Pennsylvania Health Insurance Plans

The monthly cost for one person in Pennsylvania varies by age, county, household income, tobacco use, plan tier, and whether coverage is purchased individually or through an employer. Individual-market shoppers may qualify for premium tax credits through Pennie, which can lower monthly costs. When comparing plans, also review deductibles, copays, provider networks, prescription coverage, and the annual out-of-pocket maximum—not premium alone.

Employers can consider fully insured plans, level-funded arrangements, self-funded plans, reference-based pricing strategies, and high-deductible plans paired with HRAs or HSAs. The appropriate option depends on workforce size, budget, claims-risk tolerance, employee needs, and administrative capacity. Franklin Benefits Group compares these structures and helps employers understand the financial, operational, and coverage tradeoffs before selecting a plan design.

With a fully insured plan, an employer pays a set premium and the insurance carrier assumes the financial risk for covered claims. With a self-funded plan, the employer pays claims directly and assumes more risk, often using stop-loss insurance for protection from large claims. Self-funding may offer greater design flexibility and reduced overhead, but it requires careful risk management.

A level-funded plan is a form of self-funding that uses a fixed monthly payment for the plan year. That payment generally covers expected claims, administrative costs, and stop-loss protection. It can provide more predictable budgeting than traditional self-funding, and a surplus may be returned to the employer if claims are lower than expected. Terms and surplus provisions vary by arrangement.

Yes. A Health Reimbursement Arrangement, or HRA, is an employer-owned account commonly paired with a high-deductible health plan. The employer can reimburse eligible medical expenses or some or all of an employee’s deductible, based on the plan design. Unused HRA funds generally remain with the employer, giving organizations flexibility in how they structure and manage their contribution strategy.

Employees may contribute to an HSA when they are enrolled in an HSA-qualified high-deductible health plan and meet applicable eligibility rules. Employers can also contribute. Unlike an HRA, an HSA is owned by the employee, and funds can remain with them if they change jobs. Contribution limits, eligibility rules, and qualified expenses are set annually under federal guidelines.

Employers should begin reviewing their health plan well before renewal to allow time for market analysis, carrier quotes, plan comparisons, and employee communication. A review should also follow major business changes, such as workforce growth, new locations, changing contribution goals, or recurring claims concerns. A Broker of Record change can be made during the plan year without waiting for renewal.

Yes. Franklin Benefits Group supports employers throughout Pennsylvania, with particular local experience in Bucks County and Montgomery County. The team also works with employers whose workforces extend into New Jersey, Delaware, and multiple states. Support includes benefits strategy, carrier comparisons, renewal management, compliance assistance, employee communications, and ongoing guidance for plan-related questions.