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.
The Centers for Medicare & Medicaid Services (CMS) reported the following information on Medicare trends in Pennsylvania for the 2021 plan year:
- A total of 2,773,770 residents of Pennsylvania are enrolled in Medicare.
- The average Medicare Advantage monthly premium decreased in Pennsylvania compared to last year — from $44.65 in 2020 to $38.97 in 2021.
- There are 246 Medicare Advantage plans available in Pennsylvania for 2021, compared to 241 plans in 2020.
- All Pennsylvania residents with Medicare have access to buy a Medicare Advantage plan, including plans with $0 premiums.
- There are 12 different Medigap plans offered in Pennsylvania for 2021.
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.
- 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 healthcare services.
- Medicare Part B. This part covers a portion of the cost for outpatient care with a healthcare professional and any medical services, tests, and supplies you receive as part of this care.
Together, these parts make up what’s known as original Medicare. While it covers, a significant portion of inpatient and outpatient healthcare services, it doesn’t cover the full amount.
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 Advantage in Pennsylvania
Medicare Advantage, or Medicare Part C, plans offer an “all-in-one” 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
- Independence Blue Cross
- Keystone Health Plan Central
- Lasso Healthcare
- UPMC for Life
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.
Medicare supplement plans in Pennsylvania
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.
Many companies offer Medigap plans in Pennsylvania. In 2021, some of the companies offering Medigap plans throughout the state include:
To be eligible to enroll in Medicare, you must:
- be at least age 65 or older
- have a qualifying disability, regardless of your age
- have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), regardless of your age
When can I enroll in Medicare Pennsylvania plans?
Your initial enrollment period for Medicare lasts from 3 months before your 65th birthday until 3 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 January 1 through March 31 each year.
Tips for enrolling in Medicare in Pennsylvania
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.
- More than 2.7 million Pennsylvania residents are enrolled in Medicare.
- There are several private insurance companies offering various types of Medicare Advantage and Medigap plans throughout the state.
- Overall, monthly premium costs have decreased for 2021 Medicare Advantage plans in Pennsylvania.
- There are also several Medigap plan options if you live in Pennsylvania and are looking for additional coverage.