Insurance Questions? We Have Straight Answers.

Pennie is Pennsylvania's own state-based ACA marketplace, launched in 2020. Unlike most states that use the federal HealthCare.gov platform, Pennsylvania residents must enroll in ACA-compliant individual and family plans through Pennie to receive premium subsidies. Pennie offers PA-specific consumer assistance, customer support, and a Pennsylvanian-focused plan-shopping experience. Keystone Health Advisors handles Pennie enrollment from start to finish at no cost to you.

Pennsylvania's market is dominated by three regional giants: Highmark (Blue Cross Blue Shield affiliate, dominant in western and central PA), Independence Blue Cross (dominant in the Philadelphia metro), and UPMC Health Plan (tied to the UPMC hospital system in Pittsburgh and western PA). Geisinger Health Plan is a major integrated insurer in central and northeastern PA. Aetna, UnitedHealthcare, Cigna, and Capital Blue Cross also compete in various PA markets.

Yes — Pennsylvania expanded Medicaid in 2015. Adults earning up to 138% of the Federal Poverty Level qualify for Medical Assistance (PA's name for Medicaid). For 2025, that's roughly $20,800 for an individual and $43,000 for a family of four. Keystone Health Advisors always checks Medicaid eligibility before recommending a marketplace plan — Medical Assistance is free, comprehensive coverage that often beats subsidized Pennie plans for eligible households.

Pennsylvania's Children's Health Insurance Program (CHIP) provides low-cost or free coverage for children in families that earn too much for Medical Assistance but still need affordable coverage. CHIP covers doctor visits, dental, vision, prescriptions, hospital care, and mental health services. Eligibility extends to families earning up to roughly 314% FPL in PA. We always check CHIP before enrolling kids on a family plan.

It comes down to where you receive care. UPMC Health Plan offers in-network access primarily within UPMC facilities (UPMC Presbyterian, UPMC Shadyside, UPMC Mercy, UPMC Children's). Highmark members have broader in-network access at Allegheny Health Network, St. Clair, Excela, and select community hospitals. If your doctor is UPMC, choose UPMC Health Plan. If your doctor is AHN or independent, Highmark is usually the right call. We map your providers to the right carrier before you enroll.

It depends on the carrier and the plan tier. Independence Blue Cross's Personal Choice PPO covers Jefferson, Penn Medicine, Main Line Health, Temple, and Einstein. Some narrower-network IBC plans (and some Aetna/UnitedHealthcare plans) exclude one or more of those systems. We verify every doctor and hospital you care about against the plan's network directory before you switch — no surprises after January 1.

For 2026 coverage, Pennie's Open Enrollment runs from November 1, 2025 through January 15, 2026. Enroll by December 15, 2025 for coverage starting January 1, 2026; plans selected December 16 through January 15 take effect February 1, 2026. Outside Open Enrollment, you can only enroll if you have a qualifying life event (job loss, marriage, birth, move). Medical Assistance and CHIP enroll year-round.