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Pennsylvania Health Insurance Consumer Guide
This guide was developed to help you choose the right health insurance plan for you and your family. The options found in Pennsylvania’s ACA Marketplace may be a good choice for many consumers, and we will guide you through the options below.
Pennsylvania uses a fully state-run health insurance Marketplace known as Pennie to enroll its residents in ACA Marketplace plans. The Marketplace provides access to health insurance products from private insurers.
Depending on your income and other circumstances, Marketplace enrollees may also get help to lower their monthly insurance premium (the amount you pay to enroll in the coverage) and possibly out-of-pocket expenses.
Explore our other comprehensive guides to coverage in Pennsylvania
Dental coverage in Pennsylvania
In 2023, seven insurers offer stand-alone individual/family dental coverage through the health insurance Marketplace in Pennsylvania.1
Pennsylvania’s Medicaid program
Medicaid expansion in Pennsylvania took effect in January 2015. As of 2023, more than 3.4 million people were enrolled in Pennsylvania’s expanded Medicaid.2
Medicare coverage and enrollment in Pennsylvania
Medicare enrollment in Pennsylvania stood at 2,875,916 people as of May 2023.3 Our guide explains everything you need to know about Medicare and Medigap plans in Pennsylvania.
Short-term coverage in Pennsylvania
As of 2023, at least one insurer was selling short-term health insurance plans in Pennsylvania.4
Frequently asked questions about health insurance in Pennsylvania
Who can buy Marketplace health insurance?
To qualify for health coverage through the Marketplace in Pennsylvania, you must:
- Live in Pennsylvania
- Be lawfully present in the United States
- Not be incarcerated.
- Not be enrolled in Medicare
Eligibility for financial assistance in the form of premium subsidies and cost-sharing reductions depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area – which depends on your age and location. In addition, to qualify for financial assistance with your Marketplace plan you must:
- Not have access to affordable health coverage through your employer. If your employer offers coverage but you feel it’s too expensive, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies in the Marketplace.
- Not be eligible for Medicaid or CHIP.
When can I enroll in an ACA-compliant plan in Pennsylvania?
In Pennsylvania the open enrollment period for individual and family coverage runs from November 1 to January 15 .5
Your coverage starts on January 1 if you enroll before December 15. But if you apply between December 16 and January 15, your coverage will begin on February 1.5
Outside of open enrollment, you’ll need a special enrollment period (SEP) to enroll or make changes to your coverage.
How do I enroll in a Pennsylvania Marketplace plan?
To enroll in an ACA Marketplace plan in Pennsylvania, you can:
- Visit Pennie to enroll in Pennsylvania’s Marketplace. Here you will find an online platform to shop, compare plans and determine your subsidy eligibility.
- Purchase individual and family health coverage with the help of an insurance agent or broker, a Navigator or certified application counselor, or an approved enhanced direct enrollment entity.6
How can I find affordable health insurance in Pennsylvania?
You may find affordable health insurance options in Pennsylvania by utilizing the state’s health insurance exchange – Pennie. Here, residents can enroll in health coverage as well as determine their eligibility for financial assistance.
As of early 2023, nearly nine out of ten eligible enrollees on Pennie saved money on their premium payments amounting to an average savings of $523/month. With subsidies, enrollees paid an average of $140 per month for health coverage.7
The Affordable Care Act provides income-based advance premium tax credits (subsidies) that offset your premium payments to help keep your expenses down. People with household incomes below 250%of the federal poverty level also qualify for cost-sharing reductions (CSR) that may reduce your deductibles and out-of-pocket expenses when you buy a Silver plan. Between the premium subsidies and cost-sharing reductions, you may find that an ACA plan is the cheapest health insurance option for you.
How many insurers offer Marketplace coverage in Pennsylvania?
The following insurers offer plans through Pennie for 2023, with varying coverage areas:8
- Capital Advantage Assurance
- Geisinger Health Plan
- Geisinger Quality Options
- Highmark, Inc.
- Highmark Benefits Group
- Highmark Coverage Advantage
- Keystone Health Plan East (Independence Blue Cross HMO)
- QCC Insurance Company (Independence Blue Cross PPO)
- UPMC Health Coverage
- UPMC Health Options
- PA Health and Wellness
- Oscar Health
Are Marketplace health insurance premiums increasing in Pennsylvania?
Insurance providers in Pennsylvania’s individual market have, in most cases, proposed higher average rates for 2024:8
Pennsylvania’s ACA Marketplace Plan 2024 Proposed Rate Increases by Insurance Company
|Capital Advantage Assurance||7.04%|
|Geisinger Health Plan||7.30%|
|Geisinger Quality Options||7.07%|
|Highmark, Inc. (EPO and PPO)||10.12%|
|Highmark Benefits Group||13.21%|
|Highmark Coverage Advantage||9.88%|
|Keystone Health Plan East (Independence Blue Cross HMO)||–3.45%|
|Keystone Health Plan Central||–0.79%|
|QCC Insurance Company (Independence Blue Cross PPO)||–2.68%|
|UPMC Health Coverage||7.80%|
|UPMC Health Options||6.37%|
|PA Health and Wellness||7.52%|
How many people are insured through Pennsylvania’s Marketplace?
What health insurance resources are available to Pennsylvania residents?
The official Pennsylvania health coverage Marketplace.
State Exchange Profile: Pennsylvania
The Henry J. Kaiser Family Foundation overview of Pennsylvania’s progress toward creating a state health insurance exchange.
Health Care Matters, Pennsylvania Office of the Attorney General
Serves Pennsylvania consumers with health-related problems.
(717) 705-6938 / Toll-free: 1-877-888-4877 (only in Pennsylvania)
Pennsylvania Consumer Assistance Program
Assists people with private insurance, Medicaid, or other insurance with resolving problems pertaining to their health coverage; assists uninsured residents with access to care.
(877) 881-6388 / [email protected]
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.Footnotes
- “Pennsylvania dental insurance guide 2023” healthinsurance.org, Accessed September 2023
- “April 2023 Medicaid & CHIP Enrollment Data Highlights” Medicaid.gov, April 28, 2023
- “Medicare Monthly Enrollment” CMS.gov, May 2023.
- “Availability of short-term health insurance in Pennsylvania” healthinsurance.org, Sept. 5, 2022
- “When can you get health insurance?” HealthCare.gov, 2023
- “Entities Approved to Use Enhanced Direct Enrollment” CMS.gov, April 28, 2023
- “2023 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2023
- “Pennsylvania Rate Review Submissions” HealthCare.gov, Accessed August 2023
- “ASPE Issue Brief (2014)” ASPE, 2015
- “Health Insurance Marketplaces 2015 Open Enrollment Period: March Enrollment Report”, HHS.gov, 2015
- “HEALTH INSURANCE MARKETPLACES 2016 OPEN ENROLLMENT PERIOD: FINAL ENROLLMENT REPORT” HHS.gov, 2016
- “2017 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2017
- “2018 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2018
- “2019 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2019
- “2020 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2020
- “2021 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2021
- “2022 Marketplace Open Enrollment Period Public Use Files” CMS.gov, 2022