Best Health Insurance in Pennsylvania (PA)

Jump straight to it: The best way to get health insurance in Pennsulvania is by using this form to get competing quotes.

The best health insurance in Pennsylvania ensures you have the coverage you need in case of unexpected illnesses, accidents or operations. But a major factor in finding the best health plan for you is its cost.

If you’re tired of paying too much for health insurance and struggling to find good resources that outline the best options available, read this list outlining affordable, high-quality health plans that will ensure you have adequate coverage for unexpected medical expenses.

Quick Look: The Best Health Insurance in Pennsylvania

• Best for Affordable Health Plan for Individuals: UPMC Health Plan
• Best for Basic Health Plan Coverage: Geisinger
• Best for Insurance with Good Value: Highmark BCBS
• Best for Nationwide Coverage: Independence BCBS
• Best for Cheapest Rates and Basic Coverage Options: Ambetter Health

Best Health Insurance in Pennsylvania

It’s a good idea to understand how different plans work as you look for the best health insurance. You might want to choose the plan with the lowest monthly premium, but the cheapest premiums often have high deductibles that could cost you more in the long run. Consider how much you use insurance to help you find the cheapest plan for your situation.

1. Best for Affordable Health Plan for Individuals: UMPC Health Plan

UPMC provides health insurance plans for many parts of Pennsylvania. 

The company has some of the cheapest plans available. In addition to reasonable monthly premiums, Silver and above plans come with affordable deductibles. UPMC ranks above average for insurance providers in Pennsylvania, according to the 2023 J.D. Power Health Plan Satisfaction Study.

2. Best for Basic Health Plan Coverage: Geisinger

Geisinger offers some of the most affordable health plans in Pennsylvania.

The service area extends through many rural parts of the state. You may not be eligible for a Geisinger plan if you live in Pittsburgh or Philadelphia.

However, if you live within the Geisinger service area, you can enjoy some of the best coverage and benefits at affordable costs.

3. Best for Insurance with Good Value: Highmark BlueCross BlueShield

Highmark BlueCross BlueShield serves the western part of Pennsylvania, including Pittsburgh.

If you live within the region, Highmark gives you one of the best provider networks. A unique and helpful service the company offers is a doctor match quiz.

You fill out an online quiz that matches your personality to an in-network provider.

4. Best for Nationwide Coverage: Independence BlueCross BlueShield

Independence BlueCross gives you access to a large provider network in PA.

It doesn’t offer the cheapest health insurance options, but Independence plans come with additional benefits that might be worthwhile for you. For example, your plan may reimburse you for fitness center memberships.

You can also use the tele-behavioral health benefit for mental health visits over the phone.

5. Best for Cheapest Rates and Basic Coverage Options: Ambetter from Pennsylvania Health and Wellness

Ambetter offers affordable health plans and you may have access to cheap dental and vision insurance, too. 

Many Ambetter plans offer the option to add dental and vision coverage to a health insurance plan. 

You’ll also get 24/7 access to a nurse advice line. You can call at any time and get answers to your health questions.

What is Health Insurance? 

Health insurance covers the cost of medical services and health care treatments. When you visit the doctor, your insurance company pays for part of your services or treatments. This helps you avoid huge medical bills that could take months or years to pay off.

Here’s how it might work. Let’s say you accidentally cut your hand while cooking. You head to the emergency room for treatment. After the doctors treat you, you find out you owe the hospital several thousand dollars in medical bills. Your insurance company covers part of the bill when you have health insurance. You must come up with the money yourself if you don’t have health insurance.

Health Insurance Terms to Know

Before diving into how to find affordable health insurance in Pennsylvania, you should know some specific lingo. Here are some of the most important health insurance terms to learn before you look for insurance:

• Premium: Your premium is the amount you pay per month for your health insurance plan. Most premiums are paid monthly.
• Deductible: A deductible is a set amount of money you have to pay out of pocket before your insurance company pays. For example, let’s say your deductible is $3,000 and you receive a treatment that’s $4,000. You pay the first $3,000 out of pocket and your insurance company covers the remaining $1,000.
• Coinsurance: Coinsurance is the amount you pay for a particular service or treatment as a percentage of the cost. You might have a 20% coinsurance for a doctor’s visit. You cover the first 20% of the cost and your health insurance plan pays the last 80%.
• Copayment: A copayment is similar to coinsurance as it represents how much you’ll pay out of pocket for a medical service. Instead of a percentage, a copayment is a fixed price. A regular doctor’s visit might be a $20 copay that’s due at the time of your visit.
• Pharmacy benefits: When you have pharmacy benefits, the insurance plan covers a range of medications — up to a point. For the most part, there is a negotiated price you will pay and the insurance company covers the rest. Keep in mind, however, that certain plans only allow certain types or brands of medications in some cases. At the same time, these plans might place restrictions on how medications are dispensed, requiring prior authorization to be approved by the provider and passed on to the carrier. 
• Provider network: A provider network is a group of doctors and healthcare facilities that contract with your insurance company. It’s almost always cheaper to visit a doctor that’s in the network. Some plans require you to visit an in-network doctor for the insurance company to cover the visit.
• Out-of-pocket maximum: The out-of-pocket maximum is the maximum amount of covered services you have to pay for in a given time, usually a year. Premium payments don’t count toward your out-of-pocket maximum. Some plans do count copayments and coinsurance toward the maximum, so make sure to check with the insurance company.

Average Cost of Health Insurance in Pennsylvania

Before you consider the cost of insurance, it’s important to know how to get health insurance. You’ll generally get health insurance as a benefit of your employment or when you purchase an individual plan. The plan you land on ultimately affects your health insurance costs.

Many employers offer group insurance plans to employees. A group, or employer, health insurance plan helps cut the cost of insurance for employees. Your employer pays for most of the premium. Your portion of the premium is usually taken out of your paycheck.

You’ll probably need an individual health insurance plan if you’re self-employed or if your employer doesn’t offer insurance benefits.

The average price for an employer health insurance plan in Pennsylvania is $6,769 annually — about $564 per month. The average cost for employers is $5,418 annually or around $451 per month. Employees can expect to pay $1,351 per year for health insurance on average or about $112 monthly.

Individual health insurance plans in Pennsylvania cost $459 on average per month. You’ll probably pay about $5,500 annually for health insurance in Pennsylvania if you need an individual plan.

Health Insurance Costs in Pennsylvania: Factors to Know

Three factors affect your cost of health insurance:

• Age
• Location
• Use of tobacco

The more likely you are to need expensive treatments and medical services, the higher the risk you pose to an insurance company. As you age, you’re more likely to experience health issues, so your insurance premiums tend to increase the older you get.

Premiums are also higher if you use tobacco products. Smoking and other tobacco products are known to cause serious health risks. Insurance companies often charge tobacco users a higher rate to account for this risk.

You’re not likely to find discounts for health insurance like you would for other types of insurance. For example, you might get a discount on your car insurance if you’re a good driver. To decrease your health insurance costs in Pennsylvania, you can:

• Get a catastrophic plan: These plans are available if you’re under 30 years old. They are designed to cover medical emergencies, such as an accident that leaves you with thousands of dollars of medical bills. You’ll need to meet a high deductible and pay for most services out of pocket, but you’ll pay less in monthly premiums.
• Quit smoking: You can reduce your health insurance risk and your costs by quitting tobacco products.
• Choose a higher deductible: Even if you don’t qualify for a catastrophic plan, you can choose a plan with a higher deductible. High-deductible plans often have lower monthly premiums.
• Visit in-network doctors: Going to a doctor in your provider network could save you a lot of money on out-of-pocket health expenses.

Types of Health Coverage

You’ll need to choose the type of plan you want when you sign up for health insurance in Pennsylvania. Two main types of plans you’ll see are the health maintenance organization (HMO) and preferred provider organization (PPO) plans. Both health insurance plan types use a provider network to help you save on medical costs.

• HMO: HMO plans require you to choose a primary care provider from the provider network. This is the doctor or healthcare facility you’ll visit each time you need to see the doctor. You’ll need a referral from your primary doctor to see a specialist. HMO plans are usually cheaper than PPO plans. When you see the doctor, you’ll make a copayment for services and your insurance pays for the rest. Let’s say you visit a doctor outside of the provider network — you’ll pay the full amount out of pocket.
• PPO: PPO plans are more flexible than HMO plans. You don’t usually need to choose a primary care provider and can visit a specialist without a referral. You can also visit any doctor, even those outside the network, and still receive insurance benefits. Expect to pay a little more for an out-of-network provider than if you went to an in-network doctor.

What Does Health Insurance Cover?

The specific insurance plan you choose determines what treatments and services are covered. If you have questions, you should contact a representative of the insurance company.

Health insurance must provide coverage for certain services. The Affordable Care Act (ACA) requires insurance companies to cover these 10 essential benefits:

• Prescription drugs
• Laboratory services
• Emergency services
• Outpatient care at a hospital
• Preventive and wellness services
• Hospitalization like overnight stays
• Pregnancy, maternity and newborn care
• Mental health and substance use disorder care
• Pediatric services, including dental and vision coverage for children
• Rehabilitative or habilitative devices and services

What Does Health Insurance Not Cover? 

Health insurance plans vary widely on what is and isn’t covered. Check for exclusions to coverage for any services or treatments you need or think you might need. Most health insurance plans don’t cover treatments that are cosmetic or experimental or that aren’t medically necessary. This means a new treatment for a chronic condition may not have coverage until it’s proven to work.

Services usually not covered by health insurance include:

• Cosmetic surgery
• Some fertility treatments
• Over-the-counter medications
• Weight loss surgery or programs
• Alternative care, like acupuncture

Find Health Insurance in Pennsylvania Today

Remember, the lowest monthly premium plan isn’t always the least expensive. If you plan to visit the doctor often, a higher premium with a lower deductible may be the right fit for you. Start looking for the best health insurance in PA — gather and compare a few quotes today.

Frequently Asked Questions