If you’ve been shopping for Medicare plans in Pennsylvania, it can feel a bit like information overload. That’s because Medicare involves several plans, each of which cover different things.
Certain Medicare parts are available directly through the government, while others are sold through private insurance companies. Or you may choose a combination of both.
When you turn 65, you automatically become eligible to enroll in Medicare. This federal health plan is also available to people of any age who have certain disabilities or medical conditions. There are two types of coverage you can get directly from the government:
- Medicare Part A. You can think of this part as hospital insurance. It covers a portion of the cost for inpatient care in a hospital or skilled nursing facility, as well as hospice care and certain home health services.
- Medicare Part B. This part covers a portion of the cost for outpatient care with your regular healthcare provider, and any general medical services and supplies you receive as part of this care.
Together, these parts make up what’s known as original Medicare. You likely don’t need to pay a premium for Part A. If you or your spouse has worked for at least 10 years, you’ve already paid for it through a payroll tax.
Since Part A is usually premium-free, it makes sense to go ahead and enroll in it once you’re eligible.
Part B, on the other hand, does have a premium that varies depending on your income.
While original Medicare covers a significant portion of inpatient and outpatient healthcare services, it doesn’t cover the full amount. You still have to pay copays, coinsurance, and deductibles. Original Medicare also doesn’t cover prescription drugs, dental, vision, or hearing services. However, you can add to your coverage with the following options:
Medicare supplement plans
Medicare supplement plans, sometimes called Medigap, help fill the gaps of what Medicare doesn’t cover. This may include enhanced coverage to help pay copays or coinsurance, as well as coverage for dental, vision, or other services.
You can purchase a Medicare supplement plan from a private insurance company. There are several different types of supplemental plans, depending on your budget and healthcare needs.
Part D plans
Part D is a type of Medicare supplement that specifically adds coverage for prescription drugs.
Medicare Advantage plans
Medicare Advantage, or Medicare Part C, plans offer an “all-in-one” full replacement for original Medicare. You can purchase a Medicare Advantage plan from a private insurance company.
Medicare Advantage plans are required by law to provide all the same coverage as original Medicare, but they typically include significant extras, like prescription drug coverage. Medicare Advantage plans often also include benefits to help with dental, vision, and hearing care, plus health and wellness programs.
The following private insurance companies offer Medicare Advantage plans in Pennsylvania:
- Aetna Medicare
- Capital Advantage Insurance Company
- Clover Health
- Geisinger Gold
- Health Partners Medicare
- Highmark Inc.
- Independence Blue Cross
- Keystone Health Plan Central, Inc.
- Lasso Healthcare
- UPMC for Life
- Vibra Health Plan
These companies offer plans in many counties in Pennsylvania. However, Medicare Advantage plan offerings vary by county, so enter your specific ZIP code when searching for plans where you live.
To be eligible to enroll in Medicare, you must:
Your initial enrollment period for Medicare lasts from three months before your 65th birthday until three months after. During this time, most people choose to enroll in Part A.
If you or your spouse choose to continue working, you may want to continue coverage under your employer-sponsored group health plan. In these cases, you’ll be eligible for a special enrollment period later on.
You can also choose to enroll in a Medicare Advantage plan or switch to a new one during the open enrollment period. This periods runs from Jan. 1 through March 31 each year.
The most important thing to remember when selecting a Medicare supplement or Medicare Advantage plan is that not all plans are structured the same way. Here are some things to consider before choosing a plan:
- What is the cost structure like? How much are the plan premiums? How much will you pay when you receive care or fill prescriptions?
- Does the network include physicians and facilities that are convenient to you?
- Is there coverage for when you travel out of network?
- Will you need to get referrals to seek care from a specialist?
- Does the plan include programs that make sense for you? For example, if you have a chronic health condition, will you have access to a disease management or health coaching plan to support you?
These resources can help you learn more about Medicare enrollment, eligibility, plans, and coverage options.
- Pennsylvania Insurance Department: Visit their website or call the consumer hotline at 877-881-6388
- The Official U.S. Government site for Medicare
- The U.S. Social Security Administration’s site
- An insurance agent can also help you understand the best options to suit your needs
This article was updated on October 2, 2020 to reflect 2021 Medicare information.
The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.