Pennsylvania Health Insurance: 2023 Coverage Guide

secure Editorial Standards

SmartFinancial Offers Unbiased, Fact-based Information. Our fact-checked articles are intended to educate insurance shoppers so they can make the right buying decisions. Learn More

Pennsylvania Affordable Healthcare Insurance

The folks in Pennsylvania have several health insurance plans to choose from and they should compare rates carefully before making any health care decisions. If you’re an individual buying health care coverage for yourself or a family, you can get the insurance you need at the best prices by comparing your options with SmartFinancial. You must enroll in a health plan during the open enrollment, unless you are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in Pennsylvania?

November 1, 2022 – January 15, 2023

How to Get Health Insurance in Pennsylvania

Get an idea of your healthcare costs for the following year based on the previous year. You’ll need this information to make good decisions which type of coverage is right for you, and which level tier will save you money. Sometimes, higher premiums end up saving you money if you frequently visit care providers.

The best way to get superior value in coverage is to health insurance quotes. After submitting the form you’ll get several competing health insurance rates to choose from, and we’ll put you in touch with an insurance agent in your area so you can buy coverage or ask questions.

What Types of Health Insurance Are Available in Pennsylvania?

The main types of health insurance plans are HMOs, EPOs, PPOs and POS plans. These are available in Pennsylvania in different tiers of coverage, which cost different prices. You can also choose a plan based on how much coverage it provides. In Pennsylvania, plans come in platinum, gold, silver and bronze, which is the cheapest type of plan you can buy.

Does Health Insurance Cover Pre-existing Conditions?

It is illegal for marketplace health plans to deny anyone health insurance coverage based on pre-existing conditions.

Compare Health Insurance Plans in Pennsylvania

Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • Did you lose or quit a job? You may have lost a job, changed jobs or even started your own business. If so, you qualify for the special enrollment period.
  • Did you turn 26? If so, you’re no longer eligible to remain on your parents’ health insurance plan but can enroll in an individual health plan outside the open enrollment period.
  • Did you move? You may have had a health plan that was only valid in one area but you moved to another region after the enrollment period ended. You can sign up for a new health plan.
  • Did Cobra coverage end? If you extended your healthcare with Cobra and reached the deadline, you can enroll in a new health plan.
  • Did you divorce? If you shared a health plan coverage with your spouse but divorced, you can buy a new health plan.
  • Did you get married? If you recently married, you may be able to get added onto your spouse’s policy or start an entirely new one together.
  • Did you have a baby? If your baby was born or brought home after the open enrollment deadline, you can buy insurance for your baby.
  • Did your spouse or partner pass away? If you were covered under your spouse or partner’s health plan, you can enroll in a new individual plan.
  • Did your spouse or partner lose coverage? If you had health insurance through a partner or spouse who lost his/her coverage for any qualifying reason, you can buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Pennsylvania?

No, only California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC still require health insurance. Otherwise, there is a tax penalty. Even though it’s not required in every state, buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Pennsylvania?

The average cost of health insurance in Pennsylvania for a 40 year old is about $329 a month. Health insurance is less expensive, the younger you are. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Pennsylvania

The best way to save on health insurance in Pennsylvania is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs.

group of friends

Medicare in Pennsylvania

health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2022, it was $7,550 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Pennsylvania

If you receive social security payments, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments. The easiest way to enroll in Medicare is by working with a trusted insurance agent to get the coverages you want. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Pennsylvania?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.


Pennsylvania State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Pennsylvania Health System are listed below:

  • Pennsylvania: Overall Ranking: 21 of 51
  • Pennsylvania: Overall Performance: Below U.S. Average
  • Pennsylvania: Access and Affordability: 14
  • Pennsylvania: Prevention and Treatment: 21
  • Pennsylvania: Avoidable Hospital Use and Cost: 32
  • Pennsylvania: Healthy Lives: 33
  • Pennsylvania: Health Care Disparities: 23

Find Affordable Health Insurance in Pennsylvania

Pennsylvania Health Insurance Coverage

The people of Pennsylvania have different kinds of health insurance while some Pennsylvania residents are not insured at all. See the breakdown below:

  • Private coverage: 52%
  • Medicaid: 20%
  • Medicare: 21%
  • Uninsured: 7%

Report: America's Health Insurance Plans

Pennsylvania Health Insurance Companies

Get a Free Health Insurance Quote Online Now.