Private Health Insurance in Pennsylvania: Your Options & How to Enroll
Finding the right private health insurance plan can feel overwhelming, but you don’t have to figure it out alone. Whether you’re self-employed, between jobs, or simply exploring options outside of employer coverage, there are multiple ways to secure a plan that fits your needs.
Get Stellar Guidance and Find the Right Plan with Confidence.
How to Buy Private/Individual Health Insurance
Unlike employer-sponsored health insurance, where your options are provided for you, private health insurance gives you the flexibility to choose a plan that fits your specific needs and budget. But with so many options, it can be difficult to know where to start and there are a few different ways to purchase private health insurance in Pennsylvania.
Insurance Buying Options
PENNIE Marketplace
PENNIE lets you compare and purchase ACA-compliant plans. You can also check if you qualify for financial assistance like premium tax credits or cost-sharing reductions.
Directly From Insurance Company
Some insurers, like Highmark, UnitedHealthcare, or BlueCross BlueShield, allow you to apply for plans directly through their websites, over the phone, or via an agent.
Through a Licensed Insurance Broker
Working with an independent broker like Stellar Health Benefits gives you access to multiple plans, side-by-side comparisons, additional customer service and expert guidance at no extra cost.
Enrollment Periods
Your ability to enroll in a private plan depends on the time of year and your circumstances.
Open Enrollment Period
Runs from November 1 through January 15 each year. This is when you can apply for a new plan or make changes to your existing coverage.
Special Enrollment Period
If you experience a qualifying life event (like losing job-based coverage, getting married, having a baby, moving and many other scenarios), you may qualify for a 60-day enrollment window outside of Open Enrollment. Contact our team to check if your situation qualifies.
Medicaid & CHIP Enrollment
If you meet income requirements, you can apply for Medicaid or the Children’s Health Insurance Program (CHIP) anytime year-round.
For most people, private health insurance must be purchased during Open Enrollment unless they have a qualifying event. If you're unsure about your eligibility, Stellar Health Benefits can help you determine your options and make sure you don’t miss an opportunity to get covered!
Types of Private Health Insurance Plans
Not all health plans are the same! Here are the most common types available in Pennsylvania:
Health Maintenance Organization (HMO)
Lower premiums but requires you to use in-network doctors and hospitals. A primary care doctor referral is needed to see specialists.
Preferred Provider Organization (PPO)
More flexibility in choosing doctors, no referrals needed, and out-of-network coverage available, though at a higher cost.
Exclusive Provider Organization (EPO)
Similar to a PPO, but with no out-of-network coverage except for emergencies.
Point of Service (POS)
A mix between HMO and PPO. Referrals are required, but you can see out-of-network doctors at a higher cost.
High Deductible Health Plan (HDHP)
Lower monthly premiums with higher out-of-pocket costs. These can be paired with a Health Savings Account (HSA) to help cover medical expenses.
Catastrophic Plans
Designed for young, healthy individuals who need low-cost coverage in case of a major accident or illness.
Short-Term Health Plans
Temporary coverage for those in transition (between jobs, waiting for employer benefits, etc.). These plans are not ACA-compliant and may not cover pre-existing conditions.
Financial Assistance for Private Health Insurance
Financial help is available only through PENNIE for eligible individuals and families:
Premium Tax Credits – These help lower your monthly premium costs. If your income falls between 100% and 400% of the federal poverty level (FPL), you may qualify.
Cost-Sharing Reductions (CSRs) – If your income is between 100% and 250% of the FPL, CSRs reduce out-of-pocket expenses like deductibles and copays.
Both types of assistance are based on income and household size, and you must apply through PENNIE to determine eligibility.
In-Network vs. Out-of-Network Providers
Choosing the right doctors and hospitals can save you money.
In-Network Providers – These doctors, hospitals, and pharmacies contract with your insurance company to offer services at lower negotiated rates. You’ll pay less when using them.
Out-of-Network Providers – If a doctor or hospital isn’t in your plan’s network, you may pay higher out-of-pocket costs or have no coverage at all. Some PPO plans provide partial reimbursement for out-of-network care, while HMOs typically do not cover out-of-network services except in emergencies.
Insurance Companies We Work With
Aetna
AllWell
Ambetter
Ameritas
Cigna
Delta
EyeMed
Geisinger
Guardian
Highmark
Humana
New Era
Peak Health
UPMC
United Healthcare
Your Stellar Health Journey Begins Here!
1
Give us a Call
Start with a free, no-obligation consultation. We’ll take the time to understand your needs and answer any questions about Medicare, individual health plans, or small business coverage.
2
Explore Your Options
We’ll walk you through plans from top insurance providers, breaking down your choices so you can find the right coverage at the right price—without the confusion.
3
Get Enrolled
Once you’ve chosen a plan, we’ll guide you through the enrollment process—making it simple, stress-free, and ensuring everything is done correctly.