Looking for the best individual health insurance options in Pittsburgh to use with an ICHRA? You’re in the right place – and there’s good news! The individual coverage HRA (ICHRA for short) is taking off where you live, thanks to a vibrant local individual health insurance market. That means more ACA-compliant, high quality health insurance choices for employees.
|We’ve put together this guide to help employees orient themselves to the local individual health insurance market in Pittsburgh to use with their Individual Coverage HRA. Health insurance can be confusing, and many employees offered an ICHRA will be buying their own health insurance for the first time. We’ve got you covered!|
Who this guide is for:
- Employees shopping for health insurance to use with their ICHRA
- Employers wanting to help their employees make educated decisions about their health plans to use with their ICHRA
- Employers of any size considering implementing an ICHRA
What this guides covers:
What is an ICHRA?
First things first. An Individual Coverage HRA (ICHRA, for short) is a fundamentally new model of benefits that allows employers to set aside tax-free dollars to reimburse employees for health plan premiums that individuals choose themselves. That means employees get to choose the best plan for their family, their unique health needs, and their budget.
2022 Pittsburgh individual health insurance options for ICHRA
Pennsylvania continues to be a success story for this new reimbursement model of benefits. The competitive individual health insurance market, with a strong carrier lineup, innovative broker partnerships, and multiple options in every county sets the stage for ICHRA to thrive.
This builds on an ongoing trend, signaling the health and affordability of the individual health insurance market. More and more employers in Pittsburgh are realizing their benefits dollars stretch further on the individual health insurance market instead of group plans, and this brings ample employee benefits too, like personalization and choice.
Disclaimer: These rates are estimates for Pittsburgh in 2021 in the 15237 zip code. Your premiums may vary and we expect slight changes for 2022. See our window shopping tool to check for exact premium rates in your area.
Pittsburgh’s competitive individual health insurance market and innovative carrier lineup mean more choices for employees. The infographic below demonstrates the wide range of carriers, network types, and average lowest cost premiums by tier.
Pro-tip: To calculate costs for adding a spouse or family to a plan, use double the rate for married, or triple for families.
No longer do employers have to choose between UPMC and Highmark BCBS in Pittsburgh; with ICHRA, employees have a choice.
Disclaimer: Plan information is based on 15237, the most populated zip code in Pittsburgh. Rates will vary by zip code and county.
Remember, all of the plans listed here are ACA-compliant, meaning they cover pre-existing conditions and 10 essential benefits. These benefits include coverage with no annual cap for the following:
- Ambulatory patient services (outpatient services)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
Have questions? Get in touch.
Employees: If you are an employee looking to sign up for individual health insurance in Pittsburgh to use with your ICHRA, our enrollment team is standing at the ready to help. You can set up a call with enrollment team here.
Business owners: If you’re a business owner and have questions about ICHRA, please schedule a time to chat with our HRA Design team to see if ICHRA is a good fit for you.
Brokers: If you’re a broker considering ICHRA as an option for a client, submit an HRA Design request to see if this is a good fit for your client.
The lineup: Pittsburgh’s best individual health insurance carriers to use with ICHRA
Pittsburgh has two carriers to choose from.
These include (in alphabetical order):
- Highmark BlueCross BlueShield
Here’s a Pittsburgh health insurance infographic for a quick visual.
|Highmark BlueCross BlueShield||UPMC|
|Recommended for ICHRA||✔️||✔️|
|Easy Enroll options||✔️||✔️|
*Autopay is a new feature on our platform that enables employers to take advantage of ICHRA and all its benefits without asking their employees to pay premiums out of pocket and wait for reimbursements.
One simple monthly payment that covers all of the reimbursements for insurance premiums (and medical expenses) for all employees. Our platform will manage the payments for employees’ health benefits, reconciling their premiums and allowance with payroll. Learn more here.
*Easy Enroll is a plan feature that allows employees on the Take Command platform to enroll directly in the portal with no further steps needed. This is the simplest type of plan to choose.
*Off-exchange options are important for employees that choose a plan that costs more than their allowance, since they’ll have to put in some of their own money to cover the difference. That difference can be tax-free when combined with a Section 125 payroll deduction but only for off-exchange plans (due to some ACA restrictions).
Here’s another handy infographic that includes some of our favorite things about each individual health insurance carrier in Pittsburgh.
How much does individual health insurance cost in Pittsburgh per carrier?
The below rates are 2021 estimates based on Pittsburgh zip code 15237 only. We will update with 2022 rates as the information becomes available.
What we love:
- $0 copays for telehealth and on most commonly used prescriptions
- Access to the Care Program (aid for special needs, asthma care, diabetes, and more)
- Blue365 program for gym, products, hearing and vision perks
- AutoPay eligible
- Easy Enroll options
- Recommended for ICHRA
Lowest cost by metal tier for Highmark BlueCross BlueShield in Pittsburgh
What we love:
- AutoPay eligible
- Easy Enroll options
- Recommended for ICHRA
- Telehealth visits with 24/7 nurse line
- MyHealth Community discounts for gyms, museums, zoos, etc.
- Free health coaching with local coaches
$0 preventive care that can help you and your family stay healthy. Screenings, immunizations/vaccines, and health exams for adults and children are covered at 100 percent.
No-cost preventive medications.
RxWell, a free app that you can use to cope with mental health and wellness-and build a stronger you.
Top-ranked doctors and hospitals, plus a national extended network when you need it.
Urgent care anytime, anywhere—covered at 100 percent—through UPMC AnywhereCare and UPMC Children’s AnywhereCare.
Six free counseling sessions through LifeSolutions®. You can also have free consultations related to financial wellness, legal issues, and more.
Personal Health Care Concierge
Plan options for UPMC in Pittsburgh
In order of most affordable to most expensive:
UPMC Partner Network (EPO): The network includes all UPMC providers as well as some non-UPMC providers. In a true emergency, you can seek care from any emergency department, even if the hospital is not in the Partner Network. The emergency care you receive will be covered at the in-network benefit level.
UPMC Select Network (EPO): The UPMC Select Network includes all UPMC providers as well as a select group of non-UPMC providers. Like the Partner Network, the Select Network is designed to encourage you to seek care from UPMC providers. However, the Select Network covers more non-UPMC providers than the Partner Network. You can seek care from any emergency department in a true emergency situation, even if the hospital is not in the Select Network. The emergency care you receive will be covered at the in-network benefit level.
UPMC Standard Network (HMO): The UPMC Standard Network gives you access to many high-quality providers. This includes all UPMC doctors and hospitals, a certain group of non-UPMC providers, and most community hospitals. You must select a primary care provider and get a referral to see most specialists. In an emergency, you can visit any emergency department. Your emergency care will be covered at the highest benefit level, even if the hospital does not participate with UPMC Health Plan.
UPMC Premium Network (PPO): The UPMC Premium Network—our highest-priced and broadest network and it is available throughout our service area. This network allows you to use in- and out-of-network providers. The Premium Network also offers the most flexibility in terms of cost sharing. You may pay less if you choose in-network providers than if you choose out-of-network providers. You can seek care from any emergency department in a true emergency situation, even if the hospital is not in the Premium Network. The emergency care you receive will be covered at the in-network benefit level.
Lowest cost by metal tier for UPMC in Pittsburgh
For rates in your area based on your age, family size, and other variables, check out our window shopping tool!
What health plans are in network with your hospitals in Pittsburgh?
|Highmark BlueCross BlueShield||UPMC|
|Allegheny Health Network (i.e., Allegheny General / Valley Hospital)||✔️|
|Saint Clair Health Systems||✔️||✔️|
|University of Pittsburgh Health Care Systems (i.e., anything with UPMC in it)||✔️||✔️|
|Excela Health Systems (Westmoreland, Frick, Latrobe Hospital||✔️||✔️|
Disclaimer: Please check with your provider to make sure they take your insurance as networks can change.
How do I choose the best individual insurance plan for me?
One of our favorite things about ICHRA is that it allows employees to choose the best plan for them, as opposed to a one size fits all group plan where they only have one or two options. At Take Command, we have tools to help employees sort through the options.
- Doctor search: Try out our doctor search tool to ensure that your trusted doctors stay in network with your new health plan. Try out our window shopping tool and search for plans that work with your doctors!
- Prescription search: Prescriptions can also be a big expense! Different carriers cover them differently, so it’s important to price check and take a good luck at formularies for all of your health plan options, especially if there’s something you take regularly to manage chronic conditions. Our new prescription search tool allows you to compare plan coverage and formularies side by side to find the best coverage at the lowest cost to you. Check it out here.
- Be informed! We’ve put together an Open Enrollment Guide that will give you all of our best tips and tricks.
How Take Command can help
With an abundance of quality health insurance plans for employees to choose from throughout the state, Pittsburgh employees are positioned for success in terms of satisfaction with their ICHRA.
Learn more about why Pennsylvania is prime for ICHRA in our blog post on the subject.
- Employees: If you are an employee looking to sign up for individual health insurance in Pittsburgh to use with your ICHRA, our enrollment team is standing at the ready to help. You can set up a call with enrollment team here.
- Business owners: If you’re a business owner and have questions about ICHRA, please schedule a time to chat with our HRA Design team to see if ICHRA is a good fit for you.
- Brokers: If you’re a broker considering ICHRA as an option for a client, submit an HRA Design request to see if this is a good fit for your client.
Other questions? Email email@example.com or chat with us on the website. We’d be pleased to help!