Individual and Family Plans

Find Your Plan

Looking for quality coverage and big savings? Jefferson Health Plans offers a variety of plans. Choose the right option for you!

Count on us for affordable plans, access to top providers near you, no referrals, and more! Explore our plans in more detail below.

Ready to enroll?

Call 1-833-608-0366 (TTY 711)

Shop Plans

By clicking Shop Plans, you will be redirected to pennie.com.

Which metal tier is right for you?

We offer plans in three metal tiers: Bronze, Silver, and Gold. Choose a plan in a metal tier that best suits your healthcare needs and budget. You can count on the same quality of coverage across tiers.

BRONZE

Premium Costs: $

Out-of-Pocket: $$$

	Advanced premium tax credits*
	Cost-sharing reductions*

BEST IF: You don't go to the doctor often and want lower premiums

SILVER

Premium Costs: $$

Out-of-Pocket: $$

	Advanced premium tax credits*
	Cost-sharing reductions*

BEST IF: You want to pay a lower premium and keep out-of-pocket costs lower

GOLD

Premium Costs: $$$

Out-of-Pocket: $

	Advanced premium tax credits*
	Cost-sharing reductions*

BEST IF: You go to the doctor often and want lower out-of-pocket costs

Which plan type should you choose?

Deciding between a health maintenance organization (HMO) and preferred provider organization (PPO) plan can feel overwhelming, but we’re here to help! Look at the chart below for a breakdown of the differences between these plans. No matter which one you choose, you get affordable, quality coverage.

HMO

HMO stands for health maintenance organization. HMO plans typically require you to select a primary care provider (PCP). Your PCP will coordinate your care and provide referrals to specialists when needed.

With an HMO plan from Jefferson Health Plans, you do not need a referral to see a doctor, specialists, or other providers in the network. Care outside the network is generally only covered in case of an emergency. HMO plans usually have lower monthly premiums and out-of-pocket costs.

PPO

PPO stands for preferred provider organization. PPO plans offer more flexibility.

You can see any doctor, including out-of-network providers, without a referral. Seeing providers in the network costs less.

PPO plans typically have higher premiums but give you more freedom to choose your providers.

Find the HMO or PPO plan for you

$0 Deductible + Bronze + HMO

$0 medical deductible*
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
FREE first primary care provider (PCP) visit*
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible*
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible*
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Need help finding the right plan for you? Call 1-833-435-1990 (TTY 711) to speak with a licensed benefits advisor.

Call now

$0 Deductible + Bronze + PPO

$0 medical deductible (in-network)
Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Affordable premiums
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible (in-network)
Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
FREE first primary care provider (PCP) visit*
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

$0 medical deductible (in-network)
Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Flexibility for out-of-network provider visits
$0 virtual care through JeffConnect
$0 preventive drugs
Two FREE primary care provider (PCP) visits**
Comprehensive medical and hospital coverage
Broad provider network with doctors near you
No referrals required
Low-cost generic and brand name prescription drug coverage

Click below to view or download the 2025 plan brochures.

Plan Brochures

*when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans

**when seeing Tier 1 providers on HMO plans and in-network providers on PPO plans; visits are per benefit year

Need help finding the right plan for you? Call 1-833-608-0366 (TTY 711) to speak with a licensed benefits advisor.

Call now

Member Benefits

No matter which plan you choose, you can count on these benefits:

Learn More

$0 Primary Care Visit*

Schedule your visit today!

$0 Medical Deductible Plans

Affordable options to fit your budget.

Low-Cost Prescription Drugs

Coverage for brand-name and generic prescriptions.

Range of Plan Options

Choose the plan that's right for you.

Strong Network

Access to more than 13,000 providers,** including many near you!

No Referrals Needed

Direct access to doctors, specialists and more.

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

**Network size based on Jefferson Health Plans data as of July 2025.

Commonly Asked Questions

Metal tiers — Bronze, Silver, and Gold — help you compare plans based on your budget and health needs. The difference between the tiers is based on how the cost of covered services is split between what the health insurance plan pays and what you pay. The quality of care you get in a plan is the same across metal tiers.

Bronze: Lower monthly premiums, higher costs when you use care
Silver: Moderate premiums and out-of-pocket costs
Gold: Higher premiums, lower costs when you use care

If you qualify for Cost Sharing Reductions to lower your costs, you must enroll in a Silver plan to use this benefit.

Think about your health needs and budget to find the best match for you and your family.

If you don’t visit the doctor often and want lower monthly premiums, consider Bronze plans.
If you want a balance between monthly costs and lower costs when you need care, Silver plans may be a good fit. Silver is the only metal level that qualifies for both the advanced premium tax credits (APTC) and cost-sharing reductions if you are eligible.
If you visit the doctor regularly or take prescriptions often, Gold plans can help lower your out-of-pocket costs.

Our plans offer comprehensive medical and hospital coverage, plus more. Plans include the 10 Essential Health Benefits (EHBs) listed below:

Hospitalization
Prescription drugs
Laboratory services
Pregnancy, maternity and newborn care
Ambulatory outpatient services
Emergency services
Mental health and substance use disorders
Rehabilitative care
Preventive and wellness services
Chronic disease management

During Open Enrollment, which runs from November 1 to January 15, you can buy a new plan, renew your plan, or make changes to your plan.

During the Special Enrollment Period, from January 16 to October 31, you may be able to shop for or make changes to your plan if you have had a qualifying life event such as loss of health coverage, changes to your household like getting married or having a baby, or a change in residence.

If you applied for coverage through Pennie®, Pennsylvania’s official health insurance marketplace, and want to make changes to your plan, you will need to contact Pennie®.

A primary care provider (PCP) is the doctor you see for most of your health care needs. To find a primary care provider, use our online directory, or call us at 1-833-422-4690 (TTY 1-877-454-8477).

HMO stands for Health Maintenance Organization. HMO health plans require you to select a primary care provider, or PCP, who will be your main medical contact for routine care and to recommend other in-network providers when needed for specialty care. Services are covered when you seek care from providers within the HMO network. If you go outside of the network for care, typically only emergency services are covered.

Jefferson Health Plans require you to choose doctors and hospitals within the HMO network. If you need assistance finding the right in-network provider, use our online directory.

Yes. With JeffConnect, you can access a board-certified provider 24/7. JeffConnect is a convenient and affordable alternative to an office visit or urgent care when you have a medical concern that is not an emergency.

Yes. All plans from Jefferson Health Plans cover mental health and substance abuse services.

Your health care coverage is considered in-network when you use a provider, hospital, or facility that participates in our HMO network. To find out if a provider is in-network, use our online directory.

Yes. With Jefferson Health Plans, you are covered for medically necessary services for unexpected illnesses or emergency care no matter where you seek care.

Yes. All Jefferson Health Plans provide prescription drug coverage. Many plans offer low-cost Tier 1 and Tier 2 generic prescription drugs to help you save.

The drug formulary is a list of medications selected by Jefferson Health Plans for their medical effectiveness, positive results and value. It includes all generic medications plus a defined list of brand-name medications. You can save money by using medications that are included on the formulary.

To locate a participating pharmacy, use our convenient search tool. You can also call us at 1-833-435-1990.

Yes. Our health plans actually offer low-cost generic Tier 1 and Tier 2 drugs with no deductibles. Generic drugs are as safe and effective as brand-name drugs and could cost less.

Tier 1 prescription drugs are commonly prescribed preferred generic drugs. Tier 2 prescription drugs are also generic drugs, but they cost a little more than those in Tier 1. In many cases, you can save money by choosing these types of drugs over more expensive brand-name ones.

A copay, copayment, is the fee you pay when you see a doctor or receive other services.

A deductible is the amount you pay each year before your health plan starts paying for covered services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of the costs for health services. Once you have paid this amount, your insurance will begin to pay a portion, or all, of your health care costs, depending on the health plan.

If you choose a health plan with a high deductible, you will have a lower monthly premium. If you choose a health plan with a low deductible, you will have a higher monthly premium.

This is the maximum amount you’ll pay for health care services in a plan year. Care for covered services you receive after you reach the out-of-pocket maximum will be fully covered by the health plan. Out-of-pocket maximums vary by plan and can be found in your benefits brochure. The out-of-pocket maximum does not include premiums or charges for covered services that are not Essential Health Benefits (EHBs).

Find Your Plan

Premium Costs: $

Out-of-Pocket: $$$

Premium Costs: $$

Out-of-Pocket: $$

Premium Costs: $$$

Out-of-Pocket: $

Find the HMO or PPO plan for you

HMO Plans

$0 Deductible + Bronze + HMO

Need help finding the right plan for you? Call 1-833-435-1990 (TTY 711) to speak with a licensed benefits advisor.

PPO Plans

$0 Deductible + Bronze + PPO

Need help finding the right plan for you? Call 1-833-608-0366 (TTY 711) to speak with a licensed benefits advisor.

What are Metal Tiers?

How Do I Decide Which Metal Tier to Purchase?

What are the 10 Essential Health Benefits covered by Jefferson Health Plans’ Individual and Family Plans?

When can I buy or make changes to my health plan?

What is a primary care provider (PCP)?

What is an HMO?

Can I choose any doctor?

Do your health plans include virtual visits?

Are mental health services covered?

What does in-network mean?

Are emergency services covered?

Are prescription drugs covered?

What is a drug formulary?

How do I find an in-network pharmacy?

Are low-cost generic prescription drugs available?

What are Tier 1 and Tier 2 prescription drugs?

What is a copay?

What is a deductible?

What does out-of-pocket maximum mean?