▶Watch: Private PPO vs. ACA Marketplace — which is right for you? (50 sec)
Can you still get private health insurance in Pennsylvania? Yes — and Pennsylvania is one of the better markets in the country for it. Fourteen carriers sell individual and family plans for 2026, the state runs its own exchange (Pennie) with a reinsurance program that holds down unsubsidized premiums, and — unlike Arizona or Texas — Pennsylvania still has real PPO plans from Highmark, Independence Blue Cross, Capital Blue Cross, and Geisinger. We compare private medical plans side by side with Pennie marketplace coverage, from Philadelphia to Pittsburgh and everywhere between.
Pennsylvania runs its own marketplace, Pennie. Open enrollment for 2027 Pennie coverage runs November 1, 2026 through January 15, 2027. Enroll by December 15 for coverage that starts January 1; enroll by January 15 for a February 1 start.
But many Pennsylvanians won't get much help from Pennie in 2027. The enhanced subsidies expired at the end of 2025, so households earning above 400% of the federal poverty level get no premium tax credit at all and pay full price, and premiums are rising again for 2027. Self-employed Pennsylvanians, two-income families, and early retirees in their late 50s and early 60s are hit hardest.
For 2026, fourteen carriers sell individual and family plans in Pennsylvania, but availability is strongly regional: Highmark Blue Cross Blue Shield / Highmark Blue Shield (western, central, and northeastern PA), Independence Blue Cross and Keystone Health Plan East (Philadelphia and its four collar counties), Capital Blue Cross (Harrisburg and central PA), UPMC Health Plan (western and central PA), Geisinger Health Plan (central and northeastern PA), Jefferson Health Plans (Philadelphia region), plus Ambetter and Oscar Health in select regions. Two name changes for 2026: Pennsylvania Health & Wellness now sells as Ambetter, and UPMC Health Coverage became UPMC Health Plan. No carrier left the state.
Carriers, networks, and hospital access differ by region. Here is how the market breaks down:
Penn Medicine, Jefferson Health, Main Line Health, Temple, and CHOP. Independence Blue Cross / Keystone East, Jefferson Health Plans, Ambetter, and Oscar compete here — the state's most crowded market.
UPMC versus Allegheny Health Network. UPMC Health Plan and Highmark are the two dominant carriers, and each favors its own hospitals — network verification is essential.
Penn State Health (Hershey), WellSpan, and UPMC Central PA. Capital Blue Cross, Highmark, Geisinger, and UPMC all sell plans across the Susquehanna Valley.
Lehigh Valley Health Network (now part of Jefferson Health), St. Luke's University Health Network, and Geisinger. Highmark, Geisinger, and Capital Blue Cross are the main carriers.
Pennsylvania's hospital systems each play a distinct role, and network access varies by plan:
Pittsburgh-based and the largest system in the state, with 35+ hospitals across western and central PA and nationally ranked specialty care — but tightly tied to UPMC Health Plan.
The University of Pennsylvania Health System (Hospital of the University of Pennsylvania, Penn Presbyterian, Pennsylvania Hospital, Lancaster General) — Philadelphia's top-ranked academic medical center.
Now one of the largest systems in the state after combining with Lehigh Valley Health Network — 30+ hospitals from Philadelphia to the Lehigh Valley and Poconos.
Danville-based, integrated with its own health plan and now part of Risant Health — the anchor for central and northeastern Pennsylvania.
Highmark's own system in Pittsburgh (Allegheny General, West Penn, Forbes, Jefferson Hospital) — the network that Highmark plans are built around.
Milton S. Hershey Medical Center and Penn State Children's, plus WellSpan's York and Lancaster hospitals — central Pennsylvania's referral hubs.
Whether these systems are in your network depends entirely on which plan you choose — and because Highmark and Independence PPOs reach broadly while UPMC, Jefferson, and Ambetter HMO/EPO plans are tighter, this is the question that matters most. Before you enroll, we verify your doctors and preferred hospitals against each plan's current network so there are no surprises.
Many Pennsylvanians start with a hospital, not a plan — searching things like "insurance that covers Penn Medicine," "private insurance for UPMC," or "a PPO that accepts Hershey Medical Center." That's the right instinct. Lower-cost HMO and EPO plans are often built around one health system, and top-ranked hospitals are often the first ones left out. Private PPO plans with national networks can open access to more of these hospitals — and we confirm your hospital and specialists are in network before you enroll.
These are among Pennsylvania's top-ranked hospitals in recent U.S. News & World Report Best Hospitals rankings, and the ones our clients ask about most:
Ranked #1 in Pennsylvania and frequently named to the U.S. News national Honor Roll. Philadelphia plans →
Ranked #2 in Pennsylvania and #1 in the Pittsburgh metro, with multiple nationally ranked specialties. Pittsburgh plans →
Jefferson Health's flagship, including Pennsylvania Hospital — among the state's top-ranked hospitals, recognized in multiple adult specialties.
The top-ranked hospital in the Harrisburg metro and central Pennsylvania's academic medical center and referral hub. Central PA plans →
Ranked #1 in the Lancaster metro, with high-performing marks across numerous procedures and conditions. Central PA plans →
Two more of Western Pennsylvania's top-ranked UPMC hospitals — Magee for women's and maternity care, Passavant serving the North Hills.
The Lehigh Valley's flagship hospital, now part of Jefferson Health.
Tower Health's flagship and one of Pennsylvania's recognized top hospitals.
The anchor of central and northeastern Pennsylvania, integrated with Geisinger's own health plan.
With the enhanced federal subsidies expired, many Pennsylvania households are paying full price for the first time — roughly 500,000 Pennsylvanians hold Pennie plans, and about one in five get no subsidy at all. Your exact premium depends on your age, ZIP code, and household size — which is why we quote every carrier and every route to coverage before recommending anything.
Traditional marketplace and off-exchange plans are not the only route. Many Pennsylvanians — especially the self-employed, independent contractors, tradespeople, farmers and small-business owners — also qualify for true employer-level group coverage regulated under federal ERISA and Department of Labor rules. Qualifying as a bona fide employee takes only a few basic requirements — full-time work is not required — and pre-existing conditions are covered, just as with any employer group plan. You get the same kind of group PPO coverage large employers offer, with nationwide networks like PHCS, and enrollment is open year-round, not just during open enrollment. Call us to see if you qualify.
The honest answer: it depends on your subsidy. If you qualify for a meaningful premium tax credit, a marketplace plan through Pennie is usually the better value. If you get little or no subsidy — the situation many Pennsylvania households found themselves in after the enhanced credits expired at the end of 2025 — an off-exchange private medical plan (a Highmark or Independence Blue Cross PPO, for instance) or employer-level group coverage frequently wins on network, price, or both. A five-minute comparison settles it, and our service is free either way.
Between 55 and 65 and not on Medicare yet? Early retirees in Pennsylvania, people between jobs, and anyone whose spouse is moving to Medicare can compare private PPO, ACA, and COBRA options side by side in our guide to health insurance before Medicare.
Yes — Pennsylvania is one of the few states where individual-market PPOs remain, offered by Highmark, Independence Blue Cross, Capital Blue Cross, and Geisinger, on and off exchange. Employer-level ERISA group plans also provide PPO coverage for those who qualify.
Yes. Every ACA-compliant private plan covers pre-existing conditions — no medical questions, no exclusions. ERISA employer-level group plans cover pre-existing conditions as well, just as with any employer coverage.
Pennie and off-exchange ACA plans: during the annual fall open enrollment period (Pennsylvania's runs through mid-January), or year-round within 60 days of a qualifying life event. Employer-level ERISA group plans: enrollment is open year-round for those who qualify.
Penn Medicine participates with selected plans, and participation can differ between plans from the same insurance company. Some lower-cost HMO and EPO plans in Southeast PA are built around other systems. We check which Pennie and private PPO options at your ZIP code include HUP and Penn Presbyterian before you enroll.
UPMC Health Plan is built around UPMC hospitals, while Highmark plans are built around Allegheny Health Network, and the two often don't overlap. If you want UPMC, we check each option's current network before you enroll.
Hershey Medical Center participates with selected plans from carriers such as Capital Blue Cross and Highmark, and access varies by plan type. Tell us you want Penn State Health and we'll compare the options that include it.
Start with the hospital, not the price. Give us your preferred hospital — Penn Medicine, UPMC, Jefferson, Penn State Health Hershey, Lancaster General, Lehigh Valley, Reading or Geisinger — plus your doctors, and we'll compare every Pennie and private PPO option at your ZIP code that includes them.
No. Premiums are identical with or without an agent — carriers pay us, not you. You get the comparison and enrollment help at no cost.
Compare Every Private Health Plan Available at Your Pennsylvania ZIP Code
Free comparison from a licensed Pennsylvania producer (NPN 2764713) — Pennie, off-exchange, and employer-level options.
Rate change figures are 2026 approved averages from the Pennsylvania Insurance Department; premiums vary by age, ZIP code, and household size. Employer-level group plan availability subject to eligibility requirements.
