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Who are the major Pennsylvania health insurance companies?
Aetna, UnitedHealthcare, Independence Blue Cross, UPMC, Keystone, Capital Blue Cross, Highmark, Jefferson Health Plans, Geisinger, Ambetter, Oscar, Humana, and Cigna offer competitive under-65 and Senior rates in Pennsylvania. Occasionally, other carriers offer group or off-Exchange plans that should be considered. Several of the carriers are regional, such as Geisinger and Keystone. UPMC offers most of their products in the western and central portions of the state. UPMC and Highmark are the two carriers that offer Marketplace plans in Western Pa.
Additional carriers that offer Medicare products, but not under-65 medical plans, include AARP (through UnitedHealthcare), Ace Property And Casualty, Accendo, AFLAC, Allstate, Allwell, American Home Life, AmeriHealth, Devoted CHOICE, Elips Life, Gateway Health, Health Partners, Lasso Healthcare, Manhattan Life, Medico, Mutual Of Omaha, New Era Life, Provider Partners, SilverScript, United American, and Wellcare.
Non-Obamacare (Affordable Care Act) coverage is offered by several additional carriers. Plans are available at any time throughout the year, including outside of Open Enrollment periods. National General (Allstate) previously offered competitive short-term plans, but are no longer approved to offer temporary plans in the Keystone State. UnitedHealthcare continues to offer several affordable short-term options. UHC temporary plans are most popular outside of the Open Enrollment periods. Temporary coverage provides inexpensive medically-underwritten plans that can be quickly approved. However, only four months of coverage can be offered, making these plans a poor choice to replace ACA coverage.
What is “catastrophic” health coverage and should I consider it?
“Catastrophic” insurance plans are designed to cover major medical expenses, such as inpatient and outpatient hospital visits, surgical expenses and emergency room charges. Pennsylvania Premiums are fairly low, but office visits and prescriptions are generally limited, compared to other more comprehensive options. For healthy individuals and families, this type of coverage can potentially save a substantial amount of premiums, and is worth considering, especially since preventive coverage is provided with no waiting period.
Under-65 Catastrophic Marketplace plans offered are Independence Blue Cross Personal Choice EPO Catastrophic, Oscar Secure, Geisinger Marketplace All-Access Value, Highmark my Blue Access Major Events PPO Catastrophic 9200, Capital Blue Cross Catastrophic PPO 9200/0/0, UPMC Catastrophic $9,200/$0, Highmark Together Blue Major Events EPO Catastrophic 9200. and Highmark my Direct Blue Blue Major Events EPO Catastrophic 9200.
When enrolling in a Marketplace plan, you must be under age 30, or prove “financial hardship” to qualify for these types of policies. Also, since a federal subsidy will not be provided on “catastrophic-tier” contracts, often a Bronze or Silver option is less expensive, and provides more coverage. The highest allowable deductible and maximum out-of-pocket expense per individual is $9,200. This amount is likely to increase in 2026.
Sometimes, “blended” policies are offered, which combine high deductible and coinsurance with upgraded office visit and RX benefits. You still will pay more for larger claims but also receive better coverage for routine events. “Value” and “Saver” are often descriptions used for these types of policies. For Seniors, Plans F and G (High-Deductible) offer a policy that features lower premiums than other Supplement options. However, most expenses must be paid out-of-pocket before benefits begin. Many carriers offer these policies, and monthly premiums are generally less than $60 per month. Plan F (HD) Supplement plans are not offered to new enrollees.
What if I only need coverage for a few months?
A “short-term” policy could be your best option. Prices are substantially lower than comprehensive policies and you may select the number of months you would like to be insured. Applications are brief and are often approved within 24 hours. At any time, you can cancel your policy. Generally, coverage can be kept for up to four months (see above). If you need a cheap Pa short-term healthcare quote, it takes less than two minutes to calculate. Unlike Pennie plans, qualified preventative benefits are not fully covered.
UnitedHealthcare offers excellent options. Coverage, however, is no longer offered for up to 360 days with $2 million of available benefits. The UnitedHealthcare Choice Network provides countrywide availability of physicians and hospitals. Telemedicine options are also available. Popular short-term fans include Value Select, Value Plus, Copay Select, Value Select A, Plus Select A, and Copay Select A. A prescription discount card can reduce out-of-pocket drug costs by as much as 25%. More comprehensive RX options are also offered. A benefits cap may apply on specific plans.
Highmark and Capital Blue Cross were previously good choices, but they no longer offer temporary coverage. Aetna, Cigna, and Independence Blue Cross also do not offer this type of coverage at this time. Previously, National General (Allstate) (Aetna PPO Network) offered competitively-priced temporary plan, but since 2019, plans have not been offered in the Keystone State. Since you can cancel any policy with a simple request, you can often buy a more benefit-rich plan, although it will cost more. Note: Allstate purchased National General’s business several years ago. Their plans are offered in may states. Allstate also offers Medicare Supplement coverage in many states.
How Do I Buy Health Insurance In Pa Through The Pennie Exchange?
“Exchange” policies are the contracts that originated from the passage of Affordable Care Act federal legislation. All plans are guaranteed to be approved, regardless of what medical conditions you may have (or had). Federal tax assistance is provided to persons under 400% of the FPL (Federal Poverty Level). They take the form of an instant tax credit and are immediately applied to your premium. Thus, under the right conditions, it is possible that 100% of your rate is paid by the federal government.
The Pennie Exchange is the state’s exclusive Marketplace for individuals and families. Federal subsidies are offered to qualifying households. Multiple carriers are offered in all counties, although rates and available plans will vary. Pennie can be contacted in a variety of ways, including text, email, and phone. Open Enrollment for applicants under age 65 occurs in November, December, and January. Senior Pa Medigap Open Enrollment begins October 15th and continues through December 7th. Applicants that are Medicare-eligible typically can not apply for an ACA plan. However, they may purchase their own Part D prescription drug plan.
What is a PPO?
A PPO is a “preferred provider organization” that negotiates lower rates with groups of hospitals, doctors and other providers. Membership in the PPO allows a substantial discount below their regularly charged rates. Most Pennsylvania companies offer PPO policies, and they are the most popular type of coverage. You will often save as much as 50% by utilizing providers in your network. Typically, a PPO provides more flexibility than an HMO. Medical care is also available when traveling outside of your residential area.
These types of networks are regulated by the Department of Insurance. The DOI reviews financial risks and details of certificates and policies and A higher level of benefits is often provided when specific physicians and hospitals are utilized. The Pa Department of Health ensures that sufficient providers are available in the counties that are serviced.
Filing a PPO claim is very quick and often doesn’t require any paperwork that you have to complete. And yes, you can use a PPO out-of-state. For example, Highmark, Aetna, and UnitedHealthcare offer extensive network coverage across the US. Geisinger’s providers are mostly in-state. Other carriers, such as Allstate, utilize Aetna’s PPO network.
What is an HMO?
A health maintenance organization (HMO) is a type of managed care organization that medical coverage in the US. Unlike traditional health coverage, an HMO has very specific guidelines under which doctors, specialists and other providers can operate. A typical plan offers comprehensive services with low copays and no deductibles or co-insurance. Coverage is restricted to “in-network” only. Physicians, hospitals and medical facilities agree to provide service at a lower agreed rate. A pcp (primary care physician) may be required to coordinate your healthcare. Out-of-network coverage is typically not available, unless the event is an emergency.
In Pennsylvania, Keystone, UPMC, Capital Blue Cross, and Highmark offer very competitive HMO rates. Maternity benefits are included, which makes contracts ideal for young growing families. However, often out-of-state doctors and hospitals are not in the network. A primary care physician (pcp) is selected, and he/she will coordinate your treatment, including visits to specialists. Emergency treatment is typically considered “in-network.”
What Is The Best Supplemental (Medigap) Plan In Pennsylvania?
If you have reached age 65, then you are probably eligible for Medicare. Although standard benefits pay most of your medical expenses, there are still gaps in coverage that could result in thousands of dollars of additional out-of-pocket costs. For many Seniors, this represents a risk that can put tremendous pressure on their household budget.
Supplemental plans can potentially pay most (or all) of these expenses. Some of the most common examples are Part A coinsurance and hospital bills, Part B copayments or coinsurance, Hospice care, skilled nursing facility costs, and Part A and B deductibles. Available policies are designated by the letters A, B, C, D, F, G, K, L, M, and N. “Advantage” plans are also offered by many carriers. Part D prescription drug coverage is also offered. Part G (HD) plans typically offer the lowest premiums.
Several of the Medigap insurers are:
Ace Property And Casualty
Aetna
AARP-UnitedHealthcare
AFLAC
Allstate
Bankers Fidelity
Capital BlueCross
Cigna
Heartland National Life
Highmark
Humana
Independence Blue Cross
Manhattan Life
Medico
New Era Life
United American
United Of Omaha
Woodmen Of The World
Will my pre-existing condition be covered?
If you are applying (enrolling) for a qualified Marketplace plan, your pre-existing conditions will be covered, regardless if you are entitled to receive a federal Obamacare subsidy. This includes policies issued after Open Enrollment ends, assuming you are utilizing an approved Special Enrollment Period (SEP) exception, such as losing benefits at work, moving to Pennsylvania from another state, or getting married. Senior Medigap plans also cover pre-existing conditions.
However, temporary, non-qualified, and limited benefit policies will probably exclude past and present conditions, and will also leave potential large out-of-pocket medical expenses when large claims are filed. Short-term plans, however, are viable alternatives, especially for applicants that have not secured coverage by December 15th. Unfortunately, ST plans (since last year’s legislation) are only offered for a maximum of four months.
How much do I have to pay to use this Web service?
There is no cost for our services and we have never charged any fees or expenses. We can also guarantee that you will receive the lowest allowable pricing in the state since the Department of Insurance regulates rates. And it’s easy to get online direct prices by entering your zip code at the top of the page. You can choose to compare and apply directly online or contact us for help. Temporary plans can be approved within 24 hours. Carriers offer additional products, including life, disability, final-expense, dental, and vision plans.
Can I buy a customized policy?
Yes. Once we have determined the type of coverage you want, we create a personalized plan that features the deductibles, copays and premium that you want. We make sure that your doctors are Network-approved, and the company is highly-rated. Customization includes tax-subsidies and out-of-pocket costs and premiums to match your budget. If you are eligible for Medicare, additional products are offered.
If your household income is too high to receive any instant tax credits, we show you the “Off-Exchange” policies that feature the lowest premiums and potential out-of-pocket maximums. If you regularly take medication, it’s important to choose a plan that covers the drug without having to meet a deductible. Many Medigap plans publish their Formulary drug list to help you compare options. Copays and coinsurance can vary, depending upon the insurer and your county of residence.
