Medicare, the federal health insurance program based in the US, provides coverage to lower hospital bills for people aged 65 and above or people with certain disabilities who qualify for Medicare.
This extensive program features many plans covering different aspects of healthcare insurance. For example, the standard plan, Original Medicare, features parts A and B covering inpatient and outpatient care, respectively.
Since Medicare has complex programs, it’s best to learn about all your available options before enrolling yourself into a plan. Let us look into Medicare plans in Pennsylvania.
Medicare in Pennsylvania
As with the rest of the US, Medicare in Pennsylvania also runs as a fee-for-service program, providing access to healthcare insurance.
Given the aging population of Pennsylvania, Medicare plans have now become more important than ever. A surprising 2,875,916 Pennsylvania residents are enrolled in Medicare.
With time, Medicare plans in Pennsylvania have gained popularity amongst senior citizens. As a result, there has been an increase in the number of Medicare Advantage plans from 262 in 2023 to 281 in 2024.
General Analysis | Ratings of Medicare Plan Providers in Pennsylvania
| Insurance Company | Medicare Rating | A.M. Best rating | Better Business Bureau (BBB) rating | J.D. Power ranking |
| Aetna | 4 stars | A+ | A+ | 6th out of 9 |
| Cigna | 4 stars | A- | Not rated | 8th out of 9 |
| Highmark | 4.5 stars | A | A- | 3rd out of 9 |
| Humana | 4 stars | A- | A+ | 2nd out of 9 |
| UnitedHealthcare | 3.5 stars | A- | A | 4th out of 9 |
Medicare in Pennsylvania by the Numbers
According to the 2024 demographics, the total number of Medicare beneficiaries in each plan is as follows.
| Total number of people enrolled in Medicare | Medicare Advantage plans | Medicare Supplement Plan (Medigap) | Medicare Part D (Prescription Drug Coverage) |
| 2.8 million beneficiaries. | Nearly 49% (1.3 million) of all Pennsylvania residents with Medicare are enrolled in private Medicare Advantage plans. | More than 31.86% (701,000) of Pennsylvania residents are enrolled in Medigap plans. | About 26.82% (590,020) of Medicare beneficiaries in Pennsylvania have stand-alone Medicare Part D. |
Type of Medicare Plans in Pennsylvania
Medicare beneficiaries in Pennsylvania can choose Original Medicare, Medicare Advantage plans, Medicare Prescription Drug Coverage Plans (Part D), and Medicare Supplement Insurance Plans (Medigap).
If you fulfill the eligibility criteria, you can enroll yourself into any of these plans for cost-efficient coverage options.
However, before choosing a Medicare program, you must look into your healthcare concerns and what each plan offers for Pennsylvania residents.
This can help you effectively meet your healthcare insurance needs. Let us look into the various available plans in Pennsylvania.
Original Medicare
The standard Medicare plan, also known as Original Medicare, is a fee-for-service insurance comprising two parts. Original Medicare Part A is hospital insurance, while Part B is medical insurance.
Medicare Part A covers your hospital stay, skilled nursing facilities, and lab tests, while Part B provides coverage for doctors’ visits, home health care services, preventive care, etc.
With Original Medicare, you have to pay a deductible along with the fee incurred during your outpatient or inpatient visit.
Enrolling yourself into Original Medicare provides you more flexibility as compared to other Medicare plans as Original Medicare does not have a limited network of healthcare physicians.
You can utilize Medicare facilities at any hospital across the United States that collaborates with Medicare. Thus, Original Medicare comes with more flexibility for beneficiaries and is ideal for those who travel a lot.
Medicare Advantage Plans (Part C)
Beneficiaries enrolled in Original Medicare can have access to Medicare Advantage plans (Part C), which comprise Part A and Part B coverage through private health insurance companies.
Medicare Advantage plans also offer additional benefits, working as a one-stop solution to all your healthcare insurance needs. These benefits include coverage for vision, hearing, dental care, and wellness programs.
As of 2024, nearly 49% of all Pennsylvania Medicare beneficiaries are enrolled in Medicare Advantage plans. This considerable figure represents a steady increase in beneficiaries joining Medicare Advantage plans in Pennsylvania.
In 2024, Pennsylvania is served by 281 Medicare Advantage plans. With such a huge number of Medicare Advantage plans available, it may seem daunting to pick a plan that suits you best. Here is a list of the best Medicare Advantage plans available in Pennsylvania.
- Aetna Medicare
- Cigna
- Clover Health
- Health Partners
- Highmark
- Humana
- Independence Blue Cross
- UnitedHealthcare
- Wellcare by Allwell
However, Medicare Advantage plans come with certain limitations. For instance, these plans are offered by private health insurance companies that work within a restricted network of healthcare providers.
If you’re enrolled in a specific network, you cannot consult a specialist outside of your network without a referral. To seek treatment outside the network, you need prior authorization.
Types of Medicare Advantage Plans in Pennsylvania
- Health Maintenance Organizations (HMOs)
- Preferred Provider Organizations (PPOs)
- Special Needs Plans (SNPs)
- Private Fee-For-Service Plans (PFFS)
Medicare Prescription Drug Coverage (Part D)
Medicare Prescription Drug Coverage, popularly known as Part D, covers the cost of prescription medicines.
Beneficiaries with Original Medicare can apply for Part D regardless of resources, health status, and income, as this coverage helps lower prescription bills by covering the cost of drugs.
Part D includes a monthly premium that varies from company to company, but generally, a yearly deductible applies to coinsurance and copayments for prescription drugs.
One notable factor about Part D coverage is that a late penalty applies for those who are initially eligible but do not enroll themselves for prescription drug coverage even when they do not have creditable drug coverage.
This encourages beneficiaries to enroll on time before they need expensive medication.
This strategy helps with the Medicare plan’s cost management. Therefore, you must annually review your drug prescription before the open enrollment period to make changes to your Medicare plan to avoid future penalties and high premiums.
In Pennsylvania, about 26 stand-alone Part D prescription drug plans are offered with premiums costing $5 to %193 per month.
Medicare Supplement (Medigap)
Medicare supplement, also known as Medigap, is a secondary coverage plan that provides beneficiaries with additional health insurance to lower out-of-pocket costs.
However, to have access to Medicare supplements, you must be enrolled in Original Medicare as it does not operate independently.
Medigap only provides coverage for the aspects of healthcare insurance not included under Original Medicare. Therefore, it is called supplemental insurance. In Pennsylvania, 67 insurers offer Medigap to people aged 65 or above or those who qualify for Medicare due to a disability.
Cost of Medicare Plans in Pennsylvania 2024
The cost of Medicare plans in Pennsylvania varies depending on the coverage option you select and the type of plan you choose.
Original Medicare Part A has premiums, deductibles, and coinsurance rates set federally, while Part B depends on your income.
Medicare Advantage plans have varying costs depending on the type of coverage and additional benefits it offers. The average monthly premium for Medicare Advantage decreased last year from $30 to $27.
| Original Medicare | Medicare Advantage | Medigap | Part D |
| Part A premium: $0 to $506 per month Part B premium: $164.90 per month | Average monthly premium in 2024 for a Medicare Advantage plan in Pennsylvania is $27.94. | $90 – $175 | $62.80 |
Eligibility and Enrollment for Medicare in Pennsylvania
What makes you eligible for Medicare in Pennsylvania? Medicare has the same eligibility criteria across all the States. You qualify for Medicare if:
- You are 65 years old or above
- You have a medical disability
- You have end-stage renal disease (ESRD)
- You have amyotrophic lateral sclerosis (ALS)
You must be approved by the Social Security Administration for either your age or disability to be eligible for Medicare.
Enrolment Period for Medicare Plans in Pennsylvania
Medicare has an initial enrolment period (IEP) and a general enrolment period (GEP). The initial enrollment period is 7 months, starting 3 months before your 65th birthday.
However, if you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) between January 1st and March 31st every year.
How to Choose the Right Medicare Plan in Pennsylvania
Before you choose a Medicare plan in Pennsylvania, you must evaluate your healthcare needs, preferences, and budget.
Assessing your medical needs can help you figure out a rough estimate for your prescription drugs for the following year. You can also get an idea about your hospital stays and routine checkups.
Moreover, comparing the costs of various Medicare plans can help you make a cost-efficient decision. You must also check the formulary of Part D plans to make the most of your prescription drug coverage.
In addition to this, you must utilize resources such as the Pennsylvania Department of Aging to better understand Medicare plans in your area. Here are some key factors to consider when choosing your Medicare plan.
Key Factors to Consider Before Applying for Medicare
- Consider your health status and medical needs for the following year.
- Look into Medicare premiums, deductibles, coinsurance, and copayments to make a financially reasonable decision.
- Look into the Medicare plan’s network to learn more about healthcare professionals in Pennsylvania.
- Consider Medicare Advantage plans if you require extra benefits that Original Medicare doesn’t cover.
Applying for Medicare in Pennsylvania
Applying for Medicare in Pennsylvania is a straightforward procedure. You can apply online, through mail, or by visiting your nearest Social Security Office.
If you receive your social security benefits you automatically get enrolled in Part A and B. You receive your Medicare ID in the mail before your 65th birthday. However, if you’re new to Medicare, you can sign up during the initial enrollment period beginning three months before you turn 65.
To streamline the enrollment process, you can seek professional advice from Silveredge’s licensed advisors. They can effectively resolve your Medicare-related queries, helping you make cost-efficient decisions.
Tips for Enrolling in Medicare in Pennsylvania
Medicare programs tend to vary from plan to plan. Thus, it’s crucial to enroll yourself in a plan that suits you best. Original Medicare and Medicare Advantage plans significantly differ from each other.
However, these are the two primary available plans in Pennsylvania. Therefore, you must thoroughly understand these two plans to make an informed decision.
Here are some considerations before you enroll yourself into a Medicare plan.
- Consider the cost structure of each plan. Look into the plan premium, coinsurance, and copayments.
- Before receiving care, estimate your prescription bills to know if you’d require Medigap or drug coverage.
- Look into the network’s physicians to know your choices.
- Look into out-of-city coverage when you travel.
Additional Resources for Medicare in Pennsylvania
Utilizing maximum resources with the right advice streamlines the process of getting Medicare. You need to look into the various tools and resources available in your state before signing up for a Medicare plan.
Here are some of the most important resources for Medicare in Pennsylvania.
| Organization | How you can get help | Website & Contact Info |
| Pennsylvania Department of Aging (PDA) | The Pennsylvania Department of Aging (PDA) supports senior citizens by providing them with various resources such as care facilities, protective measures, and channels for reporting elder abuse. | Website | (717) 783-1550 |
| Pennsylvania Department of Human Services (DHS) | The Pennsylvania Department of Human Services (DHS) runs a Medicaid program, known as Medical Assistance, offering health coverage to qualifying low-income seniors or those with limited resources. | Website | (866) 550-4355 |
| Pennsylvania Insurance Department | The Pennsylvania Insurance Department provides senior citizens with online insurance information. | Website | (877) 881-6388 |
| Pennsylvania Area Agencies on Aging | The Pennsylvania Area Agencies on Aging supports local seniors by helping them develop community-based long-term care. | Website | (717) 783-1550 |
Securing Your Health in the State of Pennsylvania With Silveredge
Securing your healthcare insurance with the help of Silveredge can provide seniors with comprehensive coverage plans tailored to their needs.
Whether you want to resolve queries about the enrollment process or need help comparing plans, Silveredge is here to provide you with a myriad of solutions that cater to your healthcare insurance needs. Embrace Silveredge to take a step towards a secure and happy future!
