Open Enrollment is here! Enroll now through Jan. 15

Browse our plans now so you have time to choose the right coverage. We have plan options that fit your budget—like plans bundled with vision and dental coverage or $0 copays with UPMC First Care®—can help you meet your budget and care needs.

We’re here for you! Give us a call 1-877-563-0296 (TTY: 711)

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The Value of Choosing UPMC Health Plan

Benefits of Choosing UPMC Health Plan

  • Quality comprehensive coverage 
  • Large, diverse provider network
  • Award-winning customer service1
Benefits of Membership

Health Insurance
Basics

  • Understand the language of health insurance
  • Learn how to buy health insurance
  • See if you’ve experienced a qualifying life event
Health Insurance Basics

Healthcare
Legislation

  • Learn about Pennie®, Pennsylvania's health insurance marketplace
  • Learn about the Affordable Care Act (ACA)
  • See if you qualify for financial
    assistance
Health Care Legislation

Benefits to keep you healthy

Our plans include benefits such as $0 preventive care that covers many health services for adults and children at 100 percent,2 no-cost preventive medications,3 and access to top-ranked doctors and hospitals and an extended network4 to help keep you healthy.

Mental and physical wellness benefits

You can have six free counseling sessions through LifeSolutions®5 and free health coaching to help you take care of your mental and physical health.

Support when you need it

Our video visits platform gives you 24/7 access to treatment that is covered at 100 percent by most plans.6 Use the UPMC Health Plan app to access the platform and your health insurance information. Contact our exceptional Health Care Concierge team for help navigating your benefits through a quick online chat or phone call.

How to Buy Individual Health Insurance from UPMC Health Plan

Choosing health coverage for your family is an important decision. Taking time to explore your options can help you find a plan that fits your healthcare needs and budget. You can compare individual health plans online, shop for coverage, and learn whether you qualify for financial assistance.

Depending on your income and household size, you may be eligible for financial assistance. A subsidy is a form of financial assistance that can that lower your monthly premium. Cost-sharing reductions lower what you pay when you receive care. These forms of financial assistance are available through Pennie®, Pennsylvania's health insurance marketplace.

When you find the health coverage that’s right for your family, you can enroll online. If you need help understanding your options and potential savings, we are here for you. Call us at 1-877-563-0296 (TTY: 711). You can also go to upmchealthplan.com/marketplace.

If you qualify for Medicaid or need help understanding your options, you can contact your local County Assistance Office at 1-877-395-8930 (TTY: 711).

Health Insurance Plans and Services for Individuals and Families in Pennsylvania

UPMC Health Plan offers plans and services to fit a variety of needs. Here you’ll find information on our individual health insurance options, Medicare and Medicaid plans, coverage for children, Special Needs Plans, and other services.

Plans and Services
Plans and Services

About Individual Health Insurance: FAQs

Can I get coverage if I’m self-employed?

Yes! If you're self-employed, you can purchase an individual health insurance policy. You can compare health plans online and learn whether you qualify for financial assistance to lower the cost of coverage.

How much does individual health insurance cost in Pennsylvania?

The cost of individual health insurance varies depending on the type of plan you purchase. There are many options available, allowing you to choose coverage that fits your healthcare needs and budget.

Depending on your income and household size, you may be eligible for financial assistance. Subsidies can help lower your monthly premium, while cost-sharing reductions can lower what you pay when you receive care. These forms of financial assistance are available through Pennie®, Pennsylvania's health insurance marketplace.

When can I enroll?

You can enroll in a plan each year during Open Enrollment, which generally runs from Nov. 1 through Jan. 15. If you experience a qualifying life event, you may be eligible for a special enrollment period. A special enrollment period allows you to enroll in a health plan outside of Open Enrollment. In most cases, you have 60 days from the date of the qualifying life event to enroll in a new plan. If you are already enrolled in a plan and experience a qualifying life event, your options for changing plans during the benefit year may be limited.

Can I keep my doctor?

You may be able to keep your doctor. However, the doctors, hospitals, and facilities you can visit will depend on your plan's network. When selecting a health insurance plan, it's important to check whether your current providers are in the plan's network. Our provider search tool allows you to find medical, dental, vision, and behavioral health providers who can help you get the care you need. To learn if your provider is in our network or to find a new one, visit upmchealthplan.com/find.

1Go to upmchealthplan.com/best for award information. 

2Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

3Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.

4Go to upmchealthplan.com/best for award information. For network access details, visit upmchp.us/networkaccess.

524/7 video visits are available to UPMC Health Plan members who are located in Pennsylvania at the time of the visit. The service is available to members of your household who are 18 years old or older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.

624/7 video visits are available only to UPMC Health Plan members who are in Pennsylvania at the time of their virtual visit. Members may select a UPMC provider, subject to provider availability and discretion. Members or the member’s parent or legal guardian must accurately verify their physical location and that they are in Pennsylvania at the time of the visit. Limitations may apply for members of administrative services only (ASO) plans who have opted out of coverage. A parent or legal guardian must be present during the video portion of the visit for children younger than 18. Providers employed or contracted by UPMC retain discretion regarding the treatment of patients ages 0-2. 24/7 video visits for children ages 0-2 are unavailable from 11 p.m. to 7 a.m. in Pennsylvania.

Contact the plan for more information. Limitations, copayments, and restrictions may apply.