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Pennsylvania Health Insurance

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Learn more about each insurance carrier here: Aetna, Cigna, Cigna PDP, Coventry Health Care, Golden Rule, Highmark BCBS,UnitedHealthcare Life Insurance Company Compare health insurance quotes from nearby states: New Jersey Health Insurance, Ohio Health Insurance

There are many health insurance options open to those in the state of Pennsylvania who are uninsured or underinsured, but there are several questions to keep in mind during your research. If your employer does not offer health insurance, are you healthy enough to obtain health insurance on the individual market? If so, HealthPlanOne can be of service to you in quoting plans appropriate for your needs and price range. Are you self-employed? HealthPlanOne can also assist sole proprietors and small business owners in obtaining small group coverage. Do you have any pre-existing conditions, disabilities, or are you below an income level which could qualify you for free or low-cost health care programs offered by the government? You may be eligible in Pennsylvania for Medicaid, CHIP, adultBasic, or the high risk pool. See if you're eligible for any of these options by reviewing the information on this page. Please consider all of these important questions when beginning your search for health coverage.

What Every Pennsylvanian Should Know About Health Insurance

The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer, the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not medically underwritten, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.

Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through HealthPlanOne. Simply visit our Short-Term information page for your free quotes.

What If I'm Between Jobs?

It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important. Notably, if you have had group health coverage in Pennsylvania for one year (18 months for late enrollees), and you switch jobs and go to another plan, the new health plan cannot impose another pre-existing condition exclusion period, provided there is no break in your coverage for more than 63 days.

Because it is important not to have a break in coverage, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government, you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs, to invest in an individual/family insurance policy through HealthPlanOne.

With individual coverage, you choose the health insurance carrier and benefits you want with the help of HealthPlanOne. We will quote plans for you and your family from all the different carriers available in Pennsylvania so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs, a plan on the individual market through HealthPlanOne could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Pennsylvania each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.

If you're healthy and are unhappy with the health insurance offered by your employer, are between jobs, or are not offered benefits by your company, enter your zip code into the HealthPlanOne quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat (see the button to the right) or toll-free at (877) 567-5267 to answer any questions.

Small Group Plans

If you are self-employed, you could qualify for a small group plan in Pennsylvania. You must have 2 or more eligible employees, who each work at least 20-25 hours. The minimum time you must have been in business before applying varies by carrier; some require 6 months in business. All carriers in Pennsylvania do medically underwrite for small group plans. This means that though no one in the group can be denied coverage, the carrier can increase the rates based on the health history of employees enrolling. HealthPlanOne can help you by quoting plans for small groups. Simply call us at (877) 567-5267.

If you're not healthy, there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.

Medicaid and Medicare in Pennsylvania

Your second option is to see whether you qualify for the Medicaid program. Medicaid works in practice much like having regular health insurance; if you qualify you'll receive a Medicaid card which you can show your doctor at an appointment. If your doctor participates in Medicaid, the State will pay the bill for the appointment minus any other health insurance you may have. The program pays for many medical services including in- and outpatient hospital care, laboratory services, nursing home care, home health care, transportation necessary to receive medical care (ambulance rides), and other services. More information concerning Medicaid, including specific qualifications as well as income requirement can be obtained by contacting the Pennsylvania Department of Public Welfare's Recipient Hotline at 1-800-692-7462.

Click here to view Pennsylvania Medicare Advantage Plans.

CHIP - Children's Health Insurance Program

CHIPprovides free or low-cost quality health insurance to uninsured children whose families earn too much to qualify for Medicaid, but not enough to purchase private health insurance. Children under age 19 may be eligible for CHIP based on their family's income. More information about CHIP and eligibility requirements can be obtained by contacting the CHIP toll free helpline 1-800-986-KIDS or by visiting . All eligibility requirements (including family income guidelines) are available at . Though there is no income limit for CHIP (you can never make too much money to be in the program) the higher your income, the more you will be expected to contribute toward the program in premiums, though these premiums are still very low. See the income/expected premium chart here:


This program is administered by the Pennsylvania Insurance Department and offers basic benefits for adults aged 19-64 and are within income guidelines and eligibility requirements, available here: . The program is meant to cover adults who do not qualify for any part of the Medicaid program. Benefits include hospitalization, physician services (primary care and specialists), emergency services, and maternity care. More information about adultBasic can be obtained by calling 1-800-GO-BASIC or visiting their website, .

Pennsylvania's High Risk Pool Alternative - BCBS

Your final health insurance option is the result of a new Pennsylvania law which makes it easier for you to get individual insurance under certain situations, including if you left a job where you had group health insurance, or had another plan for more than 18 months without a break of more than 63 days. Specifically, if you meet certain criteria, you are considered an eligible individual and guaranteed the right to buy individual health coverage from Blue Cross and Blue Shield plans in Pennsylvania without a pre-existing condition exclusion period. To be an eligible individual, you must: have had 18 months of continuous credible coverage, at least the last day of which was under a group health plan; have used up any COBRA continuation coverage for which you were eligible; not be eligible for Medicare, Medicaid or a group health plan; not have other health insurance. You must apply for health insurance for which you are an eligible individual within 63 days of losing your prior coverage.

For information check out our HIPAA Insurance page.