Pennsylvania Health Insurance

Here’s what you need to know about health insurance in Pennslyvania. The Keystone State offers various options for health insurance to fit your budget and health needs. You can qualify for financial help with Marketplace plans or coverage through low-income programs. 

• State Marketplace Plans: Essential health benefits/coverage differs by metal levels
  • Catastrophic Plans: Lower-cost emergency coverage available for those under the age of 30
• Medicaid: State/Federal healthcare program for those with lower income or certain disabilities
• Medicare: Federal healthcare program for those age 65 and older and those with certain disabilities

Explore these different types of major medical health insurance plans in Pennslyvania based on your health needs, budget, as well income, and age eligibility. 

Pennslyvania ACA Marketplace

Pennslyvania offers affordable health insurance for individuals and families through Pennie, the state Marketplace.

NOTE: If you’re self-employed with no employees, you qualify as an individual. 

• Plans are available in four metal levels: bronze, silver, gold, and platinum.
  • Each metal plan covers a percentage of your healthcare costs, from 60% (bronze) to 90% (platinum), with bronze being the least expensive and platinum the most expensive.
  • Catastrophic plans are also available for individuals under the age of 30.
• All plans provide comprehensive coverage, including essential health benefits such as hospitalization, maternity care, prescription drugs, and preventive services.

Open enrollment is from [November 1 to January 15] each year for independent individual and family health insurance plans regulated by the Affordable Care Act (ACA). 

Subsidies For Pennslyvania Health InsuranceACA Plans 

Obamacare (ACA) subsidies are financial aid to help pay for your monthly premiums based on your income and household size, not your employment status. So you can still qualify for savings on an Obamacare plan even if you’re unemployed or in between jobs. You can report your expected income from unemployment benefits when applying for coverage.

• Subsidies are available if the benchmark plan costs more than 8.5% of your income, with no cap on income level. 
• Our ACA subsidy calculator helps you determine your eligibility for healthcare subsidies based on your income, household size, and location. The tool also accounts for special cases like unemployment benefits.”

Catastrophic Health Insurance for Financial Hardship

Catastrophic health insurance is typically for those under 30, but if you’re over 30 and facing financial hardship (e.g., eviction, high medical debt, or bankruptcy), you can qualify for a hardship exemption to purchase a catastrophic plan.

While not as comprehensive as standard Obamacare plans, catastrophic plans include all ACA essential health benefits. 

Plans for Students in Pennslyvania

• College Health Insurance: Enrolling in your school’s health plan is one of the best ways to get low-cost health insurance. Most plans qualify as coverage under the Affordable Care Act (Obamacare), meaning they offer the essential health benefits required.
• Parent’s Health Plan: Under the ACA, you can usually stay on your parent’s health plan until age 26. You can enroll even if you don’t live with your parents, they don’t claim you as a dependent, or you leave school. Coverage typically ends on your 26th birthday.
• Pennsylvania Obamacare Insurance for Students: You can purchase your own Obamacare plan through Pennie. Keep in mind that you must enroll during the Open Enrollment Period unless you qualify for a Special Enrollment Period.

If You Qualify for Low-Income Coverage

Medicaid 

You may qualify for low- or no-cost Medicaid insurance if you have a disability, are 65 or older, pregnant, under 19, a parent or caretaker of a Medicaid-enrolled child, or a childless adult aged 19 to 64. Additionally, residents aged 18 to 26 who were in foster care on or after their 18th birthday are eligible. Income limits for Medicaid in Pennsylvania vary by demographic.

See if you qualify. 

Children’s Health Insurance Program (CHIP)

CHIP is available to low-income children 18 and younger. Depending on your household income, your child may qualify for free or low-cost health insurance through CHIP. For example, your child could get CHIP for free if you earn up to $36,234 for a two-person household in Pennsylvania. 

Pregnant women under 19 can also get coverage through CHIP as well as benefits for the child upon birth.

Medicare

There are several Medicare options available. The default is Original Medicare, which includes Part A (hospital) and Part B (medical) insurance, managed by the federal government. 

Many enrollees add plans sold by private insurance companies, such as Part D (prescription coverage), Medicare Supplement, and Medicare Advantage plans. These plans fill in gaps of coverage that Part A and B don’t cover. 

Short-Term Medical Plans

Short-term health insurance is meant to be temporary until you’re able to get coverage under a traditional plan. It’s available for up to 3 months with a 1-month extension. Unlike plans purchased through the Health Insurance Marketplace, short-term health insurance is not required to include the 10 essential health benefits outlined in the ACA, and it generally doesn’t cover preexisting conditions.

Next Steps

Whether you’re applying for health insurance in Pennslyvania for yourself or a family of four, make sure to review all your options. Examine what makes sense for your needs and budget.

Resources

• Health Insurance Marketplace (healthcare.gov)
  • Click here to apply for coverage, compare plans, and enroll. For questions, call 1-800-318-2596 (TTY: 1-855-889-4325).
• State Assistance
  • Click here to find a local navigator or certified application counselor to help you get health benefits coverage.
• Understanding Health Insurance
  • Click here for resources to better understand health insurance and the marketplace.

Article Sources

1. Pennie. “Learn Overview.” Pennie. Accessed June 12, 2024. https://pennie.com/learn/learn-overview/.
2. Pennsylvania Insurance Department. “How to Get Health Insurance.” Pennsylvania Insurance Department. Accessed June 12, 2024. https://www.insurance.pa.gov/Coverage/Pages/how-to-get-health-insurance.aspx#:~:text=All%20PA%20residents%20who%20are,November%201%20through%20January%2015.
3. Pennsylvania Insurance Department. “ACA Health Rate Filings.” Pennsylvania Insurance Department. Accessed June 12, 2024. https://www.insurance.pa.gov/Consumers/HealthInsuranceFilings/Pages/ACA-Health-Rate-Filings.aspx.
4. KFF. “Medicaid in Pennsylvania.” KFF. Accessed June 12, 2024. https://files.kff.org/attachment/fact-sheet-medicaid-state-PA.
5. Pennsylvania Department of Aging. “Medicare Counseling.” Pennsylvania Department of Aging. Accessed June 12, 2024. https://www.aging.pa.gov/aging-services/medicare-counseling/Pages/default.aspx.
6. Pennsylvania Insurance Department. “Find an Insurance Professional.” Pennsylvania Insurance Department. Accessed June 12, 2024. https://www.insurance.pa.gov/Consumers/FindInsProfessional/Pages/default.aspx.