Pennsylvania Health Insurance
Under the Affordable Care Act, everyone in Pennsylvania is required to have health insurance or pay a tax penalty for not having coverage. If you don’t have insurance and employer-based coverage isn’t an option, we’re here to help you avoid the penalty and get the best insurance for your health, as well as your budget.
So, what do residents of Pennsylvania need to know about their health insurance options?
To start, it’s important to understand that you can purchase health insurance through a couple online marketplaces, referred to as the public and private exchanges. These exchanges allow you to research, compare, and buy health insurance.
The public exchange is the online marketplace offered by the government. Each state can choose to run its own marketplace, or default to the federal marketplace: HealthCare.gov. You can also choose to purchase health insurance through the private exchanges – either through a private insurance company, an online insurance seller, or an agent or broker. Start shopping here.
From cost, coverage options, and eligibility, here’s some useful information to help you find the coverage you need to protect your health.
Pennsylvania Health Insurance at a Glance, 2014
|Number of Insurers in the Individual Health Insurance Marketplace||10|
|Total Number of Individuals Determined Eligible to Enroll in a Marketplace Plan||549205|
|Number of Individuals Eligible to Enroll in a Marketplace Plan with Financial Assistance||332915|
|Determined or Assessed Eligible for Medicaid/CHIP by the Marketplace||42335|
|Individuals Potentially Eligible for Premium Tax Credits through Marketplace||715000|
Average Premium Cost in Pennsylvania
Monthly premiums are based on a single 40-year-old at 250 percent of poverty in a major city.
| Second-Lowest Cost Silver Plan Before Subsidies
|Second-Lowest Cost Silver Plan After Subsidies||$ 193.00|
|Lowest-Cost Bronze Plan Before Subsidies||$ 238.00|
|Lowest-Cost Bronze Plan After Subsidies||$ 130.00|
Want to see if you qualify for savings through a health insurance subsidy? Click here to learn more.
Medicaid in Pennsylvania
Medicaid is a state program partially funded through the federal government to assist low-income families with their health insurance costs.
Medicaid eligibility is typically based on how your household income stacks up against the federal poverty level, though the income limit does vary in every state.
Medicaid Expansion in Pennsylvania
Thanks to the Affordable Care Act, states have been given additional federal funding to increase their Medicaid eligibility pool to include individuals (under 65) with an income up to 138 percent of the federal poverty level (FPL).
However, not all states have expanded Medicaid – and there’s no deadline for when they need to do it.
Pennsylvania has taken part in the Medicaid expansion, effective January 1, 2015. As a result, you’ll likely qualify for low-cost coverage through Medicaid if your annual household income is at or below the following levels:
|Family Size||Household Income|
To learn more about Medicaid qualification in Pennsylvania, visit Medicaid.gov.
- Information for Pennsylvania Health Insurance at a Glance, 2014, is from The Kaiser Family Foundation State Health Facts: http://kff.org/statedata/
- Average premium information is from The Kaiser Family Foundation State Health Facts: http://kff.org/other/state-indicator/2014-monthly-premiums-for-a-single-40-year-old-at-250-percent-of-poverty-in-a-major-city-in-each-state/. Premiums will vary based on city of residence, age, family size, and tobacco use.
- Income eligibility for states that have expanded Medicaid is from the HealthCare.gov: https://www.healthcare.gov/qualifying-for-lower-costs-chart/
- 2014 Poverty Guidelines are from the U.S. Department of Health & Human Services: http://aspe.hhs.gov/poverty/14poverty.cfm