Pennsylvania Health Insurance Consumer Guide

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.

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.

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

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.

Source: CMS.gov⁸

The following insurers offer plans through Pennie for 2023, with varying coverage areas:⁹

• 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
• Cigna

Insurance providers in Pennsylvania’s individual market have, in most cases, proposed higher average rates for 2024:⁹

Source: HealthCare.gov⁹

In the open enrollment period for 2023 coverage, 371,516 people signed up for private plans through the Pennsylvania Marketplace.⁷

Source: 2014,¹⁰ 2015,¹¹ 2016,¹² 2017,¹³ 2018,¹⁴ 2019,¹⁵ 2020,¹⁶ 2021,¹⁷ 2022,¹⁸ 2023,⁷ 2024¹⁹

Pennie
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]