Health insurance · Pennsylvania
ACA Marketplace Health Insurance in Pennsylvania
Pennsylvania has expanded Medicaid: an adult qualifies up to about $22,025 in 2026, and marketplace subsidies pick up above that.
- Under 65
- Pennie
- Financial assistance for those who qualify
Marketplace coverage in Pennsylvania
Pennsylvania’s Medicaid expansion covers an adult earning up to about $22,025 in 2026 — 138% of the federal poverty level — and Pennie, the state’s own exchange rather than healthcare.gov, applies the premium tax credit to everyone above that line.
A real person calls you back.Licensed agents in our Greenwood Village, Colorado office — not a call center, not a robot.
Where Pennsylvania residents buy marketplace coverage
Every plan sold on the marketplace covers the ten essential health benefits, none can decline you or charge more for a pre-existing condition, and the premium tax credit is applied through the same application.
Pennie
Pennsylvania marketplace plans are sold through Pennie. It is a state-based marketplace with its own enrollment system and its own open enrollment window. A licensed agent can enroll you there at no extra cost — the carrier pays us; your premium does not change. See how ACA marketplace plans work.
Medicaid expansion in Pennsylvania
Pennsylvania has expanded Medicaid. An adult with household income up to about 138% of the federal poverty level qualifies for Pennsylvania Medicaid rather than a marketplace plan — in 2026 that is roughly $22,025 for one person, $29,863 for two, $37,702 for three and $45,540 for four. Above those lines the premium tax credit takes over and is applied to a marketplace plan. There is no coverage gap: the application checks income first and routes each household to the right program. Expansion status per KFF’s Medicaid expansion tracker (as of August 2026) and medicaid.gov; income lines from the 2026 HHS poverty guidelines.
What you would actually pay, and when you can enroll
The sticker price is not what most people pay
Premium tax credits are based on your household income and household size, and they are applied directly to your monthly premium rather than paid back at tax time. We check what you qualify for before you pick a plan, so you are comparing what you would actually pay each month, and we tell you if a plan’s deductible or network makes the cheapest premium a poor choice.
Open enrollment in Pennsylvania
Open Enrollment is the annual window when anyone can sign up for a marketplace plan or change the one they have. It generally runs from November into January. Pennie is a state-based marketplace and sets its own window, which has often run longer than the federal one. Outside that window you need a qualifying life event — losing job coverage, moving, marriage, or a new child — to enroll. Dates are set each plan year; a licensed agent will confirm the current ones on the call.
Turning 65 in Pennsylvania?
If you are turning 65, or already have Medicare, a marketplace plan is usually the wrong product: once Part A and Part B begin, the premium tax credit ends and Medicare becomes primary. The natural next step is a Medicare Advantage plan for your county.
Pennsylvania insurance regulation
Pennsylvania Insurance Department
Marketplace plans sold in Pennsylvania are regulated by the Pennsylvania Insurance Department, which approves the plans and rates carriers may offer, licenses the agents who sell them and handles consumer complaints.
Common questions in Pennsylvania
Where do Pennsylvania residents buy marketplace coverage?
Through Pennie, Pennsylvania’s own exchange, not healthcare.gov. Pennie checks Medicaid eligibility first — about $22,025 for one person in 2026 — then calculates the premium tax credit for everyone above that line. A licensed agent can help you enroll at no extra cost.
Has Pennsylvania expanded Medicaid, and what is the income line?
Yes. Household income up to about 138% of the federal poverty level — roughly $22,025 for one person, $29,863 for two, $45,540 for four in 2026 — qualifies for Pennsylvania Medicaid. Above that, premium tax credits apply to a Pennie plan, so Pennsylvania has no coverage gap.
Is Pennie’s open enrollment the same as healthcare.gov’s?
Not necessarily. Pennie is a state-based marketplace and sets its own window, which has often run longer than the federal one. The dates are set each plan year; we confirm the current Pennie window on the call.
I am turning 65 in Pennsylvania. What happens to my Pennie plan?
Once Medicare Part A and Part B begin, the premium tax credit ends and Medicare becomes primary, so the Pennie plan should end when Medicare starts; tell both Pennie and your agent the start date so you are not billed for a month you cannot use. PA MEDI, the state’s Medicare counseling program at 1-800-783-7067, is a free second opinion on the Medicare Advantage plans filed for your Pennsylvania county.
Prefer we call you? Here is what happens next.
A real person calls you back.Licensed agents in our Greenwood Village, Colorado office.
A licensed agent calls you back
During business hours: Monday to Friday 9 to 7, Saturday 9 to 5, Mountain Time.
We focus on what you actually need
Tell us whether you need help with Final Expense insurance, Medicare or another health coverage question. Your agent reviews the options that apply to your situation.
You decide what fits
We explain the important differences and next steps. If an option makes sense, we can help you move forward. There is no fee for speaking with us.
Sources
- Pennie — the marketplace for Pennsylvania
- medicaid.gov — Adult Coverage Expansion map and the May 2026 Medicaid & CHIP enrollment highlights (expansion status)
- Pennsylvania Insurance Department — state insurance regulator
- Wikimedia Commons — state outline (CC0)
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Last updated: September 2026