Picking the Best ACA Health Plans in Pennsylvania for 2023
As open enrollment for health coverage in 2023 begins in November 2022, it is important to know what to look for in health coverage plans. This article will walk you through the best plans in Pennsylvania. For this persona, we used: a 30-year-old female who does not smoke and has no disability, making $70,000 a year. However, the best plans for you may vary from the ones we chose and listed below based on your profile.
What are the Best Plans on the Pennsylvania Health Insurance Marketplace?
The Pennsylvania Health Insurance Marketplace is called Pennie. It is important to note that Pennie includes ACA health plans from multiple companies, but only two are listed below as they best fit the persona we chose. You can browse plans by inputting your personal information in this plan comparison tool.
The two plan types listed are EPOs and PPOs. You can find more information on the four main ACA health plan types, along with HSAs, later on in this article.
The tables below display the best plans on Pennie for a person of the profile described above. They are sorted by metal tier, including the plan name and type, monthly premium cost, and deductible amount.
Bronze Tier Plans
| Plan (Carrier+ Name) | Monthly Premium | Deductible Amount | Plan Type |
|---|---|---|---|
| UPMC Health Plan - Advantage Bronze | $197.47 | $6,700.00 | Bronze EPO |
| UPMC Health Plan - Advantage Bronze | $208.73 | $6,700.00 | Bronze EPO |
| Highmark - Together Blue Bronze 3800 | $214.15 | $3,800.00 | Bronze EPO |
| Highmark - Together Blue Bronze 3800 + Adult Dental and Vision | $242.42 | $3,800.00 | Bronze EPO |
| Highmark - my Direct Blue Bronze 3800 | $262.03 | $3,800.00 | Bronze EPO |
| Highmark - my Direct Blue Bronze 3800 + Adult Dental and Vision | $281.54 | $3,800.00 | Bronze EPO |
| Highmark - Together Blue Bronze 6900 HSA | $217.34 | $6,900.00 | Bronze HSA EPO |
| Highmark - my Direct Blue Bronze 6900 | $266.20 | $6,900.00 | Bronze HSA EPO |
| Highmark - my Blue Access Bronze 6900 HSA | $293.65 | $6,900.00 | Bronze HSA PPO |
| UPMC Health Plan - Advantage Bronze Premium Network | $260.64 | $6,700.00 | Bronze PPO |
| Highmark - my Blue Access Bronze 3800 | $289.14 | $3,800.00 | Bronze PPO |
| Highmark - my Blue Access Bronze 3800 + Adult Dental and Vision | $308.65 | $3,800.00 | Bronze PPO |
Silver Tier Plans
| Plan (Carrier+ Name) | Monthly Premium | Deductible Amount | Plan Type |
|---|---|---|---|
| UPMC Health Plan - VirtualCare Silver Partner Network | $277.36 | $4,500.00 | Silver EPO |
| UPMC Health Plan VirtualCare Silver Select Network | $293.18 | $4,500.00 | Silver EPO |
| Highmark - Together Blue EPO Silver 2900 | $321.21 | $2,900/$0 | Silver EPO |
| UPMC Health Plan - Advantage Silver Partner Network | $328.50 | $3,500/$0 | Silver EPO |
| UPMC Health Plan - Advantage Silver Partner Network | $329.67 | $1,500/$0 | Silver EPO |
| UPMC Health Plan Advantage Silver Partner Network | $343.70 | $6,800/$0 | Silver EPO |
| UPMC Health Plan Advantage Silver Select Network | $347.24 | $3,500/$0 | Silver EPO |
| UPMC Health Plan Advantage Silver Select Network | $348.48 | $1,500/$0 | Silver EPO |
| Highmark - Together Blue EPO Silver 2900 + Adult Dental and Vision | $349.49 | $2,900/$0 | Silver EPO |
| UPMC Health Plan Advantage Silver Select Network | $363.30 | $6,800/$0 | Silver EPO |
| Highmark - my Direct Blue Silver 2900 | $404.68 | $2,900/$0 | Silver EPO |
| Highmark - my Direct Blue EPO Silver + Adult Dental and Vision | $424.19 | $2,900/$0 | Silver EPO |
| Highmark - Together Blue Silver 3250 HSA | $298.82 | $3,250.00 | Silver HSA EPO |
| Highmark - my Direct Blue Silver 3250 HSA | $374.49 | $3,250.00 | Silver HSA EPO |
| Highmark - my Blue Access PPO Silver 3250 HSA | $399.80 | $3,250.00 | Silver HSA PPO |
| Highmark - my Blue Access Silver 2900 | $427.06 | $2,900/$0 | Silver PPO |
| UPMC Health Plan Advantage Silver Premium Network | $436.07 | $3,500/$0 | Silver PPO |
| UPMC Health Plan Advantage Silver Premium Network | $440.18 | $1,500/$0 | Silver PPO |
| Highmark - my Blue Access Silver 2900 + Adult Dental and Vision | $446.57 | $2,900/$0 | Silver PPO |
| UPMC Health Plan Advantage Silver Premium Network | $455.26 | $6,800/$0 | Silver PPO |
Gold Tier Plans
| Plan (Carrier+ Name) | Monthly Premium | Deductible Amount | Plan Type |
|---|---|---|---|
| Highmark - Together Blue Gold | $272.89 | $0.00 | Gold EPO |
| UPMC Health Plan - Advantage Gold Partner Network | $284.32 | $1,000/$0 | Gold EPO |
| Highmark - Together Blue Premier Gold 0 | $291.38 | $0.00 | Gold EPO |
| UPMC Health Plan - Advantage Gold Select Network | $300.54 | $1,000/$0 | Gold EPO |
| Highmark - Together Blue Gold 0 + Adult Dental and Vision | $301.17 | $0.00 | Gold EPO |
| Highmark - Together Blue Care Advantage Premier Gold 0 | $306.88 | $0.00 | Gold EPO |
| Highmark - Together Blue Premier Gold 0 + Adult Dental and Vision | $319.66 | $0.00 | Gold EPO |
| Highmark - Together Blue Care Advantage Premier Gold 0 + Adult Dental and Vision | $335.15 | $0.00 | Gold EPO |
| Highmark - my Direct Blue Gold 0 | $339.72 | $0.00 | Gold EPO |
| Highmark - my Direct Blue Gold 0 + Adult Dental and Vision | $359.23 | $0.00 | Gold EPO |
| Highmark - my Direct Blue EPO Premier Gold 0 | $363.12 | $0.00 | Gold EPO |
| Highmark - my Direct Blue Premier Gold 0 + Adult Dental and Vision | $382.63 | $0.00 | Gold EPO |
| UPMC Health Plan - Advantage Gold HSA | $247.97 | $3,100.00 | Gold HSA EPO |
| UPMC Health Plan - Advantage Gold HSA | $262.12 | $3,100.00 | Gold HSA EPO |
| UPMC Health Plan - Advantage Gold HSA Premium Network | $328.00 | $3,100.00 | Gold HSA PPO |
| Highmark - my Blue Access Gold 0 | $372.63 | $0.00 | Gold PPO |
| UPMC Health Plan Advantage Gold Premium Network | $377.86 | $1,000/$0 | Gold PPO |
| Highmark - my Blue Access PPO Gold 0 + Adult Dental and Vision | $392.14 | $0.00 | Gold PPO |
| Highmark - my Blue Access PPO Premier Gold 0 | $397.57 | $0.00 | Gold PPO |
| Highmark - my Blue Access PPO Premier Gold 0 + Adult Dental and Vision | $417.09 | $0.00 | Gold PPO |
What are the types of health plans?
The two types of plans listed above are EPOs and PPOs. The table below outlines the four types of plans you may come across when browsing through them.
Types of Health Insurance Plans
| Health Maintenance Organization (HMO) | This plan typically has lower premiums and out-of-pocket costs, and flexibility in choosing providers. You will have to pay completely out-of-pocket for out-of-network providers. |
|---|---|
| Point of Service Plan (POS) | This plan usually has higher premiums because they cover out-of-network providers and have a higher cost for in-network care. |
| Preferred Provider Organization (PPO) | This plan allows you to freely choose physicians out-of-network without referrals. It is a good option if you can afford high premiums and need frequent care. |
| Exclusive Provider Organization (EPO) | This plan is not commonly chosen and only covers in-network services. |
Some of the plans also include an option of adding an HSA (Health Savings Account). An HSA is an account in which you use tax-exempt money to pay for deductibles, co-payments, co-insurance, etc. which helps lower the costs of health insurance. These can only be used if you have a high deductible health plan (HDHP), so you will know whether the plan you choose is HSA eligible when browsing through them.
What Should I Consider When Picking a Health Plan?
When looking for a health plan, you should consider a few things. First, you must consider your health needs, finances, and how much you can afford. These are things that will likely change as time goes on, but having an understanding before selecting will help you make the best decision.
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What are your health needs?
When picking a health plan, you want to consider your health needs. This includes what medications you currently take, chronic conditions like diabetes, and how often you need to see your medical provider. If necessary, do you need to see specialists? Will asking for a referral from your PCP be more difficult than helpful? Finally, consider whether you plan on making any major life changes soon.
Life changes can include:
- Having a child
- Getting married
- Retiring early
- Moving
- Switching careers
Once you’ve figured out your health needs, you can move on to the next step of deciding which health plan is best for you. Some health plans also provide you with dental and vision care.
If you’re looking for a health plan to cover you and your family, you can still consider the above to help rank your options. If you’re married, your spouse may receive health insurance through their job; check to see if their plan offers more benefits.
What’s your financial situation?
After you’ve thought about your health needs, take the time to calculate your budget moving forward. Including things like housing, transportation, and even entertainment costs is important. Then you can see how much of your budget can go toward health insurance.
If you’re someone with an income that fluctuates, such as a freelancer or short-term contracted employee, you should think about how this will impact your budget at its highest and lowest. For people who live in cities with a high cost of living, you will find that the average cost of health insurance for one person varies compared to cities with a low cost of living.
You’ve done your budget and understand how much your current lifestyle affects your finances. Be mindful not to blow all your money on health insurance, as you still need a savings account. We’ve even figured out a few things to keep in mind when lowering your expenses.
How much can you afford?
You have your health needs and budget figured out. Now you can select the health plan that will best meet your needs. If you find that you will have a high deductible, you can offset that with a service like Mira that offers a significant discount on lab tests and prescriptions.
If you decide to select a high deductible health plan (HDHP), you will find that you will have a lower monthly premium. These plans are typically helpful to relatively healthy people who don’t plan to have significant medical expenses. You can pair an HDHP with a Health Savings Account (HSA), which allows you to use your pre-taxed funds towards medical expenses like copays and deductibles. However, you cannot use this to pay for your monthly premium.
Average Lowest Cost Premiums by Metal Tier in Pennsylvania (2023)
| Metal Tier | Lowest Cost Monthly Premium |
|---|---|
| Bronze | $292 |
| Silver | $420 |
| Gold | $380 |
What if you frequently travel?
If you travel a lot and need coverage during this time, look at PPO plans. Preferred Provider Organization plans will give you access to out-of-network coverage and allow you to see specialists without a referral. These plans do often come with a high premium. Multiple PPO plans are offered in Pennsylvania. Since UPMC has the most providers within Pennsylvania, Highmark plans may be a better option if you frequently travel because it has more out-of-network coverage.
What happens if you can’t afford any plan on the exchange?
If you cannot afford any plans on the exchange, there are alternative options available. Some of these options include care memberships, medical cost-sharing, and discount cards. There is no penalty if you choose to be uninsured in Pennsylvania. The federal law requiring tax penalties on those who are uninsured was repealed in 2019.
How to enroll in an ACA plan?
Pennie is the state-wide online marketplace to compare and sign up for ACA plans in Pennsylvania. With the Pennie site, you have three options to sign up for a plan: online, over the phone, or through an assister or broker. When you start an application for coverage, Pennie will have you complete a series of application questions, including primary contact information, family and household information, income information, and additional health information.
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ACA Health Plans in Pennsylvania Frequently Asked Questions (FAQs)
Below are some frequently asked questions about health insurance in Pennsylvania we gathered for you.
What health insurance terms should I understand during this enrollment period?
We’ve gone over PPO, HDHP, and HSA. You should also know what a Flexible Spending Account (FSA), Self-Pay Pricing (SPP), and Special Enrollment Period (SEP) are. We have a list with a few more insurance terms that will help you during this enrollment period.
What requirements do I need to meet to be eligible in Pennsylvania?
To sign up for an ACA plan in Pennsylvania, you must be a Pennsylvania resident and either be a U.S. Citizen, U.S. National or have qualified immigration status. You cannot buy a plan through Pennie if you have Medicare coverage. Pennie health plans typically only cover providers and hospitals in the United States.
What are the benefits that my plan is required to provide?
Under the Affordable Care Act, there are ten benefits that every plan must cover (essential health benefits). Included are doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more. However, not every plan is the same, and you will see what is offered by every plan when you compare them.
When is the special enrollment period?
If you miss open enrollment and you’ve had a qualifying life event such as having a baby, a change in income, or health insurance loss, you may be able to apply 60 days prior or 60 days after the event to enroll in a health plan. To see if you qualify, go to healthcare.gov and fill out a few questions. The site will direct you to either answer more questions or to the site for Pennsylvania.
Bottom Line
You can enroll in a Pennsylvania ACA health insurance plan through the state exchange, Pennie. There are easy ways to browse through the plans by inputting your personal information and figuring out which plans work best for you. You should compare plans based on metal tiers and the differences between deductible and premium amounts. As open enrollment runs from November 1, 2022, through January 15, 2023, it is essential to become familiar with the enrollment process.
If you’re looking for a more affordable alternative to health insurance, Mira might be a great fit. For an average of $45 per month, members get access to low-cost urgent care visits, affordable lab testing, and discounted prescriptions at up to 80% off. Sign up today and start saving on healthcare.
Michelle Fleming is a sophomore at the University of Texas at Austin majoring in Public Health, focusing on biostatistics and informatics and minoring in Health Communications. Michelle is passionate about bridging the gap in health inequalities through advocacy and policy, especially within minority groups.
