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Shop Affordable Pennsylvania PPO Plans in all 67 Counties

Pennsylvania PPOHave you been shopping for a Pennsylvania PPO plan and not finding what you’re looking for? Or are you just trying to research the Pennsylvania PPO health insurance market and compare PA PPO rates?  At Vista, we pride ourselves on our knowledge of PPOs and plan options. We’ll help  you will find all the information needed to help you shop and compare Pennsylvania PPO plans



Pennsylvania PPOPennsylvania PPO Insurance Carriers

These are the carriers that currently offer Pennsylvania PPO health insurance plans in 2022, however, they are only made available to Small Businesses.  If you’re working individuals, Freelancer, or Self Employed then please call us to get the latest individual carrier PPO plans 



Pennsylvania PPO

What to Know When Shopping for a Pennsylvania PPO Insurance Plan

We have assembled some of the more common concerns when shopping for a Pennsylvania PPO health insurance plan.

Are Your Doctors In-Network – Before signing any health insurance contract, always make find out if your doctor(s) are part of the network even though a PA PPO plan will cover you for any out-of-network services.  Always remember that when you visit an out-of-network doctor, the cost may be substantially higher than if that doctor was in-network.

Always confirm with the Carrier and with your doctor that they are a participating in-network provider. Don’t make the assumption based on the response made by the receptionist. Speak with the office manager to ensure that the office is participating.

Why the concern? Well, bear in mind that if your out-of-network provider suggests services, then most likely all of those services performed by that doctor will be considered will most likely be considered out of network, even if the hospital or facility and providers are in-network.  With a PA PPO health plan, any of your out-of-network medical treatment will count towards your out-of-network deductible and coinsurance.

Lower Monthly Premium May Result in Higher Costs– Health insurance has a simple life formula: the lower your monthly cost is, then most likely you are going to pay higher costs when you use your health plan. If you’re in good health and don’t see any future health-related issues and have few to no prescriptions, then perhaps the best choice would be to opt for a less expensive non PPO plan.

If you do find that your medical and monthly prescription usage is high, then it may be more costly in the long run to purchase a plan with a higher monthly premium. Be sure to make a fair assessment of your current health when shopping for a Pennsylvania PPO health insurance plan.

Health Insurance is a contract –, both parties the insurer and the insured agree to live up to their end of the contract (usually for a length of one year). If you find that mid-year, you’re not happy with your plan, you most likely can’t go back to your insurance company and ask to change coverage.  Do the research and choose the right plan that suits your needs before signing the contract.  If you had insurance through a State Marketplace and it has lapsed, you’re then able to get a PA PPO health plan mid-year, as long as you are employed. 

Types of Insurance Coverage – EPO, HMO, PPO, POS, HDHP, and HSA  describe different types of health coverages, that provide you with or without the need for referrals to see specialists and receive out-of-network and out-of-state coverage. Additionally, different plans may have different requirements relative to the need for referrals. If you’re are receiving care and often see specialists out-of-network then you most likely would want a plan that offers that flexibility.

Those of us who travel often for work or those living in multiple states per year may want to consider a Pennsylvania PPO plan, it offers that flexibility that is needed. The last two types,  HDHP and HSA’s allow you to set up a tax-free savings account specifically for qualified medical costs  For a better understanding of these types of coverage please refer to the following article.

Are Essential Health Benefits Covered? – All Pennsylvania PPO plans cover the 10 essential health benefits. This provides you with a guaranteed minimum level of coverage, which is the standard set by the Affordable Care Act. Why would we need a minimum standard level? Well, the cost of medical care is prohibitive without insurance in place and can often lead to financial ruin. Ensuring that a plan includes the minimum essential health benefits provides a safeguard.



Pennsylvania PPOPennsylvania PPO Rates for 2022

Below is a table of Individual Pennsylvania PPO plan options.  The information included,  such as Rates and benefits are approximated. Please call for specific plan information

  Cigna Elite PPO Advantage 5000 Cigna Elite PPO Silver 3000 Cigna Elite PPO 1000
National National National
In-Network Benefits Cigna PPO OAP Network Cigna PPO OAP Network Cigna PPO OAP Network
Office Co-pay $20 $40 $30
Specialist Co-pay $60 $60 $50
Rx: Generic/Brand/High Brand $0/25%/50% after deductible $0/25%/50% $0/25%/50%
Emergency Room 30% after deductible 30% after deductible 20% after deductible
Hospital Co-pay 30% after deductible 30% after deductible 20% after deductible
Referrals Needed No No No
In-Network Deductible (single/family) $5,000/$10,000 $3,000/$6,000 $1,000/$2,000
Max Out of Pocket (single/family) $8,150/$16,300 $8,150/$16,300 $8,150/$16,300
In-Network Co-Insurance 30% 30% 20%
Out-of-Network Benefits
Deductible $10,000/$20,000 $6,000/$12,000 6,000/$12,000
Out of Pocket Max (single/family) Unlimited Unlimited Unlimited
Co-Insurance 50% 40% 50%
Other Benefits
Vision/Dental Pediatric Vision and Dental Pediatric Vision and Dental Pediatric Vision and Dental
Mental/Substance 30% after deductible 30% after deductible $50
Renewal Date 12/31/2022 12/31/2022 12/31/2022
Single $735.00 $905.00 $1,285.00
Couple $1,400.00 $1,790.00 $2,635.00
E+child $1,213.00 $1,520.00 $2,2215
Family $1,743.00 $2,225.00 $3,305.00
Summary of Benefits Cigna Elite PPO Advantage 5000 Cigna Elite PPO Silver 3000 Cigna Elite PPO 1000



Pennsylvania PPOMost Common Questions Regarding a Pennsylvania PPO Health Plan

How much does a Pennsylvania PPO cost?

Pennsylvania PPO Health plans are more expensive than other plans because of the flexibility that a PPO provides.  Use the table above to see PA PPO rates and shop plans in your state

Does my doctor accept Pennsylvania PPO Insurance?

Using the list above, locate and select your company. Once you’re on their website, locate the PPO network section. Additionally, you can always contact  your doctor’s office, however, its best to verify with the health insurance company

Where can I buy a Pennsylvania PPO health insurance plan?

PA PPO Health plans are purchased through local and web broker representatives that can set the health plan up and also assist with any premium or claims-related issues that you may have during the plan year.  It’s always a better option to work with a broker rep that is appointed with all carriers in your region, giving you a better selection to choose a carrier and plan.

How do I qualify for a PA PPO plan?

The person applying must either be one of the following: employed, self-employed, or a freelancer.

Can I buy a PA PPO plan anytime?

Yes.  Pennsylvania A PPO health insurance plans go into effect at the beginning of any month during the year. Most Companies require the application to be completed by the 15th of the month for a 1st of the month start date.

What happens if I’m not happy with my PA PPO health plan, can I change it?

A PPO  is a contract, that under most conditions cannot be changed until your PPO plan is up for renewal,  usually one year after the start date and often January 1st.  You can change from one  PA PPO company mid-year to another company, however, are no plans within the same company.

What makes a PPO plan special?

PPO health plans are flexible, that’s what makes them stand out. You can go to any health care provider that you choose. That’s a very strong advantage as compared to other plan types, such as HMO plans, where you must use their in-network providers. For those who travel regularly and need to be able to see doctors anywhere in the country find PPO plans especially valuable.

Do I have to be self-employed or part of a group to buy a PA PPO plan?

There two most common ways of getting a PA PPO health plan are: As an employee whose company has a PPO plan option.  Others including individuals, freelancers, and sole proprietors need to join a business association that is offering a PPO.

Does the PA State Exchange sell PPO health plans?

Not for Individual health plans. EPOs and HMO plans are the most common options offered through the Federal Exchange and State Exchanges.  For a small business, yes, though the PPO plan selection is limited.

Do freelancers qualify for PA PPO plans?

Since the creation of the Affordable Care Act,  freelancers, and sole props are considered individuals which means they would need to join a business association that offers Pennsylvania PPO health plans, to purchase an eligible PA PPO plan.

Can seniors 65 and older qualify for a PPO plan?

IF that senior is an Employee of a company that has a PPO option then yes they can opt to keep their plan instead of going on Medicare.  For someone not working, they would not be eligible for a Pennsylvania PPO plan.

Are PA PPO plans offered as short-term medical plans?

Yes here are shot term PPO Plans available however almost all short-term medical plans are not comprehensive health insurance plans. Buyer beware, be sure to review the summary of benefits.

Why are PPO plans more expensive than other types of health plans like HMOs?

Their flexibility and higher reimbursement rates paid to select doctors and hospitals are a key component in their cost. They are almost always more expensive than a standard  HMO where someone must stay within the network and utilize the contracted providers.  Remember that you buying into a plan that provides you with national coverage.

Why are there more hospitals and doctors in a typical PPO plan than non-PPO plans?

National health insurance companies pay select doctors and hospitals above-average reimbursement rates to have them be a part of their PPO network. These are doctors who don’t normally accept the reimbursement rate of lesser plans such as HMOs

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