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: $$$

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Advanced premium tax credits*

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Cost-sharing reductions*

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

Premium Costs: $$

Out-of-Pocket: $$

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Advanced premium tax credits*

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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: $

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Advanced premium tax credits*

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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! 

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.

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:

Primary Care Provider (PCP):
Choose your PCP (or we'll assign you one) to help coordinate your care

Monthly premiums and out-of-pocket costs:
LOWER $

Out-of-network coverage:
You'll need to see a doctor in our network for most services, except in the case of a medical emergency

PPO:

Primary Care Provider (PCP):
Choosing a PCP is suggested, but not required

Monthly premiums and out-of-pocket costs:
HIGHER $$

Out-of-network coverage:
You have the flexibility to see out-of-network doctors, but it will cost more

Best if:

You care more about affordability or prefer using a PCP to manage your care

Best if:

You care more about flexibility and choice of both in- and out-of-network providers


Find the HMO or PPO plan for you

HMO Plans

Value + Gold + HMO

  • $0 medical deductible
  • $0 virtual care through JeffConnect
  • $0 preventive drugs
  • $0 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 plan brochures.

Plan Brochures

 

*when seeing a Tier 1 provider for HMO plans and an in-network provider for PPO plans. One $0 visit per plan 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
  • $0 first primary care provider (PCP) visit*
  • Low-cost generic and brand name prescription drug coverage

 

Click below to view or download the plan brochures.

Plan Brochures

 

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

  • $0 virtual care through JeffConnect
  • $0 preventive drugs
  • $0 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 plan brochures.

Plan Brochures

 

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

  • $0 medical deductible
  • $0 virtual care through JeffConnect
  • $0 preventive drugs
  • $0 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 plan brochures.

Plan Brochures

 

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

  • $0 virtual care through JeffConnect
  • $0 preventive drugs
  • $0 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 plan brochures.

Plan Brochures

 

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

  • $0 virtual care through JeffConnect
  • $0 preventive drugs
  • $0 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 plan brochures.

Plan Brochures

 

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

Plan Brochures

 

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

Plan Brochures

 

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

Plan Brochures

 

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

Need help finding the right plan for you? Call 1-833-830-1762 (TTY 711) to speak with a licensed benefits advisor.

Call now

PPO Plans

Value + Bronze + PPO

  • $0 medical deductible (in-network)
  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • $0 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 plan brochures.

Plan Brochures

 

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

  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • $0 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 plan brochures.

Plan Brochures

 

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

  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • $0 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 plan brochures.

Plan Brochures

 

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

  • $0 medical deductible (in-network)
  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • $0 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 plan brochures.

Plan Brochures

 

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

  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • $0 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 plan brochures.

Plan Brochures

 

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

  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • $0 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 plan brochures.

Plan Brochures

 

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

  • $0 medical deductible (in-network)
  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • 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 plan brochures.

Plan Brochures

 

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

  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • 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 plan brochures.

Plan Brochures
  • Flexibility for out-of-network provider visits
  • $0 virtual care through JeffConnect
  • 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 plan brochures.

Plan Brochures

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
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$0 Primary Care Visit*

Schedule your visit today!

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$0 Medical Deductible Plans

Affordable options to fit your budget.

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Low-Cost Prescription Drugs

Coverage for brand-name and generic prescriptions.

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Range of Plan Options

Choose the plan that's right for you.

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Strong Network

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

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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.

Frequently 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).

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