Health Insurance Pennsylvania 2021

Last modified: January 31, 2021

Do you want to purchase the best health insurance in PA? If you are searching for health insurance, you should check out the health insurance marketplace in  PA by visiting Pennie.com. At the State Marketplace, you will discover several different types of PA health insurance plans

Which health insurance provider should you choose? We have compared the different health insurance providers in PA by comparing their plans, prices, and customer reviews. You can use our detailed Pennsylvania health insurance guide to assist you in your decision.

Health Insurance Companies in PA

Below is a list of health insurance providers in PA and the plans they offer.

UPMC Health Plan

Plans

  • Catastrophic 
  • Gold 
  • Silver 
  • Bronze 
  • Medicaid
  • UPMC Community HealthChoices (for people eligible for both Medicare and Medicaid)
  • Pennsylvania Children’s Health Insurance Program (CHIP)
  • Coverage for Individuals and Families
  • Medicare Special Needs Plans (SNP) 

Geisinger Health Plans

Plans

  • Medicare Advantage Plans  – such as the Geisinger Gold, which offers coverage for hospital, medical, and prescription drugs, including additional benefits such as dental and vision for people 65 years and older.
  • Individual and Family Plans  – offered through Medicare, Medicaid, the State Marketplace, and CHIP for children.
  • Health Insurance for Businesses –  based on the ACA guidelines. Those PA health insurance plans are for businesses with one to 50 employees, more than 50 employees, and businesses searching for an alternative health insurance plan. 

Capital Blue Cross

Plans

  • Catastrophic – low monthly premiums and high out-of-the-pocket expenses. This health insurance coverage is for people under 30 or who meet the income requirements.
  • Bronze – low monthly premiums and high out-of-the-pocket expenses. 
  • Silver – equal monthly premiums and out-of-the-pocket expenses.
  • Gold – high monthly premiums and low out-of-the-pocket expenses.
  • Platinum – high monthly premiums and low out-of-the-pocket expenses. 

Highmark

Plans

    • EPO Gold (Standard, Enhanced, and Preferred) 
    • PPO Gold (Standard and Enhanced)
    • EPO Silver (Standard, Enhanced, and Preferred)
    • PPO Silver (Standard and Enhanced)
    • EPO Bronze (Standard, Enhanced, and Preferred)
    • PPO Bronze (Standard and Enhanced) 
  • Medicare
  • Individual and Family Plans through the Affordable Care Act (ACA)
  • The Children’s Health Insurance Program (CHIP)  – coverage to children under the age of 19 regardless of household income in PA

Oscar

Plans

    • Catastrophic or Secure Plan is for people under the age of 30 years old. It is for people who only want emergency health insurance coverage. It offers a low premium and a high deductible.
    • Bronze – an option for people who are in good health. This is for people who visit the doctor rarely and only take generic prescription drugs. It offers a low premium and a high deductible.
    • Silver – for people needing routine medical care throughout the year and take generic prescription drugs. It offers a moderate premium and a moderate deductible. The health insurance company covers 70% of the health costs while you pay 30% of the medical costs.
    • Gold – best for individuals with chronic medical conditions who take brand-name prescription drugs or need to undergo an upcoming medical procedure. It offers a high premium and a low deductible.
    • Platinum – people with chronic medical conditions and need to take more than one brand name prescription medication or plan to undergo a major medical procedure. It offers a high premium and a low deductible. The health insurance company covers 80% of the medical costs while you pay 20% of your medical costs.
    • Medicare 
  • Health Coverage Plans for Businesses 

Assurant

Plans

  • Catastrophic – provides cost-effective health coverage for everyday needs, preventive care, and hospitalization with special benefits for accidental injuries with flexible premiums. 
  • Individual Health Insurance
  • Group Health Insurance  
  • Special Programs (include Gym Reimbursement and Dental and Vision Discount Plan)

Celtic

Plans

  • Celtic Basic are high deductible health insurance plans
  • Preferred Provider Organization plans

Cheapest Health Insurance Plan by Cities in PA

If you are trying to find cheap health insurance in PA, the three insurance providers offering the cheapest health insurance in PA areUMPC Health Plan, Highmark, and Geisinger. If you live in Pennsylvania, you can expect to pay $9,258 on health care expenses each year.

You can select from three common PA health insurance plans. You can choose a bronze, silver, or gold health insurance plan. You will pay a higher premium each month if you opt for a higher coverage level.

  • Bronze($335 per month)
  • Silver($449 per month)
  • Gold($486 per month)

As you can see, the most affordable health insurance in PA is the Bronze plan, with the Gold plan being the most expensive, which means you’ll find yourself paying a higher premium each year for health insurance. 

Gold health insurance plans cost almost 38% more than Bronze ones. Gold health insurance covers about 80% of the medical expenses, whereas Bronze plans cover about 60% of the medical expenses. 

If you want the lowest level of health insurance coverage, you should choose Catastrophic plans where the premiums are low, but the deductible is high ($8,150).

Cheap Health Insurance in PA by Cities 

The estimated insurance premiums are for a single adult, aged 40.

  • Philadelphia ($334 per month)
  • Pittsburgh ($270 per month)
  • Allentown (363 per month)
  • Erie ($270 per month)
  • Reading ($428 per month)

Average Cost of Health Insurance in PA 

What is the average cost of health insurance in Pennsylvania?

The average health insurance rates in PA for individual health insurance plans are $459 each month and $5,500 each year. The health insurance quotes in PA depend on several factors, including the city you reside in. You will have to compare the various rates from health insurance companies to obtain low-cost health insurance in PA.

The average cost of health insurance by family size in Pennsylvania?

The size of your family can increase your monthly premium in the state. You also need to look at your coinsurance and copays when purchasing individual and family health insurance. 

Coinsurance refers to the percentage of expenses a person pays after they have met their deductibles, while copays refer to a fixed amount covering the medical services a person pays to the doctor before they receive a medical service.

You can choose a plan by factoring in the level of medical care you need. For instance, if you need more health coverage, opt for Gold and Platinum health coverage plans to get low deductibles, coinsurance, and copayment but higher premiums.

Size of Family Average Cost of Health Plan Per Month
Individual and child $746
Couple aged 40 $933
An adult couple and one child $1,213
Adult couple and two children $1,492
Adult couple with three children $1,771

Pennsylvania Health Insurance Guide 

Types of Health Insurance

  • Employer-provided for you and your family

You and your family can obtain Pennsylvania health insurance coverage from your employer, or you and your kids can obtain health insurance coverage through your partner’s employer. 

  • Private health insurance for individual or family plans

You can obtain individual health insurance in  PA or family health insurance from the PA health insurance exchange. The state provides private health insurance in PA through its federally operated health insurance exchange. 

You can apply for health insurance PA through the State Exchange or insurance companies that operate privately. Most private health insurance companies in PA offer the Affordable Care Act (ACA) or Obamacare

Government-assisted

  • Medicare

Medicare provides affordable health insurance coverage in PA to people aged 65 years and older. You can choose from different health coverage options. This includes Part A, B, C, and D. You can qualify for the Medicare Savings Program if you meet these requirements: 

  • Individual income limit per month: $1,456
  • Married couple income limit per month: $1,960

Medicare Coverage

  • Part A – coverage for inpatient hospital care, hospice, in-home care, surgery, lab tests, and a skilled nursing facility. 
  • Part B – coverage for outpatient care and doctor and health care services, including in-home care, medical equipment, and a few preventive services.
  • Part C – coverage for everything in Part A and B. This also includes dental, hearing, vision, and prescription drug coverage. 
  • Part D – coverage for outpatient prescription drugs. Most private health insurance companies in PA provide it with health coverage. It can also act as standalone health coverage for anyone with Medicare. 

How Many Are Enrolled Under Medicare in Pennsylvania?

Medicare enrollment in the state covers around 2.8 people living in the state. 45% of the state’s beneficiaries have health coverage under the Medicare Advantage coverage plan instead of the Original Medicare coverage plan. 

Medicaid

Medicaid is health insurance coverage for children and low-income families. It allows them to get low-cost or free health insurance in PA. The state has established Medicaid financial requirements for people wanting to obtain affordable primary care. For a household with:

  • 1 person, the maximum annual income should be $16,971 
  • 2 people, the maximum annual income should be $22,930
  • 3 people, the maximum annual income should be $28,888
  • 4 people, the maximum annual income should be $34,846

Coverage for Children

The Children’s Health Insurance Program (CHIP) and Medicaid are two options for children to receive health coverage. Through both types of health insurance, children will be eligible to go for regular visits to physicians, receive dental care, and get immunizations. Apart from children, families, and seniors, people with disabilities can also look into this option.

Tips to Save on Health Insurance in PA

Do you want to save money on individual health insurance in PA? If you are considering buying health insurance from a Pennsylvania health insurance provider, these tips will help you reduce your premium.

  • Increase Your Deductibles

You can increase your deductible to reduce your monthly premiums. The downside to doing that is that you won’t receive comprehensive health coverage.

  • Shop Around and Compare

You need to consider many health insurance companies in PA  before you select one. You can compare the various quotes. If you increase your deductible and change your copays and coinsurance, it will affect the cost of your health insurance coverage plan, so factor both of them too when deciding on the insurance provider to go with.

  • Take Care of Yourself

You can turn to over-the-counter medicines and home remedies for alleviating normal illnesses such as sore throat, allergies, and coughs. If the symptoms persist, you need to visit a healthcare professional. 

  • Eliminate Your Poor Habits

Bad habits can increase your premium. If you smoke, for instance, you need to quit.  If you can’t quit smoking, work out daily, eat healthy food, and take vitamins.

  • Inform Your Doctor that You Want to Take Generic Medications

Branded and generic prescriptions differ in price but not in their benefits. You can tell your doctor to prescribe you the generic version of the brand name prescription medication. 

  • Review Your Health Coverage before You Go in for Treatment

You need to review your health insurance coverage plan before visiting a healthcare professional for treatment. In doing so, you will know what your health insurance plan provides coverage for and what it doesn’t. Once you know, convey it to your doctor, as there might be a way to reduce your medical expenses.

Factors that Contribute to Your Premium Costs

  • Body Mass Index

If you have a high Body Mass Index (BMI), you will be at higher risk of developing a medical condition. Therefore, health insurance providers in PA may charge you a higher monthly premium.   

  • Tobacco Use

Smoking can increase your risk of developing a health condition and cause your premium to increase.

  • Age

Most health insurance providers charge a higher premium to older people than they do to younger people. 

  • Cost-Sharing Reductions

Cost-sharing reductions can reduce your out-of-the-pocket costs. People earning an income under 200% of the poverty level will benefit the most.

  • Pre-Existing Conditions

The current law states that health insurance providers in PA can’t refuse to provide health insurance to a person with a pre-existing condition. Once you have health insurance, they will have to pay for medical treatment for your pre-existing condition. 

Factors that don’t affect premiums

Under the ACA, health insurance companies in the state can’t charge a different price for the same health insurance coverage plan for men and women. They also can’t charge you more if you have a pre-existing medical condition and cover the costs of it from the first day your health coverage starts.

Should You apply as a family or individually?

Individual health insurance in PA may cost you less, as health insurance companies are likely to charge more for covering an entire family.

Pros & Cons

The Pros

The Cons

Final Verdict

FAQs

When is PA open enrollment for 2021 health insurance coverage?

The 2021 open enrollment period starts on November 1, 2020, and ends on January 15, 2021.

Did Pennsylvania expand Medicaid?

Yes, the state expanded Medicaid on January 1, 2015.

What is the income limit for Medicaid in Pennsylvania?

The maximum income limit for Medicaid in the state for one person is $16,971 each year, whereas the maximum income limit for Medicaid for four people is $34,846 each year.

Why is healthcare so expensive in Pennsylvania?

Healthcare insurance coverage in the state is expensive because it has a higher elderly and disabled population than the national average.

What does short-term health insurance cover?

Short-term health insurance in PA provides preventive care, urgent care, doctor visits, and emergency care.

What is the uninsured population rate in PA?

In the state, 7.6% of men and 5.7% of women in 2017 lacked health insurance. Families choosing health insurance can apply for CHIP health insurance PA if they are younger than 19 and uninsured.

Is health insurance mandatory in Pennsylvania?

Yes, today the state requires every resident to have health insurance that complies with the Affordable Care Act. This is why it is important to purchase the best health insurance in PA to provide you with coverage and benefits.