Pennsylvania Health Insurance Guide

From scenic mountains and rolling farmland to vibrant urban centers like Philadelphia and Pittsburgh, Pennsylvania remains a desirable place to live — and understanding your health insurance options here is key to protecting your health and finances.

As of 2025, the uninsured rate in Pennsylvania reflects steady enrollment and efforts to expand access. If you’re currently without coverage, here’s what you need to know about getting insured in Pennsylvania.

Health Insurance Options in Pennsylvania

Pennsylvania offers a range of health insurance options tailored to residents’ needs, depending on age, income, employment, and family size. Here are the most common coverage types available:

Employer-Sponsored Insurance

Many people in Pennsylvania receive health insurance through their employer. If your workplace offers coverage, this is usually the most cost-effective and convenient option.

ACA Marketplace Plans

The Affordable Care Act (ACA) allows individuals and families to buy health insurance through state or federal Marketplaces. These plans offer essential health benefits, free preventive care, and protection for preexisting conditions.

If you don’t have employer coverage, you may qualify for subsidies to lower your premiums. Use our ACA Subsidy Calculator to check your eligibility.

Starting this year, the Centers for Medicare & Medicaid Services (CMS) is requiring income verification to confirm eligibility for premium subsidies. As part of this effort, CMS will reduce the ACA subsidies by $5 per month for individuals who are automatically re-enrolled in fully subsidized plans without verified eligibility.

ACA Plan Types

ACA marketplace plans are available in four tiers: Bronze, Silver, Gold, and Platinum, each with distinct coverage levels. Plans also vary by provider networks and out-of-pocket expenses, so compare carefully to find what fits your needs.

Marketplace Plans:

• Bronze: Low monthly premiums, higher out-of-pocket costs; ideal for minimal healthcare usage.
• Silver: Moderate costs; eligible for cost-sharing reductions (CSRs).
• Gold: Higher monthly premiums with lower out-of-pocket costs; best for frequent healthcare users.
• Platinum (if available): Highest premiums, lowest out-of-pocket costs.

Metal Tier Breakdown:

Medicaid

Pennsylvania Medicaid, also known as Medical Assistance, provides free or low-cost coverage for eligible low-income residents. Medicaid plan benefits typically include preventive care, hospital visits, mental health services, prescriptions, and more.

Short-Term Plans

Short-term medical (STM) plans offer temporary health coverage and can be a practical solution for individuals who are between jobs, recently lost employer coverage, waiting for ACA or Medicare eligibility, or need affordable protection during a coverage gap.

STM plans are available in Pennsylvania and follow federal rules, but they are not regulated by the ACA. That means they can deny coverage based on pre-existing conditions and typically do not include comprehensive benefits like maternity, mental health, or preventive care.

While short-term medical plans are not a substitute for long-term health insurance, they may be ideal in situations where you’re temporarily uninsured and want protection from unexpected medical events.

STM Plan Enrollment

Unlike ACA-compliant plans, short-term health plans are available year-round.

Quick Coverage Start: Many short-term plans can begin as soon as the next day after your application is approved.

Children’s Health Insurance Program (CHIP)

Known as CHIP in Pennsylvania, this program helps children and pregnant women in families that earn too much for Medicaid but need affordable insurance.

Student Health Insurance

College students in any state have multiple health insurance options, including staying on a parent’s plan until age 26, enrolling in a school-sponsored plan, or applying for coverage through the ACA Marketplace. Depending on your income and location, you may also qualify for Medicaid, CHIP, or low-cost catastrophic or short-term plans—making Pennsylvania student health insurance accessible and flexible for a wide range of needs.

Medicare

Medicare plans are available for residents aged 65+ and younger individuals with qualifying disabilities.

• Medicare Advantage (Part C)
  • Medicare Advantage is an alternative to Original Medicare offered by private insurers to those enrolled in Parts A and B. These plans often include extra benefits and cost protections but typically require using a specific network of providers.
• Prescription Drug Plans (Part D)
  • Medicare Part D provides prescription drug coverage for anyone with Medicare, helping pay for medications and many vaccines. Offered by private insurers, these plans vary in cost and coverage and can be joined during specific enrollment periods.
• Medicare Supplement (Medigap)
  • Medicare Supplement plans, or Medigap policies, help cover the out-of-pocket costs that Medicare Part A and Part B don’t pay. Since Original Medicare (Parts A and B) lacks an out-of-pocket maximum, these plans can limit your expenses for medical services.

COBRA Coverage

If you’ve recently lost job-based insurance, COBRA allows you to continue your employer coverage temporarily—typically at full cost.

Enrollment Periods in Pennsylvania

Open Enrollment for 2026 Coverage:

November 1, 2025 – January 15, 2026

During this window, all eligible residents can apply for, renew, or change their marketplace health plans.

Special Enrollment Period:

Available year-round for those experiencing qualifying life events, such as:

• Loss of coverage
• Marriage or divorce
• Birth or adoption of a child
• Relocation
• Major change in income

You typically have 60 days from the event to enroll.

Health Insurance Providers in Pennsylvania

As of 2025, these insurers typically offer individual and family plans through the Pennie state exchange:

• UPMC Health Plan
• Independence Blue Cross
• Geisinger Health Plan
• Highmark Blue Shield
• Oscar Health

Plan availability may vary by county or zip code.

Understanding Health Insurance Costs

When selecting a plan, be sure to understand these common cost terms:

• Premium: Monthly payment to maintain your plan.
• Deductible: What you pay before insurance covers services.
• Copayment (Copay): Fixed amount per visit/service.
• Coinsurance: Shared costs with your insurer after the deductible.
• Out-of-Pocket Maximum: Your yearly cost cap for covered services.
• In-Network vs. Out-of-Network: Staying in-network helps you avoid higher charges.

This helpful glossary breaks down common terms so you can make confident coverage decisions.

Bottom Line

Health insurance in Pennsylvania comes with many choices—whether from your employer, through the ACA marketplace, or public programs like Medicaid and Medicare. By staying informed and comparing plans during the right enrollment periods, you can secure affordable, reliable coverage that supports your well-being and budget.

Need help choosing a plan? Use our ACA Subsidy Calculator to see if you are eligible for ACA plan financial aid or speak with a licensed insurance agent about all your options.