Pennsylvania Health Insurance

Health Insurance Overview

Pennsylvania residents have many options for health care coverage. There are numerous Pennsylvania insurance providers to choose from, along with a variety of Pennsylvania medical insurance plans designed to meet the specific needs of individuals, families and groups.

Whether you need independent self-employed health coverage, or your employer simply doesn’t offer group Pennsylvania health insurance benefits. Whether you are looking to cover your spouse and children under the same low rate, or you are a small business that wants to provide your employees with affordable coverage. Whatever your situation, we are your one stop resource for all your health care needs – including reliable Pennsylvania medical insurance from the best Pennsylvania insurance providers around.

Each state is unique in its laws and regulations, as well as the types of coverage it offers. Here you will find an array of resources and useful information to help you better understand Pennsylvania health insurance and the range of options available to you. This includes current facts and statistics about residents, important state legislation, financial assistance and public Pennsylvania health insurance programs, and even details on some of the top Pennsylvania insurance providers.

To compare specific Pennsylvania medical insurance plans offered by the various Pennsylvania insurance providers, and get a personalized quote for the options that are right for you, contact us now for free. We’ll connect you with a highly qualified insurance agent near you who will be happy to help you with all of your Pennsylvania health insurance needs.

At Healthcare Solutions Team, we’re committed to making affordable health care accessible to everyone. Our group of elite Pennsylvania health insurance advisors is dedicated to helping match the right coverage to fit the unique needs of all families, individuals and groups. Not a resident of Pennsylvania? Find your state here.

Pennsylvania Health Insurance Facts & Statistics

Total Pennsylvania Residents – 12,422,200

Total Health Insurance Coverage In Pennsylvania:
Employer – 54%
Individual – 5%
Medicaid – 15%
Medicare – 15%
Other Public – 0%
Uninsured – 11%

Average Individual Monthly Premiums – $225

Average Annual Single Employee Contribution for Employer-Based Health Insurance Plan – 19%

Average Annual Single Employee Premium for Employer-Based Health Insurance Plan – $954

Average adjusted hospital cost per inpatient day – $1,837

Source data according to the Kaiser Family Foundation ( (2009-2012 data) and

Pennsylvania Medical Insurance Laws, Regulations & Policies

There are several Pennsylvania health insurance laws and regulations that are put in place to protect policyholders living in the state. Most Pennsylvania insurance providers will look at an applicant’s health before they accept them into a plan and set premiums. But the Blue Cross and Blue Shield companies are required to offer a guaranteed issue health plan, where every applicant is accepted.

Pennsylvania health insurance law requires all health plans to cover these medical services:

  • Mammograms and cervical cancer screening
  • Diabetes care
  • Post-delivery care for new mothers
  • Vaccinations for children

Pennsylvania insurance providers must also cover mental health conditions and physical health conditions equally.

Pennsylvania residents who have recently left a group health plan with an employer are protected under the federal HIPAA if they also meet other requirements. Insurers are required to accept all HIPAA-eligible residents and cannot restrict coverage.

Pennsylvania Health Insurance Resources


Commonwealth of Pennsylvania Access to Social Services. Visit the website.

Pennsylvania Health Insurance High Risk Pool

The Patient Protection and Affordable Care Act established temporary national high risk pools to provide health insurance to those with pre-existing conditions. Residents in Pennsylvania with pre-existing conditions can get health insurance from the Pennsylvania Health Plan (NHHP-Fed). This works similar to regular Pennsylvania health insurance policies and requires enrollees to pay monthly premiums and out-of-pocket costs.

Enrollees in the Pennsylvania program pay around the same amount that people without medical conditions pay for health insurance. The estimated monthly premium costs for Pennsylvania residents are around $283. The plan includes a $1,000 deductible for in-network visits and $10,000 for out-of-network visits. There is also a $5,000 out-of-pocket limit for in-network. Those eligible for the plan will have access to health insurance coverage for hospital and doctor visits, emergency services, prescription drugs, and more.

Individuals may apply for the Pennsylvania PCIP if they are a United States’ citizen, have a pre-existing condition, and have been without health insurance for six months. For more information on the Pennsylvania health insurance high risk pools visit

To stay up-to-date on the latest health care reform news, visit:

Pennsylvania Medical Insurance and Health Care Programs

The state of Pennsylvania offers residents quite a few public health insurance programs to assist low-income residents in getting access to affordable health care and insurance coverage. These programs include:

  • Medicaid (Medical Assistance)
    The Medicaid program in Pennsylvania is known as Medical Assistance and provides low-earning residents and disabled citizens health coverage. Learn more about Medical Assistance on its website.
  • Pennsylvania’s Children’s Health Insurance Program
    Some children who do not qualify for Medicaid, but cannot afford private insurance, can get covered through PaCHIP. Learn more about PaCHIP here.
  • Pennsylvania adultBasic
    This program is designed for adults who have no health insurance and meet eligibility requirements. To find out more about the adultBasic Pennsylvania medical insurance program here.
  • The Healthy Women Project
    This program, also known as the Breast and Cervical Cancer Prevention and Treatment program, promotes the early detection of breast and cervical cancer and provides free cancer screenings for low-income women. Learn more about this Pennsylvania medical insurance program for women online.
  • Pennsylvania Medicare
    Seniors can find Pennsylvania health insurance through Medicare Advantage, Medicare Supplement and Original Medicare.

The Federal Health Coverage Tax Credit is also available for Pennsylvania trade workers and early retirees. This tax credit helps pay for health plan premiums. Learn more about the FHCTC here.

Pennsylvania Insurance Providers

Aetna Health Insurance

Aetna is one of the largest health insurance providers in America with more than 30 million members. Its network includes more than 787,000 health care professionals.

Aetna AARP Health Insurance

Aetna covers more than 30 million members and is one of the largest health insurance companies in the country. Policyholders have access to more than 787,000 doctors, hospitals and other health care providers.

Assurant Health Insurance

Assurant Health, headquartered in Milwaukee, has been offering quality insurance products and coverage to more than 1 million members since 1982. Assurant is committed to providing health insurance plans that have broad coverage while providing valuable protection.

Capital BlueCross Health Insurance

Capital BlueCross has been providing its 1.4 million members with the utmost value in health insurance since 1938 with its extended network of over 11,000 providers and 37 hospitals.

Celtic Health Insurance

Celtic concentrates on individual health insurance, offering a wide variety of plans for both individuals and families.

First Priority Life Health Insurance

Starting in 1938, Blue Cross of Northeastern Pennsylvania covers nearly 600,000 customers. Blue Cross of Northeastern Pennsylvania and its subsidiaries offer comprehensive portfolios of health insurance to customers in northeastern and north central Pennsylvania.

Geisinger Quality Options Health Insurance

Geisinger Quality Options is one of the nation’s largest rural HMOs and provides high quality, affordable health insurance benefits using its network of providers, consisting of more than 37,000 physicians, facilities, and hospitals.

Golden Rule Health Insurance

Golden Rule Insurance Company provides affordable and customized health insurance plans for millions of individuals and families.

Great American Health Insurance

Great American Insurance Company, part of Great American Financial Resources Inc., is a leading provider of health insurance and other coverage solutions.

Health America Health Insurance

In Pennsylvania, Health America’s care network includes 26,000 physicians and more than 200 hospitals. Its health plans were also rated number one by the NCQA in more categories than any other Pennsylvania insurance company.

IBX Health Insurance

Independence Blue Cross provides high-quality health insurance coverage for more than 3 million residents of Pennsylvania. IBC offers a variety of individual and family health insurance options at affordable rates.

John Alden Health Insurance

John Alden Life Insurance has been selling health coverage throughout America since 1961. Today, it is part of Assurant. John Alden plans include individual health and small group coverage. It also sells Health Savings Account plans.

Standard Security Life Health Insurance

The Independence Holding Company (IHC) provides management services to large companies that deliver insurance solutions to groups and individuals. As divisions of IHC, the Standard Security Life Insurance Company of New York and the Independence American Insurance Company offer various lines of life, health and disability insurance.

Time Insurance Health Insurance

Today, Time Insurance is known as Assurant Health with insurance coverage for individuals, students, families, seniors, and businesses.

Time Short Term Health Insurance

Today, Time Short Term health insurance is offered through the Assurant name. Time short-term health plans provide comprehensive coverage for a temporary period of time at affordable rates.

UnitedHealthOne Health Insurance

Golden Rule, a United Healthcare company, has been offering affordable health insurance solutions for more than 60 years.

WorldIns ExpressMed Health Insurance

World Insurance offers several types of individual health insurance ranging from dental coverage to comprehensive major medical plans.

Important Contacts and Links

Pennsylvania Insurance Department and Department of Health

Find the contact information for the Pennsylvania health insurance and health departments at:

Pennsylvania Insurance Department
1326 Strawberry Square
Harrisburg, PA 17120
Phone: (877) 881-6388

Pennsylvania Department Of Health
Health and Welfare Building
7th & Forster Streets
Harrisburg, PA 17120