Affordable Health Insurance Plans in Philadelphia for the year 2022

Updated: November 9, 2022
Health Insurance in Philadelphia

The most affordable health insurance in Philadelphia for most people is Ambetter Balanced Care 30, the cheapest and most affordable Silver plan in 28 percent of the state’s counties.UPMC VirtualCare Silver is the state’s least expensive Silver plan (Partner Network). However, Allegheny and Erie’s counties are the only ones where this plan is offered.

The typical monthly premium for a Silver plan for a 40-year-old in Philadelphia is $498.

The state exchange in Philadelphia offers reasonably priced health insurance policies. However, certain customers can be eligible for Medicaid depending on their household income. In the state, the average cost of health insurance per month in 2022 will be $441, unchanged from 2021.


Health insurance with the lowest metal tier

In order to assist you in locating an inexpensive health insurance plan for your desired level of coverage, we check Philadelphia policies by metal tier.

For a 40-year-old, the least expensive Silver plan in Philadelphia is $312 a month.

The real cost of a health insurance plan in Philadelphia varies according to the policy you choose, your age, and the number of people insured, in addition to the metal tier. For example, a younger couple without children will pay less than an older couple with several children insured.


In Philadelphia, locating the greatest health insurance coverage.

The best health insurance option for you in Philadelphia depends on your living and income. Due to the Affordable Care Act’s (ACA) expansion of Medicaid, if your family’s income is up to 138% of the federal poverty level, you will be qualified for coverage under Medicaid in Philadelphia.

Your greatest options for health insurance for people who don’t qualify for Medicaid will likely be through the state marketplace, especially if you have a low to moderate household income.

Tax subsidies are available to many households, which can help to offset the cost of an exchange plan’s health insurance coverage.

The metal tiers used to categorize health insurance plans on the Philadelphia exchange reflect a plan’s level of benefits, out-of-pocket expenditures, and monthly rates.


The best for high anticipated medical costs are gold plans.

The gold plan is the highest metal tier available in Philadelphia, which has higher premiums but far reduced out-of-pocket costs like deductibles, copays, and coinsurance.

For instance, people who frequently use medication would want to look into Gold plans with low out-of-pocket costs for prescription pharmaceuticals.


Silver plans are ideal for persons with average medical bills or low incomes.

We normally advise looking for Silver plans if you’re seeking health insurance with affordable premiums and low out-of-pocket costs. Silver health insurance plans feature lower monthly premiums than Gold or Platinum coverage but higher out-of-pocket expenses than Bronze plans.

Additionally, Silver plans are qualified for cost-sharing reduction (CSR) subsidies if your household has a lower income, so you might be able to get even reduced deductibles, copays, and coinsurance.


Catastrophic and Bronze plans are ideal for young, healthy individuals who have finances.

Cheaper-tier policies, such as Bronze & Catastrophic plans, have lower monthly premiums. Still, due to significant cost-sharing clauses, your out-of-pocket payments will be substantially higher if you need medical attention.

Bronze plans may be the greatest value option for young, healthy customers with small anticipated medical needs and sufficient finances to cover the high deductibles, coinsurance, and copays if necessary.

Because catastrophic plans aren’t accessible to everyone and aren’t eligible for premium tax credits, we haven’t included them in our cost study. Only those under the age of 30 or those who meet specific requirements will be eligible for these policies.


Philadelphia health insurance quotes and rate changes

Each health insurance company sets its own rates, which are subsequently submitted to the government in exchange for approval. Philadelphia saw a 4% decrease in the cost of Bronze and Gold plans for 2022. The price of Silver plans, however, climbed by 7%, or around $31 more per month. Check out Well Care health insurance reviews to find a best plan for yourself.


Philadelphia short-term health insurance

Residents of Philadelphia have direct access to providers selling short-term health insurance outside of the health exchange. These insurance, which may be acquired at any time of year, are a wonderful choice if you missed the open enrollment period or lost employer-sponsored coverage.

When it comes to temporary health insurance, Philadelphia abides by federal regulations. One year is the maximum initial period of coverage, and plans may be renewed for an additional 36 months.


Philadelphia health medical plan providers

The Philadelphia state exchange currently has nine health insurance providers. Healthcare plans in Philadelphia vary by county, but Highmark or UPMC coverage is available in the vast majority of the state’s 67 counties.

Among the companies represented are:

  • Ambetter from PA Health & Wellness
  • Capital Blue Cross
  • Cigna
  • Geisinger Health Plan
  • Highmark
  • Blue Cross Blue Shield
  • Highmark Inc
  • Independence Blue Cross
  • Oscar
  • UPMC Health Plan

UPMC offers the state’s lowest-priced plan for each metal tier among these insurers, giving it an excellent option for cheap health insurance in Philadelphia.


County-by-county health insurance rates

Depending on your county, different health insurance providers and policies will be offered through the Philadelphia Health Insurance Marketplace. For instance, Ambetter Balanced Care 30, the least expensive Silver plan in Philadelphia, costs $386 for a county resident aged 40. However, residents of Pittsburgh would have to pay $312 for the cheapest UPMC medical insurance option in Philadelphia.


How can I pick the ideal private insurance policy for me?

One of our favorite aspects of ICHRA is that it gives employees the freedom to select the plan that best suits their needs as opposed to a group plan that offers only one or two options.

  • Lookup a doctor: To be sure that your dependable doctors continue to be covered by your new health plan, use our doctor search tool. Utilize our window shopping tool to look for medically compatible insurance.
  • Prescription lookup: Getting prescriptions filled can be very expensive! It’s crucial to price compare and carefully review the formularies for all of your health plan alternatives, especially if there is a medication you regularly use to manage chronic disorders. Different carriers cover them differently. You can compare plan coverage and formularies side by side using our new prescription search tool to discover the best coverage for the lowest price.


Exchange for Health Insurance in Philadelphia Introduction

Health insurance coverage for people and small companies will be made accessible through new state health insurance exchanges starting in 2014 as part of the Affordable Care Act (ACA) (also called health insurance marketplaces).

Most significantly, only insurance acquired through state-run health insurance exchanges will be eligible for important tax credits and subsidies, such as small business healthcare tax credits and individual health insurance tax credits.

For 2014, each state has three options for establishing a state health insurance exchange:

  • Create a state-based exchange first.
  • Enter into an exchange of state-federal partnerships
  • Revert to an exchange facilitated by the government.

Philadelphia will automatically use a health insurance exchange run by the federal government.


History of the Philadelphia Health Insurance Exchange

The Philadelphia Insurance Department first assumed control of the health exchange planning. The Insurance Department published a report in November 2011 that said the state would approve a state-based exchange. The Insurance Department published proposed legislation to create numerous private exchanges in January 2012. However, the ACA exchange criteria for this kind of organization were a source of concern. Governor Tom Corbett declared in December 2012 that Philadelphia would revert to the federal exchange due to unclear federal advice and costs.


What Is the Philadelphia Health Insurance Exchange?

The federally controlled health insurance exchange, commonly known as the Health Insurance Marketplace, will be used to manage the Philadelphia Health Insurance Exchange. Residents of Philadelphia will have access to details regarding all the plans offered through the Exchange beginning in October 2013. Small firms with 100 or fewer employees will also have access to the SHOP Exchange. The Exchange will begin providing coverage in January 2014. estimates that 1,242,351 or 12% of Philadelphia’s non-elderly citizens lack insurance; of these, 1,141,718 (or 90%) may be eligible for Medicaid if Philadelphia participates in the Medicaid expansion or tax credits to purchase coverage in the Marketplace.

You may read more about the Philadelphia Health Insurance Exchange here.


What Plans Are Going to Be Available on the Philadelphia Health Insurance Exchange?

The ACA’s definition of a Qualified Health Plan (QHP) will be met by each and every plan made available through the Philadelphia Health Insurance Exchange. To enable consumers to evaluate plans on a “apples to apples” basis, the plans will be presented according to the extent of coverage for essential health benefits (EHB). Bronze (pays 60%), Silver (pays 70%), Gold (pays 80%), and Platinum (pays 90%) are the four “metal” tiers. By the end of the 2013 summer, more details on the kinds of plans that will be offered and the carriers offering plans in Philadelphia are anticipated.


Exchange for Health Insurance in Philadelphia: Insurance Experts’ & Navigators’ Roles

In order to offer policies through the Exchange and to help consumers and small companies, the Philadelphia Health Insurance Exchange will abide by federal regulations.

The Philadelphia Health Insurance Exchange will allow insurance experts to register and earn any commissions from carriers directly (using their Exchange ID number and NPN).

The navigator service for the Philadelphia Health Insurance Exchange will help individuals choose their healthcare options and enroll in their new health insurance, including, for some consumers, access to premium tax credits. The federal government will administer the navigator program in Philadelphia.



Is it against the law not to have health insurance in Philadelphia?

In Philadelphia, there is no fine for not having health insurance. There is no penalty for not having insurance, even though you must state it on your federal tax return.


Who may apply for a Pennie?

All Philadelphia residents who are citizens, US nationals, or have a specific immigration status are eligible to research ACA plans and apply for coverage through Pennie, the state health insurance exchange. Additionally, Pennie will help you determine your eligibility for lower monthly payments.


In Philadelphia, are medical services free?

The state of Philadelphia provides free or low-cost medical care through the Philadelphia Medicaid program. You may get details about prices, qualifications, and application processes at the Philadelphia Department of Human Services.


How much does health insurance typically cost in Philadelphia?

Although the state market in Philadelphia offers affordable health insurance plans, certain customers may qualify for Medicaid based on their household income. In the state, the average monthly cost of health insurance in Philadelphia in 2022 will be $441, the same as in 2021.


How much does monthly health insurance for a single person cost?

2020 will see an average monthly cost of $456 for an individual and $1,152 for a family for health insurance throughout the nation. However, costs differ between the many health plans that are offered.


What are the repercussions of not having health insurance in Philadelphia?

This refers to the “individual mandate.” There is a grace period till March 31, 2014. The penalty for not having qualified coverage is $95 for adults and $47.50 for kids beginning in 2014, or up to 1% of your taxable income (up to $285 per family), whichever is higher.


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