Shopping for an ACA Plan

We make enrolling in an Individual & Family plan as simple as possible.

Shopping ACA Plans

Shopping for plans

When choosing a plan, there are a few important things to consider first.

When to sign up

The time in which you can sign up for a plan is called the Open Enrollment Period (OEP). OEP begins on November 1 and runs through December 15. You’ll need to enroll in a plan during that time for coverage that begins January 1. You may be eligible to enroll in a plan outside of this timeframe through a Special Enrollment Period (SEP), as long as you’ve experienced a Qualifying Life Event (QLE) like the loss of a job or the birth of a child.

How to find a plan right for you

Premium vs. Deductible

Weigh your monthly premium against your annual deductible.

  • Lower premiums usually mean higher out-of-pocket costs (deductibles).
  • Higher premiums usually mean lower out-of-pocket costs.

Estimate your yearly costs, not just monthly premiums.

Do you go to your PCP regularly? Do you see a specialist? How many prescriptions do you take? Don’t just focus on monthly premiums when comparing plans. Consider other costs like deductibles, copayments for primary care providers and specialist visits, as well as prescription drug coverage. Sometimes, paying a little more per month can help you save even more money over the course of the year.

It’s also a good idea to talk to your doctor about your current health and your family health history to try and anticipate future surgeries or new prescriptions that you may need down the road.

Are your doctors in network?

Do you have a favorite doctor? Before you pick a plan, make sure they’re in network.

Where to buy your plan

There are two ways to buy an ACA plan: through the Exchange or outside the Exchange. Which one you choose depends on your personal needs and financial situation, but our licensed representatives can help you make the decision.

Through the Exchange

These are Highmark plans that are bought through the federal or state government Exchange. These plans offer extra savings to those who are eligible that can lower monthly premiums and out-of-pocket costs.

Outside the Exchange

These plans are bought directly through Highmark and do not offer financial help. Additional plans may be available off the Exchange.

Highmark Direct stores

At Highmark Direct stores you can speak one-on-one with health insurance advisors who can help you:

  • Compare, pick, and enroll in an individual or family plan.
  • Get answers to health insurance questions, including how to navigate Pennsylvania’s new state-based insurance exchange, Pennie.
  • Handle administrative stuff like scheduling appointments, transferring records, and paying premiums.

Highmark Direct services are available by appointment only — and please note that there are social distancing and mask guidelines in place to ensure everyone’s health and safety.

Find a Highmark Direct location near you.

 

Give us a call at 844-601-4832

Highmark representatives are ready to assist you Monday – Friday, 9 a.m. to 7 p.m. and Saturday 9 a.m. to 2 p.m. They can answer your questions, help you get prepared to enroll, and assist you with navigating Pennie, the new Pennsylvania state-based insurance exchange.

 

New for 2021 OEP: Pennie

This year, the Commonwealth of Pennsylvania will launch Pennie, a new state-based exchange exclusively for Pennsylvania residents that allows you to browse plans, apply for financial help, and enroll. If you’ve previously used the federal exchange at healthcare.gov, Pennie will replace it.

If you qualify for financial help or would like to recheck your eligibility, Pennie is an online option for enrolling in an individual or family plan for 2021. But Highmark is still here to answer your questions, help you get prepared, and to help you enroll.

Can I still enroll on healthcare.gov? That is the site I am familiar with.

Unfortunately no, but you can call our dedicated Highmark representative who can assist you through the process.

How will this new site work?

Just like healthcare.gov, this new site will allow you to browse plans, apply for financial help, and enroll.

I don’t qualify for a subsidy, do I still have to go through this site?

No. You can still enroll directly with Highmark by either using our Highmark Shop site or calling us. But if you qualify for subsidies or CSR, or want to recheck eligibility, you must go through the state exchange or call a Highmark representative.

Additional resources

When you’re shopping for plans, you may want to make sure that your doctors, hospitals, and prescription drugs are covered. These resources will help you do just that.

Plan comparison tool

Healthsherpa

Compare plans in your area, see if you qualify for financial help, and get cost estimates.

Find in-network doctors and hospitals.

Find A Doctor will help you find in-network doctors, hospitals, and facilities.

If you don’t have a doctor, My Care Navigator can help you find one. Call 888-258-3428.

Make sure your prescription drugs are covered.

The Rx Formulary Tool lists all the prescription drugs covered by Highmark plans.