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How Pennsylvania Realtors Should Compare Health Insurance Plans
Agents compare premiums and stop. Here's the order that actually protects you.
1. Out-of-pocket maximum
The most you can spend in a year on covered care. This is the number that matters in a bad year. Marketplace plans in Pennsylvania cap around $9,200 individual; private PPOs commonly $6,000–$9,000.
2. Network — and where it works
Is your doctor in it? Is the hospital you'd actually go to in Philadelphia County in it? Does it work in another state? HMO vs. PPO decides this. Cigna, Aetna and PHCS PPO PPOs are national.
3. Deductible
How much you pay before the plan pays. Healthy agents usually do best with a mid-range deductible and lower premium, plus an HSA.
4. Premium
Only now. And compare net of subsidy if you qualify, net of the self-employed deduction either way. Pennsylvania has a flat 3.07% state income tax and many municipalities add earned-income taxes, so the self-employed premium deduction helps at the federal level and the state tax is simple.
5. Enrollment flexibility
Marketplace: once a year. Private: any month. If your income is volatile, flexibility has value.
Pennsylvania runs its own marketplace, Pennie, and hospital systems like UPMC and Jefferson are so central that many buyers choose a plan around their doctors — which is exactly what a PPO network question looks like.
Our quoting tool shows every private plan in Pennsylvania with deductible and out-of-pocket max side by side. Or check your options and we'll compare both markets for you.