Best Health Insurance Plans in Pennsylvania

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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 Care Choices in Pennsylvania

According to the Pennsylvania Insurance Department, state residents can get health care coverage through multiple avenues:

  1. Employer-provided
    1. From your employer
    2. Through your spouse's employer
    3. Through COBRA
  2. Individual or family plans
    1. Through HealthCare.gov
    2. Directly from a health insurance company
  3. Government-assisted
    1. Medicare
    2. Medicaid

Where do most Pennsylvanians get their health insurance coverage?

Pennsylvania Health Insurance Sources
Sources Percent
Employer-Provided 53%
Individual or family 6%
Medicaid 19%
Medicare 16%
Other Public Care 1%
Uninsured 5%
Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population

Five 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 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:

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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 2017, Pennsylvania had a 30.3 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.

Tobacco Use

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 percent of Pennsylvania residents smoke, the 19th highest rate in the country when it comes to tobacco use.

Age

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.

Plan Type

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 2018:

Pennsylvania Martketplace Plan Rates
Bronze Silver Gold
$365 $494 $503
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 $7,150 deductible. Investing in a higher-tier plan may save you money if you need to use your health insurance.

Location

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 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:

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 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:

Insurance marketplace plans have out-of-pocket maximums. The 2018 out-of-pocket maximum is $14,700 for a family plan and $7,350 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
  • Chemotherapy
  • 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

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:

Qualified Medicare Beneficiary (QMB)

  • Single person with a monthly income lower than $1,032.
  • Couple with a monthly income lower than $1,392.

Specified Low-Income Medicare Beneficiary Program (SLMB)

  • Single person with a monthly income between $1,032 and $1,234.
  • Couple with a monthly income between $1,392 and $1,666.

Qualifying Individuals Group 1 (QI-1)

  • Single person with a monthly income between $1,234 and $1,386.
  • Couple with a monthly income between $1,666 and $1,872.

Medicaid

The Pennsylvania Medicaid Program offers coverage to low-income families and children. These are the state's Medicaid financial requirements:

Pennsylvania Medicaid Financial Requirements
Household Size Maximum Yearly Income
1 $16,040
2 $21,599
3 $27,159
4 $32,718
5 $38,277
6 $43,837
7 $49,396
8 $54,956

Pennsylvania Office of the Insurance Commissioner

Website:
Homepage
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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