If your household is under about 138% of the poverty level (around $1,835 a month for one person in 2026), you likely qualify for Pennsylvania Medicaid at no cost. Between that and about 250%, a Pennie plan may come with a tax credit and reduced deductibles and copays. Nobody at work is going to tell you this.
Text me your age, zip, and roughly what you make a month across all your jobs. I’ll tell you which program you likely fit in before we even talk. If it’s Medicaid, I’ll say so.
I’m Nathan Baughman, owner of BIG Benefits in Doylestown. I don’t only work with people who own a business. If you don’t get coverage from an employer or a spouse, that’s the person I’m here to help, and I don’t charge for it.
Medicaid (Medical Assistance) if you’re under the income line. Free, comprehensive. I’ll point you to the application and help you understand it.
Marketplace (Pennie) with a tax credit if you’re between roughly 138% and 400% of poverty. Under 250%, pick a silver plan: the reduced cost-sharing is where the real value is.
Private, underwritten plan if you’re healthy and your income is higher than the subsidy line, or if you’d rather have a PPO.
Short-term for a gap of up to four months.
You probably qualify for something. Tips count. Sixty days. Watch the 2027 Medicaid changes.
“Nathan was great, looking for insurance for my son and myself… it didn’t make sense for myself to switch right now and he recommended we relook next year.” — Google review
Forgetting tips count. Subsidies are based on the income you report, tips included. Estimating that honestly avoids a surprise at tax time.
Missing the window. Lost hours that dropped you off an employer plan, or aged off a parent’s plan at 26? That’s a 60-day special enrollment period. It closes.
The Medicaid changes coming January 2027. Pennsylvania adults 19–64 on Medicaid will need to renew every six months and, unless exempt, show 80 hours a month of work, school or volunteering. People with variable hours are going to lose coverage. If that’s you, see the Leaving Medicaid page.
1. Is there a maximum out-of-pocket? 2. Is it an unlimited contract? 3. Is it guaranteed renewable? If a plan uses words like “deductible” and “PPO network,” that doesn’t automatically make it actual health insurance. These three questions do.
Send me an age and a zip code and I’ll send back a general idea of what’s available in your area. Twenty minutes, no charge, no pressure. Happy to answer any and all questions so you can make the most informed decision for you, your family, or your business.
