best plans in your area and get covered. And no medical questions will be asked for Exchange (Marketplace) plans. Medically-underwritten plans typically require several health-related questions to be answered.
The price you pay and the benefits you receive for your medical benefits are one of our priorities. There are hundreds of different policies that are offered, and we research and review all options. Sometimes, Exchange plans create a challenge for consumers to understand, and we are always available for guidance. Deductibles range from $0 to $8,550 and office visit copays typically range from $10-$50. The new Pennie Pa Exchange provides additional information.
Many of the most popular health insurers (Senior and under-65) for the Pittsburgh area are Aetna, UnitedHealthCare, UPMC, Humana, Highmark Blue Cross Blue Shield, Coventry, Gateway, and Advantra. Other companies such as Ambetter also are licensed in Pennsylvania but only offer under-65 plans in the Philadelphia area. Humana, Aetna, and UnitedHealthcare, (three of the nation’s largest companies), do not offer individual (Marketplace) insurance in the state, but offer Senior and Group products.
Cigna, another large insurer, also does not offer private under-65 coverage in the state. Additional Pa regional carriers such as Geisinger, are available in other areas. UPMC began writing new individual business four years ago, and they have many attractive high-deductible plans. Also, Aetna purchased HealthAmerica’s block of business, and the two entities share Aetna’s provider network. CVS is also now the parent company of Aetna.
Highmark Blue Cross Blue Shield is one of the largest health insurance companies, and serves the 29 counties of Western Pennsylvania. In this area, they have more than 5,000 employees, making them one of major financial influences in the industry. The Allegheny Health Network gives customers more choices in how they are treated, and also increases wellness opportunities. Highmark is the fourth-biggest BCBS organization in the US, and also offers coverage in West Virginia and Delaware. In 2015, the merger with Blue Cross of Northeastern Pennsylvania (BCNEPA) was completed.
The least expensive plan offered by Highmark BCBS is the Together Blue Major Events EPO 8550. Since it is offered in the “catastrophic” tier, only applicants younger than age 30 can apply. However, several financial hardship exceptions are available for persons that do not meet the age guideline. Three pcp office visits are provided that are 100% covered. Remaining visits receive the Highmark negotiated network discount. For example, the retail cost of a fourth non-preventative visit may be $120, and the negotiated lower rate could provide savings of $25-$50.
This policy is structured in a very simple way. The deductible is $8,550. Once your medical expenses exceed that amount, all covered claims are covered at 100%. Of course, mandated preventive costs are always paid by Highmark and by utilizing their large provider network, your out-of-pocket expenses will dramatically reduce. Prescriptions are subject to the deductible, although generic drug out-of-pocket costs should be nominal. One network eye exam is covered per year along with a single pair of glasses and frames. Dental checkups are fully covered every six months (network only).
A popular, yet still affordable option, is the Together Blue EPO Bronze 3800. Copays are $60 for primary care/specialist physician office visits. The major medical deductible is $3,800 and all formulary prescriptions are subject to 50% coinsurance and the deductible. The physician/surgeon fee and facility fee (ambulatory surgery center) is $350. The Urgent Care copay is $100.
The 10 available Medicare Advantage plans offered in Allegheny County are: Community Blue HMO Signature ($0 per month), Complete Blue PPO Distinct ($35 per month), Community Blue Medicare HMO Prestige ($250 per month), Freedom Blue PPO ValueRX ($75 per month), Freedom Blue PPO Select ($170 per month), Freedom Blue PPO Classic ($282 per month), Security Blue HMO-POS Basic ($54 per month), Security Blue HMO-POS ValueRX ($63 per month), Security Blue HMO-POS Standard ($199 per month), and Security Blue HMO-POS Deluxe ($266 per month).
UPMC is the other dominant carrier in the area. Their “friendly” rivalry with Highmark is covered well by the local media, but most importantly to consumers, UPMC offers a wide range of private plans for individuals and small businesses. With the top-ranked hospital in the state (University of Pittsburgh Medical Center), along with more than 30 additional participating hospitals and 4,000 doctors, plus other related medical personnel, their healthcare plans should always be considered. They are a non-profit corporation that employs more 80,000 workers.
A popular low-cost plan is the Bronze $6,950/$35 plan that uses the Partner, Select, and Premium Networks. It is the least expensive non-catastrophic plan available. Pcp office visit copays are $35 with no limits on the number of visits utilized by any family member. The generic drug copay is $30 ($60 for mail order). The policy deductible is $6,950 with maximum out-of-pocket expenses of $7,350.
Other affordable single or family plans include Advantage Catastrophic $7,350/$0 (under age 30 0nly), Advantage Silver $3,500/$25, Advantage Silver $0/$50, Advantage Silver $1,750/$50, and Advantage Silver HSA $2,700/20%.
UnitedHealthcare is one of the biggest insurers in the country and also one of the Keystone state’s biggest writers of policies. They did not participate in the Marketplace in 2018, but originally entered the Marketplace with some very competitively-priced options. Their network-provider list extends across the US, which makes it very attractive to consumers that want the flexibility of being covered if they travel.
Some of the most affordable plans previously offered included Bronze Compass HSA 4900, Bronze Compass 5500, Silver Compass HSA 1600, and Gold Compass 500. UHC’s return to the Pa private individual market is dependent on possible future legislation that would create an opportunity to underwrite plans again. However, many temporary and ancillary products are available. The most popular options are listed below:
Short term plans (Medical Copay Select, Medical Plus Select, Medical Value Select, Medical Plus Elite, and Medical Copay Select), Hospital and Doctor Fixed Indemnity, Dental, Term Life, Accidental, Critical Illness, Vision, Supplemental Indemnity, and Health Care Discount Card.
Rates (Under 65 Comprehensive Plans)
We have listed below several single and family examples with different household incomes in Allegheny County. The amount of subsidy, of course, is directly related to household earnings and the Federal Poverty Level guidelines. Rates illustrated are monthly and include federal subsidy. Five popular options are shown for each scenario.
Single 27-year-old with $21,000 income
$8 – UPMC Advantage Bronze $6,950/$35
$69 – Highmark my Direct Blue HMO 6950B
$85 – UPMC Advantage Gold $800/$20
$93 – Highmark my Direct Blue HMO 7000B
$96 – UPMC Advantage Silver $1,250/$5
Single 43-year-old with $32,000 income
$108 – UPMC Advantage Bronze $6,950/$35
$186 – Highmark my Direct Blue HMO 6950B
$207 – UPMC Advantage Gold $800/$20
$217 – Highmark my Direct Blue HMO 7000B
$221 – UPMC Advantage Silver $1,250/$5
Married 57-year-old husband and wife with $50,000 income
$2 – UPMC Advantage Bronze $6,950/$35
$247 – Highmark my Direct Blue HMO 6950B
$323 – UPMC Advantage Gold $800/$20
$359 – Highmark my Direct Blue HMO 7000B
$372 – UPMC Advantage Silver $1,250/$5
Here you can learn about HSAs which have been increasing in popularity since they were established in 2004. Because of their cost-saving features, they should always be considered for individuals or families that do not often use their coverage. UPMC and Highmark offer very attractive rates in most of Western Pennsylvania. UnitedHealthcare was one of the first companies to offer a “single family deductible.” This concept allowed every person’s expenses in the household to count towards the only required deductible.
The plans listed below are extremely popular, especially if your personal physician is in their Network. We will be happy to review your options and help determine if this type of policy is the right fit for your needs. They are a great choice for your personal medical coverage but not appropriate if you are willing to pay a higher price for the right to office visit and prescription copays. As your circumstances change each year, of course, you can change policies and carriers.
Available HSA options:
UPMC Advantage Silver HSA $2,700/20% – $2,700 deductible with maximum out-of-pocket expenses of $4,300 and 20% coinsurance.
Senior Medicare Coverage
Many carriers offer Medicare Supplement, Advantage, and/or Part D prescription drug coverage. Rates can slightly vary in each county, and some plans are not offered in all counties. Listed below are several companies that offer current products.
Supplement – AARP (UnitedHealthcare), Aetna, Continental Life, Shenandoah Life, Cigna, New Era Life, Transamerica, Medico, CSI Life, Greek Catholic Union, Manhattan Life, Companion Life, Mutual Of Omaha, Individual Assurance, American Retirement Life, Central States, Equitable, Combined Insurance, United American, Gerber, Humana, and American Retirement Life.
Advantage – Advantra, Allwell, Community Blue, Humana, UPMC, AARP, UnitedHealthcare, AmeriHealth, Gateway Health, Security Blue, and Freedom Blue.
Part D Prescription Drug– EnvisionRx, Aetna, Humana, AARP, SilverScript, Symphonix, Express Scripts, Cigna, WellCare, FirstHealth, SecureRx, Magellan, and BlueRx.
Get Rates Now
The free quote section at the top of the page will allow you to easily compare Western Pennsylvania health insurance plans. If you would like to speak to a live person, please call us at (888) 513 6446. You can apply direct or with the help of a broker. There is no cost for either method. Both “on” and “off” Marketplace plans are offered. To qualify and receive government subsidies, an “on” policy must be selected.