Before you start

Pennsylvania residence
Income information for subsidy or Medical Assistance eligibility
An SSN or ITIN for the marketplace application
A qualifying life event, if enrolling outside the annual open-enrolment window

Step-by-step

1
Enrol in your employer's plan within the new-hire window
Typically 30 days from your start date, and missing it can mean waiting for the next open enrolment. Compare the deductible and out-of-pocket maximum, not just the premium.
Via employerWho: YouFirst 30 days of employment
2
Check Medical Assistance eligibility first
Pennsylvania expanded Medicaid — called Medical Assistance here — covering adults up to 138% of the federal poverty level. Newcomers on modest early incomes frequently qualify, and enrolment runs year-round rather than in a window. Apply through the Department of Human Services or through Pennie, which screens for it.
OnlineWho: You
3
Without an employer plan, use Pennie — not HealthCare.gov
Pennsylvania runs a state-based exchange. Going to the federal site will send you back. Pennie sets its own open-enrolment dates and its own special-enrolment provisions, and it is the only route to federal premium tax credits and silver cost-sharing reductions in Pennsylvania. Check the current dates on Pennie rather than assuming the federal calendar.
OnlineWho: You
4
Choose the plan by hospital system, not only by premium
UPMC and Allegheny Health Network each own hospitals AND an insurance arm, so networks in this region are drawn along ownership lines in a way they are not elsewhere. Establish which system your nearest hospital, your children's paediatrician and any specialist you already need belong to, then work backwards to the plan. Switching mid-year needs a qualifying life event.
OnlineWho: You
5
Check the specific plan, not the insurer's name
UPMC and Highmark reached a long-term agreement in 2019 giving Highmark members in-network access to UPMC providers, which ended a bitter public dispute. It does not mean every product from either side includes the other — narrow-network options exist on both. Read the network document for the plan you are actually buying.
OnlineWho: You
6
Register with a primary care physician in month one
Do it while you are well. An established relationship is what gets you referrals and urgent slots later, and confirming the practice is in your network before the first visit avoids an out-of-network bill for a routine appointment.
In personWho: YouMonth 1
7
Learn the urgent care versus emergency room distinction
An emergency room visit for something a clinic could treat can cost a great deal even when insured. Urgent care handles fractures, stitches and infections far more cheaply. Pittsburgh has both in quantity; the difference is which door you walk through.
In personWho: You

Documents you’ll need

Proof of Pennsylvania residence
Income documentation for subsidies or Medical Assistance
SSN or ITIN
Immigration documents for marketplace eligibility categories
Evidence of losing prior coverage, if using a special enrolment period

Things most newcomers don’t know

Pennsylvania runs its own marketplace, so the federal deadlines are the wrong deadlines.

Several states in this app use HealthCare.gov. Pennsylvania does not — Pennie is a state-based exchange with its own enrolment calendar and its own special-enrolment rules, and it is the only place to get premium tax credits here. People arriving from a federal-marketplace state routinely diary the wrong date.

Source: Pennie

In Pittsburgh the insurer and the hospital are frequently the same company.

UPMC and Allegheny Health Network are both integrated payer-providers. That is unusual, and it means the usual advice to 'pick a plan then find a doctor' runs backwards here: the plan you buy is effectively a choice of which hospital system treats your family for the next year. Work out where you want to be treated first.

Source: community-reported

The UPMC–Highmark peace is real but not universal.

After years of litigation and consent decrees, UPMC and Highmark signed a long-term agreement in 2019 giving Highmark members in-network access to UPMC doctors and hospitals. Narrow-network products on both sides still exclude the other's facilities. Reading the network list for the specific plan is a ten-minute job that prevents a very expensive surprise.

Source: UPMC — Highmark agreement

Medicaid expansion means no coverage gap here.

Pennsylvania expanded Medicaid, so an adult earning below the subsidy floor is covered rather than falling into the hole that persists in non-expansion states like Florida and Texas. For a newcomer whose first months are lean — a spouse not yet working, a contract not yet started — that is a real safety net, and it enrols year-round.

Source: Pennsylvania Department of Human Services

Common mistakes to avoid

Going to HealthCare.gov instead of Pennie and losing time.
Assuming the federal open-enrolment dates apply in Pennsylvania.
Missing the 30-day new-hire enrolment window at a new employer.
Choosing a plan on the insurer's name rather than reading the actual network list.
Committing to a neighbourhood before checking which system its hospitals belong to.
Missing a Medical Assistance renewal and losing coverage you still qualified for.

Some of this may be out of date. Spotted something inaccurate? Help us keep it right for the next newcomer.