BestHealth InsurancePennsylvaniaBest Pennsylvania Health Insurance (2023 Plans)
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BestHealth InsurancePennsylvaniaBest Health Insurance in Pennsylvania
Best Overall - Oscar
Best for Low MOOP - UnitedHealthcare
Best Cheap - Ambetter
Best for Young Adults - Geisinger Quality Options, Inc.
Best for HMO - Oscar
Best for PPO - Blue Cross Blue Shield
Best for EPO - Blue Cross Blue Shield
Best Overall for Health Insurance in Pennsylvania
The best overall health insurance company in Pennsylvania is Oscar, which earned a MoneyGeek score of 62 out of 100. This insurer offers affordable premiums and better-than-average claims acceptance.
We evaluated Silver health plans in Pennsylvania, which include 432 HMO, 876 EPO and 488 PPO plans.
pros
Approves most policyholder claims
Has the third-cheapest average premiums in our comparison group
cons
Only offers HMO plans
Has relatively high maximum out-of-pocket (MOOP) costs
COMPANY HIGHLIGHTS
Oscar is our pick for the best overall health insurer in Pennsylvania, offering six Silver HMO plans in the state. The company charges an average monthly premium of $483 and has an average MOOP of $8,279.
In addition, Oscar has a low claims denial score, indicating a high likelihood of claims being accepted and processed successfully. Policyholders can be confident that very few, if any, of their valid claims will be denied if they choose Oscar as their health insurance provider.
Plan Recommendations
Based on our research, MoneyGeek recommends the following plans from Oscar:
- Silver Simple - HSA: $474 per month, MOOP of $4,850
- Silver Simple - PCP Saver: $471 per month, MOOP of $8,900
- Silver Classic - Standard: $472 per month, MOOP of $8,900
Best Health Insurance in Pennsylvania for Low Out-of-Pocket Costs
For those who value low out-of-pocket costs, UnitedHealthcare is the best health insurance provider in Pennsylvania, receiving a MoneyGeek score of 68 out of 100. Aside from having the lowest MOOP cost, this insurer also offers affordable premiums and different plan types.
We rated Gold and Platinum plans in this category, evaluating 542 HMOs, 290 EPOs and 328 PPOs.
pros
Has the lowest average MOOP cost
Third-cheapest provider out of seven insurers
Offers PPO plans
cons
Denies more claims than most competitors
COMPANY HIGHLIGHTS
UnitedHealthcare is the best health insurance company in Pennsylvania if you’re looking for low out-of-pocket expenses. This company provides Gold health plans at an average of $446 per month, with an average MOOP of $5,639 — the lowest among seven insurers in our study.
Additionally, UnitedHealthcare offers different plan types to customers, including PPO plans. This plan type is the most flexible, allowing you to pay less for in-network services and more for covered out-of-network services. In addition, you don't need a referral from your primary care doctor to see a specialist.
It’s worth noting that UnitedHealthcare has a higher claims denial rate than most competitors. The company offers 30 EPOs and 57 PPOs in the Gold tier.
Plan Recommendations
Consider this plan from UnitedHealthcare for low out-of-pocket costs:
- UPMC Advantage Gold HSA $3,000/$0 - Partner Network: $309 per month, MOOP of $3,500
Best Cheap Health Insurance in Pennsylvania
Out of the nine Pennsylvania insurers we reviewed, Ambetter came out on top as the best cheap health insurance provider in the state, earning a MoneyGeek score of 74 out of 100.
For this category, MoneyGeek weighted plans with low monthly premiums more to determine the winner. We rated Silver Plans in Pennsylvania, including 876 HMOs, 432 EPOs and 488 PPOs.
Plans with lower premiums can help you save on your monthly expenses, but they usually come with higher out-of-pocket costs when you require medical care.
If you're focused soley on cost, MoneyGeek also determined the cheapest health insurance in Pennsylvania.
pros
Offers the cheapest premiums in our comparison group
Has relatively low MOOP costs
cons
More likely to deny claims than competitors
Plan offerings limited to HMOs
COMPANY HIGHLIGHTS
Ambetter provides the cheapest average monthly premiums of all the insurers we evaluated at $439 per month. In addition, it has the lowest average MOOP costs ($7,133), meaning that policyholders don't necessarily need to make a trade-off in order to get lower monthly costs.
However, Ambetter has a higher claims denial rate than other insurers — the company denies over a third of all claims. In addition, Ambetter only offers HMO plans, which tend to be the cheapest but are also the most restrictive. The provider has 468 Silver HMO plans available in the Pennsylvania marketplace.
Plan Recommendations
MoneyGeek recommends the following cheap plan from Ambetter:
- Clear Silver: $420 per month, MOOP of $5,400
Best Health Insurance for Young Adults in Pennsylvania
Geisinger Quality Options, Inc. emerged as the best health insurance provider for young adults in Pennsylvania, earning a MoneyGeek score of 80 out of 100.
Our analysis for this category focused on health insurance providers offering Bronze, Expanded Bronze and Catastrophic plans, which typically have lower monthly premiums but higher out-of-pocket costs. Catastrophic plans cater specifically to individuals under 30 or those who qualify for a hardship exemption.
We rated a total of 580 HMO, 225 EPO and 286 PPO plans in the Bronze metal tier, as well as 8 HMO, 23 EPO, 11 POS and 28 PPO plans in the Catastrophic tier.
pros
Rarely denies claims
Has lower MOOP costs than competitors
Offers PPO plans
cons
Has relatively expensive monthly premiums
COMPANY HIGHLIGHTS
Geisinger Quality Options, Inc. is the top health insurance provider for young adults in Pennsylvania, earning a MoneyGeek score of 80 out of 100. The average cost of Bronze and Catastrophic plans from this insurer is $358 per month, with an average MOOP of $7,700.
The provider offers 58 PPO Bronze plans in Pennsylvania. PPO plans tend to be the most expensive plan type, but they offer the most coverage and flexibility. PPO plans allow policyholders to seek out-of-network care, although out-of-network services will incur higher out-of-pocket costs than in-network care. In addition, these plans don't require referrals for specialist visits.
This company also has a very low claims denial rate, meaning that policyholders can rest assured that nearly all valid claims are approved by the insurer.
Plan Recommendations
For young adults in Pennsylvania, MoneyGeek recommends the following plan:
- Geisinger Marketplace All-Access QHDHP PPO 6850 - HSA Eligible: $364 per month for 26-year-olds and $334 per month for 18-year-olds, MOOP of $6,850
Best Health Insurance by Plan Type in Pennsylvania
Health insurance providers typically offer a range of plan types with different coverage, cost-sharing and network options.
Based on our analysis of health insurance plans in Pennsylvania, Oscar is the best insurance provider for HMO plans, while Blue Cross Blue Shield is best for EPO and PPO plans in the state.
Our recommendations are limited to Silver plans, which generally offer a good balance between premiums and out-of-pocket costs. We evaluated 876 HMO plans, 432 EPO plans and 488 PPO plans in the Silver tier.
Best for HMO: Oscar
COMPANY HIGHLIGHTS
In Pennsylvania, MoneyGeek has selected Oscar as the top HMO plan provider. The company offers six HMO plans in the state, with an average monthly premium of $483 per month and average MOOP costs of $8,279. HMO plans tend to be the cheapest, but they have the most restrictive networks, so you need to be sure that the health care providers you'd like to see are in network. Oscar also has an excellent claims management reputation, indicating that it efficiently processes the majority of coverage requests.
Plan Recommendations
MoneyGeek recommends the following Silver plans from Oscar:
- Silver Simple HSA: $474 per month, MOOP of $4,850
- Silver Simple - PCP Saver: $471 per month, MOOP of $8,900
Best for PPO: Blue Cross Blue Shield
COMPANY HIGHLIGHTS
Blue Cross Blue Shield is the best PPO provider in Pennsylvania, offering 272 Silver PPO plans at an average of $611 per month with an average MOOP of $8,336. PPO plans offer the broadest coverage, allowing for out-of-network care at an additional cost. In addition, they don't require a referral for specialist visits. However, they tend to be more expensive than other plan types. Blue Cross Blue Shield denies more claims than other insurers, which is a factor worth considering when shopping for PPO coverage.
Plan Recommendations
If you’re looking for PPO plans in Pennsylvania, we recommend these plans from Blue Cross Blue Shield:
- my Priority Blue Flex PPO Premier Silver 2900: $562 per month, MOOP of $7,800
- my Priority Blue Flex PPO Premier Silver 2900 + Adult Dental and Vision: $592 per month, MOOP of $7,800
Best for EPO: Blue Cross Blue Shield
COMPANY HIGHLIGHTS
Blue Cross Blue Shield is an excellent best choice for EPO plans in Pennsylvania, providing 252 Silver plans. Its EPO plans cost an average of $512 per month with an average MOOP of $8,300. EPO plans are generally more affordable than PPOs but do not offer out-of-network coverage. However, they generally do not require a referral from your primary care provider to see a specialist. Blue Cross Blue Shield has a claims denial rate of 17.85%, which is relatively high and indicates that it is more likely than some competitors to deny claims.
Plan Recommendations
Consider the following EPO plans from Blue Cross Blue Shield:
- Together Blue EPO Premier Silver 2900: $380 per month, MOOP of $7,800
- Together Blue EPO Premier Silver 2900 + Adult Dental and Vision: $412 per month, MOOP of $7,800
How to Find the Best Health Insurance for You in Pennsylvania
When it comes to finding the best health insurance plan in Pennsylvania, your health care needs and budget are important factors. You'll need to weigh monthly premiums and out-of-pocket expenses to determine the best balance for you.
Understand when a health insurance plan will cover you
In Pennsylvania, there are several health insurance plan options available, including 1,130 PPO plans, 11 POS plans, 970 EPO plans and 2,006 HMO plans in various metal tiers.
When considering the different plan types, it's important to keep in mind that some provide broader out-of-network coverage than others. HMO and EPO plans both require policyholders to receive care from in-network providers, with HMO plans typically having the most restricted networks. Meanwhile, PPO and POS plans offer greater flexibility and allow for out-of-network care at an additional cost.
Weigh the cost of premiums vs. the cost of care
Opting for plans with lower premiums can help you save on a monthly basis, but these plans often come with higher out-of-pocket costs, which means you'll pay more when you need medical care. In Pennsylvania, for instance, the Silver Classic- Standard plan from Oscar costs an average of $472 per month and has a MOOP of $8,900. On the other hand, Oscar's Gold Elite- $0 Ded plan has an average monthly premium of $505 and an average MOOP of $8,700.
Consider Pennsylvania Medicare or Medicaid if You’re Eligible
Pennsylvania residents who are 65 or older or have a qualifying disability or illness may be eligible for Medicare.
Medicare is a government program that provides assistance for specific medical services, but there may still be some out-of-pocket costs. The program covers the following services:
- Part A: Covers hospital-related services like inpatient care, skilled nursing facility care and some home health care services.
- Part B: Covers doctor's services, outpatient care and medical and preventive services.
- Part D: Helps with the cost of prescription drugs and recommended vaccines.
Medicaid, on the other hand, is a no-cost option for Pennsylvania residents who meet the program's income requirements. If your income is below 138% of the Federal Poverty Level, you may qualify for Medicaid coverage in Pennsylvania.
Frequently Asked Questions About Health Insurance in Pennsylvania
MoneyGeek answered some commonly asked questions to help you in your search for the best Pennsylvania health insurance plan for you.
About Mark Fitzpatrick
