The Cheapest Pennsylvania Health Insurance for Individuals and Families
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If you don’t qualify for health insurance from the government or your employer, you can refer to the Pennsylvania insurance exchange for private plans.
When browsing for a health insurance plan in the exchange, keep in mind that you should find a plan that offers the best medical coverage suited to your budget. Note that the cheaper the plan’s premium is per month, the less medical coverage it offers. This means you will have to shoulder more of your medical costs, as more affordable plans tend to have higher deductibles and out-of-pocket costs.
MoneyGeek identified the cheapest plans listed in Pennsylvania’s insurance exchange based on age and different plan types to help you find suitable coverage.
The Cheapest Health Insurance in Pennsylvania by Metal Tier
Health insurance plans are categorized in different metal tiers to differentiate them based on their medical coverage, monthly premiums, deductibles and out-of-pocket costs. The metal tiers offered in Pennsylvania’s insurance exchange are Bronze, Silver and Gold.
The average monthly costs in Pennsylvania for each tier are:
- Bronze: $355 per month
- Silver: $510 per month
- Gold: $487 per month
Typically, Silver plans are more affordable than Gold policies. In this instance, Gold is cheaper than Silver, as these exceptions can happen in certain markets.
An insurance plan that has the most affordable monthly premium might be the best choice if you’re less likely to require health care — but note that cheaper plans tend to have higher out-of-pocket costs as they offer less coverage. On the other hand, plans with higher monthly premiums tend to have lower out-of-pocket costs as they provide more coverage.
The plans with the cheapest monthly premiums for each metal tier are listed in the table below. In Pennsylvania’s insurance exchange, the premiums, deductibles and out-of-pocket costs may vary within a metal tier.
If you don’t qualify for health insurance from the government or your employer, you can refer to the Pennsylvania insurance exchange for private plans.
When browsing for a health insurance plan in the exchange, keep in mind that you should find a plan that offers the best medical coverage suited to your budget. Note that the cheaper the plan’s premium is per month, the less medical coverage it offers. This means you will have to shoulder more of your medical costs, as more affordable plans tend to have higher deductibles and out-of-pocket costs.
MoneyGeek identified the cheapest plans listed in Pennsylvania’s insurance exchange based on age and different plan types to help you find suitable coverage.
Cheapest Health Insurance in Pennsylvania by Metal Tier
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- Metal TierPlanCompanyMonthly CostOOP Max
- BronzeUPMC Advantage Bronze $6,700/$0 - Partner NetworkUPMC Health Plan$222$8,550
- SilverTogether Blue EPO Silver 3450 HSAHighmark Blue Cross Blue Shield$343$6,900
- GoldTogether Blue EPO Gold 0Highmark Blue Cross Blue Shield$326$7,500
The Cheapest Health Insurance in Pennsylvania by Age and Metal Tier
Age can significantly affect your premiums. Seniors may notice that their premiums may increase as they age — this is because insurers view them as more likely to need medical services. For instance, a 26-year-old will only have to pay an average of $408 per month for a Silver plan, while a 60-year-old will have to pay an average of $1,076 per month. This is a difference of $668, showing the difference created by a 34-year gap in health insurance premiums.
Health Insurance Costs in Pennsylvania by Age and Metal Tier
Low-income individuals may be eligible for cost-sharing reductions (CSR), which can make Silver plans a better, more affordable option. This is because CSRs can lower your deductible.
Rates collected are based on a sample profile of a 40-year-old male for all types of plans available — HMO, EPO and PPO — with an HMO plan being the most common type in Pennsylvania.
Cheapest Health Insurance in Pennsylvania by Age And Metal Tier
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- PlanCompanyMonthly Rate
- BronzeEPOUPMC Health Plan$158
- BronzeEPOUPMC Health Plan$168
- BronzeEPOHighmark Blue Cross Blue Shield$180
- BronzeEPOHighmark Blue Cross Blue Shield$182
- BronzeHMOGeisinger Health Plan$196
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The Cheapest Health Insurance in Pennsylvania by County
The cost of health insurance in Pennsylvania can also vary depending on which county you live in. This is because most states have rating areas, which is a factor that insurers use to calculate your premium.
In Pennsylvania, there are nine rating areas and 67 counties. The most populous county is Philadelphia County. The most affordable plan is the Keystone HMO Silver Proactive Lite by Independence Blue Cross, which costs an average of $447 per month.
Use the table below to browse the cheapest plan in each metal tier for your respective county.
These rates are derived from plans in that county for a 40-year-old male in Pennsylvania.
Cheapest Health Insurance Plans in Pennsylvania by County
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- Metal TierCompanyCheapest PlanMonthly Premium
- ErieBronzeUPMC Health PlanUPMC Advantage Bronze $6,700/$0 - Partner Network$222
- CrawfordBronzeUPMC Health PlanUPMC Advantage Bronze $6,700/$0 - Partner Network$222
- MercerBronzeUPMC Health PlanUPMC Advantage Bronze $6,700/$0 - Partner Network$222
- VenangoBronzeUPMC Health PlanUPMC Advantage Bronze $6,700/$0 - Partner Network$222
- ClarionBronzeUPMC Health PlanUPMC Advantage Bronze $6,700/$0 - Partner Network$222
The Cheapest Health Insurance in Pennsylvania With High Out-of-Pocket Maxes
Pennsylvania residents in good health may opt to get a plan with lower monthly premiums. However, note that you may have to shoulder more of your medical expenses as low-premium plans often come with high deductibles and out-of-pocket maximums.
For those looking for cheap health insurance in Pennsylvania with a high out-of-pocket maximum, the UPMC Advantage Bronze $6,700/$0 - Partner Network plan offered by UPMC Health Plan is the best option. This costs an average of $178 per month for a 26-year-old. MoneyGeek defines a high out-of-pocket maximum as one that reaches $8,250 or higher.
UPMC Health Plan
The UPMC Advantage Bronze $6,700/$0 - Partner Network falls under the Bronze tier, the lowest tier in the state. This means it comes with low monthly premiums but high out-of-pocket expenses and is suitable for those who do not anticipate the need for much medical care.
The Cheapest Health Insurance in Pennsylvania With Low Out-of-Pocket Maximums
Older individuals of Pennsylvania or those who have extensive medical needs should opt for a health insurance plan with low out-of-pocket maximums. This generally translates to having higher monthly premiums but, in turn, your insurance will start covering your costs sooner once you’ve reached your out-of-pocket limit through frequent visits to the clinic or for prescription drugs.
The most affordable health insurance plan in Pennsylvania with a low out-of-pocket max is my Priority Blue Flex EPO Bronze 3800 + Adult Dental and Vision by Highmark Blue Cross Blue Shield which costs an average of $354 per month for a 40-year-old individual.
Note that MoneyGeek defines a low out-of-pocket maximum as one that falls below $4,250. This plan’s out-of-pocket max is $3,800.
Highmark Blue Cross Blue Shield
The my Priority Blue Flex EPO Bronze 3800 + Adult Dental and Vision plan is in the Bronze tier, which means that you get to enjoy lower monthly premiums than plans in the Silver and Gold tier with a low out-of-pocket max. This means that you are likely to hit your limit sooner and get coverage earlier from the insurer.
Cheapest EPO/HMO/PPO Health Insurance Plan in Pennsylvania
To determine the best health insurance plan for you, you need to identify your healthcare needs and preferences. There are three healthcare plan types in Pennsylvania: Exclusive Provider Organization (EPO), Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO).
The most common health insurance plan type in Pennsylvania is the HMO. These plans tend to be more affordable than the other plan types but will require you to stay within your provider's network to have medical coverage except in an emergency. PPOs are the second most common plan type and are usually more expensive, but you have a wider network and would not need a referral to see a specialist. EPOs are the least common plan type in Pennsylvania. Like an HMO, you have to stay within your provider’s network unless it is an emergency, but you don’t need a referral to see a specialist.
The cheapest plans for HMO, EPO and PPO types within Pennsylvania are:
- HMO: The Ambetter Balanced Care 12 (2021) plan by Ambetter from PA Health & Wellness, costing a monthly average of $427 for a 40-year-old.
- PPO: The UPMC Advantage Silver $0/$85 - Premium Network plan by UPMC Health Plan, costing a monthly average of $499 for a 40-year-old.
- EPO: The Together Blue EPO Silver 3450 HSA plan by Highmark Blue Cross Blue Shield, costing a monthly average of $343 for a 40-year-old.
Cheapest Plan in Pennsylvania With an HSA
If you are relatively healthy and you’re less likely to require medical attention, you can opt for a health savings account (HSA). HSA plans cost less and will allow you to give pre-tax contributions to build savings for medical expenses. The significant benefit of having an HSA is that you can also use it for non-medical expenses, but note that it loses its tax-free perk if you do so.
- Bronze: The Together Blue EPO Bronze 6900 HSA by Highmark Blue Cross Blue Shield, costing an average of $255 per month for a 40-year-old.
- Silver: The Together Blue EPO Silver 3450 HSA by Highmark Blue Cross Blue Shield, costing an average of $343 per month for a 40-year-old.
Note that HSA plans have high deductibles. This means that you may have to pay out of your own savings if you have major medical costs.
What to Know About Health Insurance in Pennsylvania
MoneyGeek gathered rates from Pennsylvania’s insurance exchange. Note that you may be able to find cheaper plans when you apply for one, as the insurer will be able to give you a personalized quote that can include discounts you are eligible for. Seniors or low-income residents may be eligible for government health insurance plans such as Medicaid or Medicare.
Private Health Insurance on the Pennsylvania Marketplace
Private health insurance plans in Pennsylvania and other states are classified into different metal tiers, which allows you to select the most suitable plan that meets your needs and preferences. Each of the tiers has its own benefits and tradeoffs.
The metal tiers in Pennsylvania are Bronze, Silver and Gold.
- Bronze: Bronze plans are the most affordable. They are the best choice for individuals who are less likely to seek medical attention but are also looking for an insurance plan that can come in handy in case of an emergency. Note that Bronze plans generally have low monthly premiums but are often paired with higher out-of-pocket maximums.
- Silver: Silver plans are considered the balanced choice as they offer more benefits compared to Bronze but are likely to be cheaper than Gold.
- Gold: Gold plans have the highest average monthly premium but offer the best benefits and medical coverage. This is the best choice for individuals who have high medical expenses.
You may be able to find even more affordable plans with increased coverage than the ones listed by MoneyGeek based on your unique income and age combination. For instance, if your annual income is between 100% and 400% of the federal poverty level, you may be eligible for premium tax credits. For example, a two-person household making between $17,420 and $69,680 may be eligible. To calculate your potential savings based on your own situation, visit the <a href="https://www.healthcare.gov/lower-costs/"target="_blank">HealthCare.gov calculator.
Take note that there is a period of time where you can apply or enroll for a new insurance plan. This is referred to as the “open enrollment” period and typically falls between November and December, but these dates were expanded due to COVID-19. There are instances in which you may receive a special enrollment period if you moved recently or changed your employment status.
If your annual income is between 138% and 250% of the federal poverty level, or between $24,040 and $43,550 for a two-person household, you may be eligible for cost-sharing reductions if you’re buying a Silver plan. These reductions can help decrease your deductibles, copayments and out-of-pocket maximums. It is also possible that you can acquire a Gold plan at a Silver plan rate if you are qualified for these reductions.
Medicaid in Pennsylvania
Medicaid is a state and federal program that can provide medical care for individuals. It’s a free option for those who are eligible. Given how Pennsylvania is a Medicaid expansion state, you can qualify for Medicaid based on income alone if it falls below 138% of the federal poverty level.
Medicare in Pennsylvania
Medicare is a federal government program that offers more affordable health insurance plans than private insurers. It is comparable to Medicaid, although it is not free. Residents of Pennsylvania who are 65 and older or have a disability or illness may be eligible for Medicare.
Medicare breaks down into three parts:
- Part A: Hospital insurance, which covers in-patient hospital stays and stays in a skilled nursing facility, hospice care and some home health care services.
- Part B: Medical insurance, which covers out-patient medical services such as doctor visits and preventive services.
- Part D: Prescription drug coverage, which helps to cover the cost of prescription drugs, including recommended vaccines or shots.
Expert Advice on Cheapest Health Insurance in Pennsylvania
- How do I take advantage of cost-sharing reductions and tax credits for health insurance in Pennsylvania?
- Outside of plans on the health insurance exchange, where else can I get health insurance in Pennsylvania?
Business Management Professor at Point Park University
Methodology
MoneyGeek's research is based on estimates, and the cheapest plan for you will depend on your individual needs and characteristics. This analysis is intended to serve as a guide and no single plan is guaranteed to be the cheapest in Pennsylvania for you
MoneyGeek collected plans and premiums for health insurance in Pennsylvania from the website for Pennie Health Link for all available metal tiers and across several age groups. Plans and premiums were analyzed in May 2021.
Health insurance premiums on this page are an estimate and exclude potential premium tax credits and cost-sharing subsidies that users may be eligible for.
About Mark Fitzpatrick
sources
- Medicare. "What’s Medicare?." Accessed July 21, 2021.