The time to sign up for your 2026 state-based health insurance in Pennsylvania is here! The program, now called Pennie, has replaced the old federal marketplace insurance system. Pam Laye, an expert in health enrollment at Keystone Health, breaks down what you need to know about getting covered.
Why health coverage is a must
Getting sick or injured is rarely on anyone’s to-do list, but almost everyone needs medical help at some point. Health insurance acts as a shield, covering the majority of costs and protecting you from huge, unexpected medical bills.
Without insurance, you’re responsible for the full bill. For instance, a three-day hospital stay could cost you $30,000, or treating a broken leg could be $7,500. Having coverage ensures you pay much less for services and helps you avoid devastating debt. To make it more affordable, the government offers tax credits and subsidies that can lower your monthly payments or reduce out-of-pocket costs like co-pays for doctor visits and prescriptions.
🗓 Key enrollment dates
The annual Open Enrollment period is happening now:
- Start Date: Nov. 1
- Deadline for January 1 coverage: Enroll by Dec. 15.
- Final deadline for Feb. 1 coverage: Enroll by Jan. 15.
If you miss the Jan. 15 deadline, you can only enroll or change plans if you qualify for a Special Enrollment Period. This is usually triggered by major life changes like getting married, having or adopting a child or a change in your current insurance, income or citizenship status.
Who can get Pennie insurance?
Anyone living legally in Pennsylvania is eligible to apply for insurance through Pennie.
Where to learn more
For full details on the program, visit www.pennie.com or call 1-844-844-8040.
During the Open Enrollment period, phone lines are staffed Monday through Friday from 8 a.m. to 7 p.m., and Saturdays from 8 a.m. to 1 p.m. After the enrollment period ends, the hours are Monday through Friday from 8 a.m. to 6 p.m.
Plan choices in Franklin County
In Franklin County, you have three insurance companies to choose from for 2026: Capital Blue Cross, Highmark, and Geisinger. They offer different types of plans:
- PPO (Preferred Provider Organization): Most companies offer PPO plans. You get the best pricing when you see a doctor who is “in-network,” but you can still see providers outside the network for a higher cost that is still cheaper than paying full price.
- EPO (Exclusive Provider Organization): Offered by Highmark, this plan means if you go out-of-network, the insurance will not cover the service, and you must pay the entire bill.
- HMO (Health Maintenance Organization): Offered by Geisinger, this plan limits coverage to doctors and facilities who work with the plan. You must also choose a primary care provider (PCP) within the network for the plan to cover your care.
Plan costs vary widely. Your deductible and out-of-pocket limit (the maximum you have to pay in a year) could range from a low of about $2,000 to as high as $15,800, depending on the plan you select.
Dental and vision coverage
Some medical plans include vision and dental benefits. If not, you can buy a dental plan separately without having to purchase a medical plan.
Already enrolled?
If you were covered by a Pennie plan last year, you will be automatically re-enrolled. However, it is always a smart move to look at your options to see if a better or cheaper plan is available for the new year.
No penalty, but don’t risk it
There is no longer a fine for not having health insurance. But remember, an unexpected trip to the emergency room can lead to massive, years-long debt. Having insurance protects your finances and offers peace of mind during medical emergencies.
How to sign up
You have several easy ways to enroll:
- Online: The most common way is at www.pennie.com.
- By Phone: Call the number above.
- With Free Help: You can meet with a Certified Application Counselor from community resources like Keystone Health’s Outreach and Enrollment Department. They offer free, step-by-step guidance. Call 717-709-7969 to schedule a free appointment.
While brokers and agents can also help, they typically charge a fee. The assistance from a Keystone Certified Counselor is free.
