Updated: October 25, 2024
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Best Health InsurancePennsylvaniaBest Health Insurance in Pennsylvania
Why Trust MoneyGeek? We downloaded plan data for Pennsylvania directly from the Centers for Medicare & Medicaid Services (CMS). MoneyGeek’s scoring methodology balances costs, claims approval and plan types to find the best providers in the state.
Plan data was updated with the CMS exchange data released in October for the 2024 enrollment period.
Ambetter has a MoneyGeek score of 73 out of 100, making it the best health insurance provider in Pennsylvania. Ambetter is notable for its affordable plan options, low out-of-pocket costs and a better-than-average claim denial rate compared to other providers.
In Pennsylvania, we evaluated a total of 55 Silver plans, which included EPO, HMO and PPO types, to determine the best health insurance.
Affordable premium rates.
Lower out-of-pocket costs.
Fewer denied claims.
Limited plan options.
MoneyGeek's top pick for the best health insurance in Pennsylvania is Ambetter. The provider offers eight Silver HMO plans at an average rate of $388 per month. The approximate MOOP cost for these plans is $5,400.
Ambetter provides Silver HMO plans exclusively, so there are no PPO or POS plans available that may offer more out-of-network coverage. HMO plans typically require choosing a primary care provider and getting referrals to see specialists.
It offers an average plan rate of $388, with the average maximum out-of-pocket cost for these plans being $5,400. Ambetter boasts a denial rate of 14.84%, which is lower than that of most competitors.
Plan Recommendations
MoneyGeek recommends the following Silver plans:
Highmark Blue Cross Blue Shield has the highest score for health insurance with low out-of-pocket costs in Pennsylvania, getting a MoneyGeek score of 86 out of 100. The insurer gives customers plans that cost less, has low costs that customers have to pay themselves and does not say no to as many customer claims as other companies do.
To find this information for Pennsylvania, MoneyGeek looked at 20 Gold EPO plans, 23 Gold HMO plans and 29 Gold PPO plans.
Affordable premium rates
Low out-of-pocket costs
Few claims denied
Variety of plan types
MoneyGeek's top pick for the best health insurance in Pennsylvania for low out-of-pocket costs is Highmark Blue Cross Blue Shield. This provider offers six Gold plans, which are known for their low out-of-pocket prices. EPO plans, like the ones Highmark offers, typically allow you to select providers within a network, focusing on coordinated care within that network.
It offers an average plan rate of $361, and the average maximum out-of-pocket cost for these plans is $7,017. Highmark Blue Cross Blue Shield has a denial rate of 13% — lower than most of the competition.
Plan Recommendations
MoneyGeek recommends the following Gold plans:
Ambetter is the best cheap health insurance provider in Pennsylvania, earning a score of 80 out of 100. The provider offers the cheapest plan options, has lower out-of-pocket expenses and denies fewer claims than many other providers.
For this category, MoneyGeek assessed 55 Silver plans in Pennsylvania, including 16 Silver EPOs, 23 Silver HMOs and 16 Silver PPOs. We prioritized plans with lower monthly premiums. Those with lower premiums often come with higher out-of-pocket costs.
Affordable premium rates
Low out-of-pocket costs
Few claims denied
Offers fewer plan options
MoneyGeek's top pick for the best cheap health insurance in Pennsylvania is Ambetter. It offers eight different Silver HMO plans. HMO plans require members to stay within their network to get coverage.
It offers an average plan rate of $407, and the average maximum out-of-pocket cost for these plans is $7,775. Ambetter has a denial rate of 15%, lower than most of its competitors.
Plan Recommendations
MoneyGeek recommends the following cheap Silver plans:
Highmark Blue Cross Blue Shield provides the best health insurance in Pennsylvania for young adults, earning a MoneyGeek score of 70 out of 100. The provider offers affordable plans and boasts better-than-average claim denial rates and average out-of-pocket costs. It's important to note that Catastrophic plans are only available to young adults under age 30.
For this analysis, we evaluated a total of 59 Bronze plans and 12 Catastrophic plans in Pennsylvania.
Affordable premium rates
Low out-of-pocket costs
Few claims denied
Variety of plan types
MoneyGeek's top pick for the best health insurance in Pennsylvania for young adults is Highmark Blue Cross Blue Shield. Since young people often pick lower coverage, Highmark offers one Catastrophic and four Bronze plans. The average cost of these plans is $200 each month, and the average maximum out-of-pocket cost is $8,770 each year.
Highmark doesn't provide PPO or POS plans, but its EPO plans let you see specialists without a referral. The company has a lower denial rate than most other insurers.
Plan Recommendations
MoneyGeek recommends the following plans for young adults:
Health insurance companies offer many different plans. The best providers for all plan categories are:
MoneyGeek's recommendations only include Silver plans. These plans strike a good balance between your monthly premium and the costs incurred when you visit the doctor. Silver plans are a smart choice for people who go to the doctor more than just once in a while. Pennsylvania has many Silver plans to choose from. There are 16 Silver EPO plans, 23 Silver HMO plans and 16 Silver PPO plans available.
MoneyGeek's top pick for the best health insurance in Pennsylvania for Silver PPO plans is Highmark Blue Cross Blue Shield. It offers three Silver PPO plans. It has an average plan rate of $626, and the average maximum out-of-pocket cost for these plans is $8,817. The insurer has a denial rate of 13.2%, so it denies fewer claims than average.
Silver PPO plans let you choose your own doctors, and you don't need a referral to see specialists. They cost more than HMO plans and might be expensive for people watching their budget. They do offer more freedom to pick your health care providers.
Plan Recommendations
We suggest the following Silver PPO plans from Highmark Blue Cross Blue Shield:
MoneyGeek's top pick for the best health insurance in Pennsylvania for Silver EPO plans is Highmark Blue Cross Blue Shield, which has three Silver EPO plans. It offers an average plan rate of $404, and the average maximum out-of-pocket cost for these plans is $8,817. The provider has a denial rate of about 13.2%, which means it rejects fewer claims than average.
Silver EPO plans are popular for health insurance due to their flexibility regarding specialist visits, often not requiring a doctor's referral. However, you're limited to health care providers within the plan's network, except in emergencies, meaning you can't freely choose any doctor.
Plan Recommendations
We suggest the following Silver EPO plans from Highmark Blue Cross Blue Shield:
MoneyGeek's top pick for the best health insurance in Pennsylvania for Silver POS plans is the one provided by Vantage Health Plan. It offers an average plan rate of $468, and the average maximum out-of-pocket cost for these plans is $8,550. The provider denies fewer claims than average, with a denial rate of approximately 24%.
Silver POS plans have benefits and drawbacks. You have the choice to see doctors inside or outside the network; however, it costs more if the doctor is outside the network. These plans are great for people who want the choice to visit any doctor and still save money when staying in-network. These plans are the fourth most common type of health plan.
MoneyGeek's top pick for the best health insurance in Pennsylvania for Silver HMO plans is Ambetter. It offers an average plan rate of $407, and the average maximum out-of-pocket cost for these plans is $7,775. The company has a denial rate of 0.14844%, which means it denies very few claims.
Silver HMO plans typically offer lower monthly costs. However, to have your visits covered, you must see doctors within the HMO network unless it's an emergency. Additionally, seeing a specialist requires a referral from your primary doctor. These plans can be cost-effective if your preferred doctors are within the network.
Plan Recommendations
We suggest the following Silver HMO plans from Ambetter:
When it comes to finding the best health insurance plan in Pennsylvania, your health care needs and budget are important factors. You'll need to weigh monthly premiums and out-of-pocket expenses to determine the best balance for you.
Understand when a health insurance plan will cover you
In health insurance, in-network doctors and hospitals have agreements with insurance companies to offer services at reduced rates. On the other hand, out-of-network providers do not have such agreements, which could result in higher costs for you. In Pennsylvania, certain plans may offer more flexibility in using out-of-network services, while others have stricter limitations. Plans that allow for more freedom in selecting doctors may come with higher costs.
In Pennsylvania, there are 16 PPO plans and 16 EPO plans. There are also 23 HMO plans.
Weigh the cost of premiums vs. the cost of care
When you choose health insurance, think of two costs. The first is what you pay every month. The second is the most you pay in a year if you get a lot of medical help. You find the best plan for you by looking at both these costs. Some plans cost less each month, but you might pay more when you see a doctor. Other plans cost more each month but don't make you pay as much for doctor visits during the year.
Let's look at different Silver plans. The one with the lowest yearly limit costs $388 each month. The average cost for Silver plans from this company is $405 per month. If a plan doesn't cost much every month and also doesn't make you pay a lot for the year, it's perfect, especially if the doctors and hospitals are great.
Medicare is available to those 65 and older or with a qualifying disability or illness. It is a federal health insurance program that offers eligible people discounts on medical treatments. There are three components to Medicare:
MoneyGeek also provides information for finding the top Pennsylvania Medicare Supplement and best Medicare Advantage plans in Pennsylvania.
Medicaid is a different federal program that offers health insurance to people whose income is below a state-set limit. Through a number of programs in Pennsylvania, families, children, pregnant mothers, elderly and disabled residents might be eligible for Medicaid benefits.
Finding an ideal health insurance plan can be complicated due to concerns about price and availability. MoneyGeek answers some frequently asked questions to help you research options.
Ambetter provides the best health insurance in Pennsylvania for 2024. However, the best choice for you will depend on your unique circumstances and needs.
A plan with reasonable prices and sufficient coverage is what you should be looking for. Despite offering reduced prices, some plans and companies might only offer a few services that may not suit all your medical needs. Your unique needs will determine what the best health insurance plan for you is.
About Mark Fitzpatrick
Mark Fitzpatrick is a Licensed Property and Casualty Insurance Producer and MoneyGeek's Head of Insurance. He has analyzed the insurance market for over five years, conducting original research and creating personalized content for every kind of buyer. He has been quoted in several insurance-related publications, including CNBC, NBC News and Mashable.
Fitzpatrick earned a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He is passionate about using his knowledge of economics and insurance to bring transparency around financial topics and help others feel confident in their money moves.
