Pennsylvania is a state filled with rich history and diverse terrain. It is also home to the 23rd best health care in the country when it comes to access, quality, and good public health.
Health insurance options in Pennsylvania
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do most Pennsylvanians get their health insurance coverage?
|Individual or family||5%|
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population|
Six percent of Pennsylvanians are uninsured, putting the State of Independence ahead of the national average. This is good news for policyholders because the more uninsured residents, the higher policy prices are for people who have insurance.
Pennsylvania health insurance companies
Pennsylvania residents have several options when it comes to choosing a health care provider. Here are the companies that offer individual and family plans in the state:
- Capital BlueCross
- UMPC Health Plan
Exchange and non-exchange plans are offered by these companies. Check provider websites to find out how your specific location can impact coverage.
Pennsylvania health insurance costs and rate factors
Pennsylvania residents spend an average of $9,258 on health care expenditures every year, more than the national average. What determines your insurance price tag? Health care costs depend heavily on individuals, mainly based on these factors:
The health insurance marketplace sorts coverage into metal tiers: bronze, silver, gold, and platinum. For more coverage, you'll need to pay more in monthly premiums.
These are the average monthly premiums for a middle-aged Pennsylvania resident in 2020:
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier|
A gold plan costs nearly 38 percent more than a bronze plan. The price jumps because gold plans cover 80 percent of medical costs, whereas bronze plans only cover 60 percent.
You may qualify for a catastrophic plan, which is the lowest level of coverage. Catastrophic plans come with low monthly premiums but a $8,150 deductible. Investing in a higher-tier plan may save you money if you need to use your health insurance.
Body mass index
According to the CDC, a higher BMI often leads to serious health conditions. Health insurance providers will often look at your BMI to analyze your risk level. A high BMI usually leads to paying more in health insurance costs.
In 2018, Pennsylvania had a 30.9 percent obesity rate, the 25th highest in the country. Out of the many PA residents who used QuoteWizard to compare health insurance plans, 32 percent have a BMI in the obese range.
It should come as no surprise that smoking causes a number of serious health issues. Because of these substantial risks, smokers tend to pay more for health insurance. About 18.7 percent of Pennsylvania residents smoke, the 34th lowest rate in the country when it comes to tobacco use.
According to HealthCare.gov, older people can pay up to three times more than younger people for health insurance. PA residents who used QuoteWizard to shop for health insurance are, on average, 42 years old.
How does location impact health care costs? Each state has different laws and regulations surrounding health insurance, as well as different insurance providers to choose from within the marketplace.
Also, most insurance costs are community rated. Your rates are dependent on the people around you. This means that the more claims your neighbor files, the more your insurance will cost you.
Living in a healthier area can lead to lower insurance premiums. America's Health Rankings put Pennsylvania as the 28th healthiest state in the US.
Pennsylvania health insurance laws
After the enactment of the Affordable Care Act, the factors insurance companies could consider while pricing policies changed drastically. Here's what they can't consider:
- Pre-existing conditions: Before the ACA, insurance companies were able to charge higher rates to people with pre-existing conditions. Now, the ACA mandates that insurance companies can't charge higher rates to people with pre-existing conditions.
- Gender: According to a study by Health Services Research, women historically pay more for health care. But the ACA doesn't allow insurance companies to charge women and men different rates for the same plan.
- Insurance and medical history: Insurance companies can't analyze your medical history and past insurance coverage. People with lapses in insurance or with past medical problems would encounter high premiums or not be able to get insurance at all.
Insurance marketplace plans have out-of-pocket maximums. The 2018 out-of-pocket maximum is $16,300 for a family plan and $8,150 for an individual plan.
Pennsylvania law requires health insurance companies to provide some coverage for the following:
- Maternity minimum stay
- Serious mental illness- inpatient and outpatient services
- Autism spectrum disorders
- Diabetic orthotics and mastectomy prosthetics
- Childhood immunization
- Mammographic examinations
- Diabetic supplies and education
There are more services that providers are required to offer at least some coverage for. Check out the full list of state-required benefits here.
Medicare and Medicaid in Pennsylvania
Medicare and Medicaid are government-funded health care programs that offer coverage to two different groups of people. Medicare assists senior citizens, whereas Medicaid helps low-income families and children gain access to health care coverage.
Medicare is available to people 65 years and older. In Pennsylvania and across the country, seniors can choose from numerous coverage options. These include types A, B, C, D, and other supplemental coverage plans. Pennsylvania Medicare also offers a Medicare Savings Program, which has multiple categories you may qualify for:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
The Pennsylvania Medicaid Program offers coverage to low-income families and children. These are the state's Medicaid financial requirements:
|Household Size||Maximum Yearly Income|
Pennsylvania Office of the Insurance Commissioner
- Insurance Commissioner:
- Jessica K. Altman
- Insurance Hotline:
- (877) 881 – 6388
- Office Hours:
- Monday - Friday
8:30 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
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