Pennsylvania is the fifth-most populous State in the US, with over 13 million residents. Of these, a whopping 2,875,916 are enrolled in Medicare.
Medicare is a fee-for-service health insurance program in the US. This comprehensive health coverage plan is administered by the federal government and funded by the General Revenue and Federal Insurance Contributions Act.
In Pennsylvania, Medicare provides comprehensive healthcare coverage to senior adults aged 65 and above, those with certain disabilities, and people with end-stage renal disease (ESRD).
The federal government administers the standard Medicare plan. In contrast, private health insurance companies provide Medicare Advantage and Medicare Supplement plans.
The Medicare Supplement Plan, also popularly known as Medigap, is an optional plan that covers what’s not covered under Medicare Parts A and B. This plan provides additional health insurance for out-of-pocket expenses. Let us look into Medigap Supplement plans and what they offer to beneficiaries in Pennsylvania.
Medicare Supplement Plans in Pennsylvania
The Medicare Supplement Plan, called Medigap, is a secondary coverage plan. The primary purpose of a Medigap policy is to lower out-of-pocket costs such as deductibles, copayments, and coinsurance associated with Medicare plans.
These costs aren’t covered by Original Medicare Parts A and B. This means that Medigap only covers what isn’t covered by Original Medicare. Thus, you must have an Original Medicare plan with supplemental Medicare, as it is not a stand-alone insurance policy.
According to the rules and regulations set by the Centers for Medicare and Medicaid Services (CMS), every plan must provide beneficiaries with the same coverage under the same plan.
Over 2.5 million Pennsylvania residents are 65 and above, making up about 19.23% of the State’s population. More than 31.86% (701,000) of Pennsylvania residents are enrolled in Medigap plans.
Since Pennsylvania’s life expectancy is just under 77, medical insurance plans are essential to lowering healthcare bills for such a huge number of older adults residing in the State.
More than 40 private health insurance providers in Pennsylvania offer Medicare Supplement plans to residents.
These Medigap plans cover out-of-pocket expenses, including copayments, coinsurance, and deductibles.
- Deductibles are costs that you cover before Medicare provides coverage for health services. Thus, deductibles apply to all Medicare Parts.
- A copayment is like a fixed payment for a doctor’s visit. This amount is paid after you pay your deductibles.
- Coinsurance is an effective cost-sharing method in which you pay a small percentage of the total amount for specific services after paying your deductibles. Your Medicare insurance plan covers the rest of the cost.
General Analysis of Medicare Supplement Plan Providers in Pennsylvania
| Insurance Company | Plan types offered | NAIC complaint rate | Premium discounts available | Share of Pennsylvania Medigap members |
| BlueCross BlueShield | A, B, C, D, F, G, K, L, M and N. | Close to expected | Average | 3.7%. |
| USAA | A, F, G and N. | Fewer than expected | Below Average | — |
| Humana | A, B, C, F, G, K, L and N. | Far more than expected | Below average | — |
| UnitedHealthcare | A, B, C, F, G, K, L and N. | Far fewer than expected | Above average | 32.6%. |
| Aetna | A, B, C, D, F, G and N. | Far more than expected | Average | 16.6%. |
| Cigna | A, F, G and N. | More than expected | Above average | 4.0%. |
Types of Medicare Supplement Plans in Pennsylvania
As of 2024, Pennsylvania offers residents ten standard Medigap plan types. Medigap Plans C and F are not available to new members.
Besides these two plans, three plans are the most popular Medigap policies, providing coverage for 75% of beneficiaries residing in Pennsylvania. These are Medigap plans F, G, and N.
Nearly 32% of Pennsylvania Medigap beneficiaries have access to Medigap Plan F, the most comprehensive Medigap coverage.
About 29% of beneficiaries have Medigap plan G, which is the highest-coverage option available to new Medicare beneficiaries, while Medigap plan N has 15% of Medigap beneficiaries. This plan has a lower premium with higher copays.
Cost Breakdown of Three Most Popular Medicare Supplement Insurance Plans in Pennsylvania
The three most popular Supplement plans in Pennsylvania are Medigap Plan F, G, and N. The cost for these plans varies. Here’s a detailed cost breakdown for these popular Pennsylvania Medigap plans.
Medicare Supplement Plan F
In Pennsylvania, more than 60 Medigap Plan F options are offered by 41 different insurance providers. The availability and monthly premiums vary depending on an individual’s age, sex, health status, and location.
Despite being one of the most popular Medigap plans across Pennsylvania, Medigap Plan F is no longer available to new applicants.
Beneficiaries who were eligible for Medicare before January 1, 2020, can sign up for plan F. In addition, people who already have plan F can keep it.
| Beneficiary | Philadelphia County | Dauphin County | Luzerne County |
| Average monthly premium for a 65-year-old female who doesn’t smoke | $214 | $175 | $161 |
| Average monthly premium for a 65-year-old female who smokes | $240 | $197 | $177 |
| Average monthly premium for a 65-year-old male who doesn’t smoke | $236 | $194 | $178 |
| Average monthly premium for a 65-year-old male who smokes | $265 | $218 | $199 |
Medicare Supplement Plan G
In Pennsylvania, approximately 67 Medigap Plan G options are offered by 42 different insurance providers, with premiums and availability depending on factors such as age, sex, location, and health status.
| Beneficiary | Philadelphia County | Dauphin County | Luzerne County |
| Average monthly premium for a 65-year-old female who doesn’t smoke | $173 | $143 | $147 |
| Average monthly premium for a 65-year-old female who smokes | $195 | $162 | $164 |
| Average monthly premium for a 65-year-old male who doesn’t smoke | $195 | $161 | $156 |
| Average monthly premium for a 65-year-old male who smokes | $220 | $180 | $209 |
Medicare Supplement Plan N
There are approximately 56 Medigap Plan N options offered by 40 different insurance providers, with premiums and availability depending on factors such as age, sex, location, and health status.
| Beneficiary | Philadelphia County | Dauphin County | Luzerne County |
| Average monthly premium for a 65-year-old female who doesn’t smoke | $130 | $111 | $127 |
| Average monthly premium for a 65-year-old female who smokes | $147 | $123 | $180 |
| Average monthly premium for a 65-year-old male who doesn’t smoke | $146 | $123 | $142 |
| Average monthly premium for a 65-year-old male who smokes | $164 | $188 | $170 |
Cost Determination of Medicare Supplement Plans in Pennsylvania
Your location, age, sex, and insurance provider company are some factors that determine the cost of a Medicare Supplement plan in Pennsylvania. Therefore, different counties in Pennsylvania also have different prices for a Medigap plan.
For example, some plans may cost less for a non-smoking 65-year-old female in Philadelphia but may cost more in some other counties. Similarly, Plans F, G, and N have different prices in different regions.
If Plan F costs less in Dauphin County, it may cost more in Philadelphia County. Similarly, some Medigap policies that may be more affordable for people aged 65 may become costly at age 85.
Generally, Medigap prices are determined in three ways.
- Community-rated: Everyone with the Medigap policy pays the same monthly premium, regardless of age.
- Issue age-rated: With this type of Medigap policy, the premium is based on your age when you first purchase the policy. The younger you are at the time of purchase, the lower your premium will be. The benefit of this rating system is that your premium won’t increase as you age. However, your premium may still go up due to inflation, healthcare cost increases, or changes in the insurance provider’s pricing.
- Attained age-rated: The premium is based on your current age and increases as you age. Therefore, plans that cost less at 65 may cost more at 85. While this type of policy may initially offer the lowest premium, it has the potential to become the most expensive over time. The premium can also increase due to inflation and other factors.
The premiums for these plans may also vary from provider to provider as significantly different private health insurance companies offer these plans. However, a Medicare Supplement Plan’s average monthly premium cost in Pennsylvania can range from $90 to $175.
Cost Comparison of the Top-Rated Medicare Supplement Plans in Pennsylvania
As all Medigap plans offer the same coverage across Pennsylvania, comparing the price differences can help you make a cost-efficient decision.
Your standardized benefits will be the same regardless of your chosen provider. Let us look into the prices of Pennsylvania’s five popular Medigap companies that provide plans G and N.
The table below provides the estimated cost for a 65-year-old non-smoker female.
| Insurance Company | Plan G Monthly Premium | Plan N Monthly Premium |
| UnitedHealthcare | $138 | $93 |
| Aetna | $143 | $95 |
| Cigna | $149 | $97 |
| Highmark* | $149 | $171 |
Medicare Eligibility 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 can qualify for Medicare if the Social Security Administration approves you for either your age or disability.
Enrollment Period for Medicare in Pennsylvania
The best time to purchase a Medigap policy is during the Open Enrollment period. Medicare has two enrollment periods besides open enrollment: your initial enrolment period (IEP) and a general enrolment period (GEP).
You can join, switch plans, or drop your coverage plans from October 15 to December 7 each year. Suppose you’re under 65 and have Medicare because of a disability or End‑Stage Renal Disease (ESRD). In that case, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65.
Besides your open enrollment period, you can get a Medicare plan during your initial enrollment period (IEP). The IEP is 7 months long, starting 3 months before your 65th birthday and ending 3 months after you turn 65. You can enroll during this period if you haven’t had Medicare before.
If you miss your IEP, you can access Medicare by applying for it during the general enrollment period (GEP) every year between January 1 and March 31. During this period, you can also change your current Medicare plans. For example, if you have a Medicare Advantage plan and want to switch to Original Medicare, you can do so during this period.
Benefits of Medicare Supplement Plans in Pennsylvania
Medicare beneficiaries in Pennsylvania can avail themselves of a number of benefits through a Medicare Supplement plan.
Medigap policies cover the gaps in standard Medicare coverage plans. Hence, one of the most important benefits is that a Medicare Supplement plan cuts down the costs associated with Original Medicare. This provides relief to senior adults residing in the State of Pennsylvania, where healthcare bills are sky-high.
There are ten standard types of Medicare Supplement plans in Pennsylvania. These plans provide a variety of options to choose from, each offering different levels of coverage, allowing individuals to select a plan that best suits their healthcare needs and budget.
Moreover, Medigap plans are standardized by the federal government. Consequently, the same type of plans offer the same benefits. For example, all plan Gs in the State will offer the same standardized benefits to enrollees.
The standardization across the plans simplifies the selection process, as beneficiaries only need to look into the premiums, insurer ratings, and competitive rates.
Another benefit of Medigap policies is the freedom to choose healthcare providers. Unlike Medicare Advantage plans, Medigap plans do not restrict beneficiaries to a network of healthcare providers.
As long as a healthcare provider or a hospital accepts Medicare, the Medigap plan will cover its share of the approved amount. This is beneficial for those who travel frequently as it doesn’t restrict beneficiaries to a limited network of providers. Therefore, having access to Medigap with Original Medicare proves more beneficial than having a standard Medicare plan.
Resources for Medicare in Pennsylvania
Utilizing maximum resources streamlines the process of getting Medicare enrollment. Several organizations across Pennsylvania provide guidance to senior adults regarding Medicare.
Utilizing these resources can help residents make a cost-efficient decision. 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 |
Select the Best Medicare Supplement Plan With Silveredge in Pennsylvania
About 2.5 million Pennsylvania residents are aged 65 and above. Major public health risks in Pennsylvania affect the overall health quality of residents.
This considerable number of senior adults require healthcare coverage plans to significantly lower the cost of routine check ups. Plans such as Original Medicare in the region provide coverage for both inpatient and outpatient care.
But beneficiaries can utilize Medicare Supplement plans for further lowering the costs associated with Original Medicare.
Medicare Supplement plans are standardized across the State. Therefore, beneficiaries receive the same benefits. The only difference is the cost of these plans, as the premiums vary from provider to provider.
You must look into the competitive rates and plan availability in your region. Seeking professional guidance through licensed advisors at Silveredge can help you compare the available plans in your county.
You can also seek advice regarding the best healthcare plan that fits your needs. Contact Silveredge today to resolve your Medicare queries!
