Individual and Family Plans
What is the ACA?

Everything you need to know about the Affordable Care Act

Enacted in March 2010, the Patient Protection and Affordable Care Act, also known as the Affordable Care Act (ACA), is a comprehensive health care reform law. It was established to help more people get access to the health coverage they need.

No matter which Jefferson Health Plans option you choose, each offers coverage for the 10 Essential Health Benefits (EHB) established by the ACA, plus more.

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Why Consider an Individual and Family Plan?

Protecting your health and your finances starts with having the right health insurance. An Individual and Family Plan from Jefferson Health Plans gives you peace of mind with quality coverage designed to fit your needs and budget. Whether you rarely visit the doctor or need regular care, our plans help keep you and your family healthy without breaking the bank.

What’s Included in an Individual and Family Plan?

All Individual and Family Plans include 10 Essential Health Benefits, covering the care you and your loved ones need most:

  • Doctor Visits & Checkups 
  • Emergency Care 
  • Hospital Stays & Surgeries 
  • Pregnancy & Newborn Care 
  • Mental Health & Substance Use Treatment 
  • Prescription Drugs 
  • Rehabilitation & Therapy Services 
  • Lab Tests 
  • Preventative Care & Wellness 
  • Pediatric Care that includes dental and vision care 

Get More with Jefferson Health Plans

We go beyond the basics to offer additional benefits:

  • $0 medical deductible plans available
  • Access to a wide range of doctors, hospitals, and specialists near you
  • No referrals required
  • $0 virtual care, anytime, anywhere
  • $0 first primary care provider (PCP) visit*

 

*When choosing a Tier 1 provider for HMO plans and an in-network provider for PPO plans. 1 $0 visit per plan year.

Ready to protect your health and your wallet?

Explore our plans or call us at 1-833-608-0366 (TTY 711) to speak with a licensed benefit advisor.

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Ways to Save
Need help paying for health insurance? We have good news!

Two types of financial savings are available for those who qualify when you buy one of our plans through Pennie®, Pennsylvania’s Official Health Insurance Marketplace*:

  • Advanced Premium Tax Credits
  • Cost-Sharing Reductions

Your household income and size determine if you are eligible to save on your health insurance. Read more below and see if you qualify.

*Learn more at www.pennie.com or call 1-844-844-8040 for assistance.

The Right Plan, Right Here

Jefferson Health Plans helps protect you and your family's health by offering a range of plans to meet different budget needs, all with quality coverage and access to top doctors and hospitals.

Advanced Premium Tax Credits

This tax credit can be taken in advance of your monthly health insurance payment (also known as “premium”) based on your expected income. If you qualify, you can use all or part of a Premium Tax Credit to reduce your monthly payment when enrolling in a Qualified Health Plan (QHP).**

Cost-Sharing Reductions

If you have a Silver Plan, Cost-Sharing Reductions can lower the amount you pay out of pocket. Reduction amounts vary by household size and income, and they can be combined with a Premium Tax Credit.

 

**Federal financial assistance can only be applied to the purchase of a Qualified Health Plan (QHP), which is an insurance plan that’s certified by the Health Insurance Marketplace®, provides essential health benefits, follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements under the Affordable Care Act.

Need Help Understanding Costs?

We've got you covered.

When choosing a health insurance plan, it is important to understand the different costs involved. These include your monthly premium, deductible, and copays. These costs can vary between plans and affect how much you’ll pay when you get care.

  • Premiums are monthly payments to maintain your coverage.
  • Deductibles refer to a fixed amount you pay for covered medical services before your insurance kicks in.
  • Coinsurance is the percentage of covered medical expenses you pay once you’ve met your deductible.
  • Copays are a fixed amount you pay for doctor visits, prescriptions, or other medical services.
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Additional Resources
Read the Affordable Care Act See if you'll save money Important tax information
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