Pennsylvania Health Insurance Guide 2025

Medicaid in Pennsylvania

Pennsylvania expanded Medicaid in 2015, providing coverage to hundreds of thousands of previously uninsured adults. Pennsylvania's Medicaid program is called Medical Assistance (MA) and offers comprehensive health benefits to eligible low-income residents.

Who Qualifies for PA Medical Assistance?

• Adults ages 19-64 with income up to 138% FPL ($20,783/year for individuals)
• Pregnant women with income up to 220% FPL
• Children under 19 with income up to 319% FPL (CHIP)
• Seniors and people with disabilities meeting income requirements
• Parents/caretakers meeting income requirements

PA Medical Assistance Benefits

• Preventive care and wellness visits
• Doctor visits and specialist care
• Hospital inpatient and outpatient services
• Prescription drug coverage
• Mental health and substance abuse treatment
• Dental services (limited for adults)
• Vision care
• Laboratory and X-ray services

How to Apply

You can apply for PA Medical Assistance through:

• Online at compass.state.pa.us
• By phone: 1-866-550-4355
• In person at your local County Assistance Office (CAO)
• Through Pennie (pennie.com) for integrated eligibility screening
• Through a certified application counselor or navigator

Health Insurance Marketplace

Pennsylvania launched its own state-based marketplace, Pennie, in 2021. If you earn more than 138% FPL or prefer private coverage with more plan choices, Pennie is your destination for shopping and enrolling.

Available Plan Types

• Bronze: Lower premiums, higher out-of-pocket costs (60% coverage)
• Silver: Moderate premiums and costs (70% coverage) - best for subsidies
• Gold: Higher premiums, lower out-of-pocket costs (80% coverage)
• Platinum: Highest premiums, lowest out-of-pocket costs (90% coverage)
• Catastrophic: Available for under-30 or hardship exemption

Enrollment Periods

Open Enrollment: November 1, 2024 - January 15, 2025

Enroll by December 15 for coverage starting January 1, 2025. PA Medical Assistance accepts applications year-round. You can also qualify for a Special Enrollment Period if you have a qualifying life event.

Average Costs in Pennsylvania

Health insurance costs in Pennsylvania vary based on your age, location, plan type, and tobacco use. Urban areas like Philadelphia typically have more carrier competition and lower premiums than rural regions.