Navigating Medicare plans in Pennsylvania can feel overwhelming, with a variety of options to choose from. Making an informed decision starts with understanding the available plans—whether you’re comparing Medicare Advantage, Part D prescription plans, or Medigap.
This guide will explain the different plan types, provide insights into costs, recommend top providers, and provide enrollment tips, ensuring you get coverage that fits your health needs and budget.
Key Takeaways
- Pennsylvania offers a range of Medicare plans, including Original Medicare, Medicare Advantage, Medigap, and Part D prescription drug plans, each with varying costs and benefits.
- Medicare Advantage plans are popular for their added benefits, such as dental and vision coverage, and some plans offer $0 premiums.
- Accessing the right resources, such as SHIP and local AAA offices, can help residents make informed decisions and find the best plan for their needs.
Medicare Plans Available in Pennsylvania
Each Medicare plan type offers varying levels of coverage, benefits, and costs, depending on your specific healthcare needs.
Original Medicare (Part A and Part B)
Original Medicare includes two parts:
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
- Part B (Medical Insurance): Covers outpatient care, doctor visits, preventive services, and medically necessary services.
Part A and Part B costs include monthly premiums, deductibles, and coinsurance, which may vary based on your income and work history.
Part B premiums in 2023 average around $164.90 monthly, with deductibles and copays varying based on services.
Medicare Advantage (Part C)
Medicare Advantage plans are an all-in-one alternative to Original Medicare. They offer Part A, Part B, and often prescription drug coverage (Part D). Many Medicare Advantage plans include additional benefits like vision, dental, and hearing coverage.
The costs, coverage, and provider network can vary by plan, so it’s important to compare options to find the best fit. Private insurance companies offer Medicare Advantage plans, and the premiums depend on the plan and region.
- 124 Medicare Advantage plans were available across the state in 2023.
- Many plans offer additional benefits such as dental, vision, and hearing coverage.
- Some plans have $0 monthly premiums, and the average premium in Pennsylvania dropped to $9.72 in 2023
| Plan Name | Monthly Premium | Coverage Highlights | Provider Network | Star Rating |
|---|---|---|---|---|
| Aetna Medicare | $0 | Dental, vision, prescription | Nationwide | 4.5 |
| UPMC for Life | $20 | Wellness programs, hearing | Regional network | 4.0 |
| Highmark BlueCross | $15 | Dental, fitness benefits | Statewide | 4.5 |
Note: Data provided is based on public resources. Star ratings and plan specifics may vary annually.
These companies offer a variety of Medicare Advantage plans, many of which feature $0 premiums and additional benefits like dental, vision, and wellness programs. Plan specifics, including networks and costs, can vary by zip code.
- Aetna
- UPMC for Life
- Highmark
- Blue Cross Blue Shield
- Independence Blue Cross (IBX)
- Humana
- UnitedHealthcare (AARP)
- Geisinger Gold
- Wellcare
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Medicare Prescription Drug Plans (Part D)
Medicare Part D plans help cover the cost of prescription medications. These plans are typically paired with Original Medicare but can also be part of a Medicare Advantage plan.
Each Part D plan has a formulary (list of covered drugs) and different medication pricing tiers. Compare formularies and costs to ensure your medications are covered at an affordable price.
- 24 stand-alone Part D plans are available statewide, helping with the cost of medications.
- Premiums vary, with $7.40 as the lowest monthly premium in 2023.
Medigap (Medicare Supplement) Plans
Medigap plans help cover the gaps left by Original Medicare, such as copayments, coinsurance, and deductibles. In Pennsylvania, popular Medigap plans include Plan G and Plan N, which offer varying levels of coverage.
Private insurers offer Medigap policies, and costs vary based on the plan, age, and location. It’s worth noting that Medigap plans don’t cover prescription drugs so that you may need a separate Part D plan.
These companies offer Medicare Supplement (Medigap) plans to help cover costs not included in Original Medicare, such as copays and deductibles. Plans like G and N are particularly popular for balancing cost and coverage.
- Mutual of Omaha
- UnitedHealthcare (AARP)
- Cigna
- Continental Life
- Highmark Blue Cross Blue Shield
- MassMutual
- Reserve National
- Standard Life
- Thrivent
- United American
- United Commercial Travelers (UCT)
- USAA Life
Learn more: How to Compare Medicare Supplement Plans
Average Costs of Medicare Plans in Pennsylvania
Medicare plan costs in Pennsylvania vary by type. Original Medicare requires premiums and deductibles, while Medicare Advantage often offers low or even $0 premiums. Medigap and Part D plans come with additional costs but help reduce beneficiaries’ out-of-pocket expenses.
| Plan Type | Average Monthly Premium | Deductible | Coverage Highlights |
|---|---|---|---|
| Original Medicare | $164.90 (Part B) | $1,600 (Part A) | Basic hospital and outpatient coverage |
| Medicare Advantage | $9.72 | Varies by plan | Includes extra benefits like vision |
| Part D (Prescription Drug) | $7.40 | $505 | Covers medications with tiered pricing |
| Medigap (Plan G, N) | $120 – $300 | None | Fills gaps in Original Medicare |
Note: Costs reflect 2023 averages and may vary by provider and location.
This breakdown helps residents compare options and choose a plan that aligns with their healthcare and financial needs.
Top Medicare Advantage and Medigap Providers in Pennsylvania
Choosing the right provider can impact your experience with Medicare. Below are profiles of leading Medicare Advantage and Medigap providers in Pennsylvania, focusing on network size, affordability, and unique offerings.
Best Medicare Advantage Providers
Many Pennsylvania residents prefer Medicare Advantage plans for the additional benefits and affordable premiums. Aetna offers a $0 premium plan with comprehensive coverage and a large national network. UPMC for Life, known for regional strength, provides access to wellness programs, while Highmark’s plans offer fitness benefits and dental care.
| Provider | Average Premium | Network Size | Customer Satisfaction Score |
|---|---|---|---|
| Aetna Medicare | $0 | Nationwide | 4.5 |
| UPMC for Life | $20 | Regional | 4.0 |
| Highmark BlueCross | $15 | Statewide | 4.5 |
Note: Data is based on available public resources and may vary year to year.
Best Medigap Providers
Medigap plans help cover out-of-pocket expenses, with top providers in Pennsylvania excelling in customer service and competitive pricing. Mutual of Omaha offers affordable rates and low complaint indices, while AARP/UnitedHealthcare balances costs with extensive plan offerings. Highmark also provides robust local options with reliable service and competitive premiums.
Plan G Medigap Providers in Pennsylvania
| Carrier | Premium | Fee | AM Best Rating |
|---|---|---|---|
| United Commercial Travelers | $104.74 | None | B+ |
| Thrivent | $103.43 | $25.00 | A++ |
| Continental Life | $107.62 | $20.00 | A |
| AARP | $108.62 | None | A |
| MassMutual | $110.04 | None | A++ |
| Mutual of Omaha | $116.07 | None | A+ |
| Highmark Blue Cross Blue Shield | $121.00 | None | A- |
| Reserve National | $121.07 | None | A- |
| USAA Life | $123.08 | None | A++ |
| Standard Life | $202.79 | None | A |
Plan N Medigap Providers in Pennsylvania
| Carrier | Premium | Fee | AM Best Rating |
|---|---|---|---|
| United Commercial Travelers | $84.28 | None | B+ |
| Continental Life | $80.47 | $20.00 | A |
| AARP | $85.91 | None | A |
| Thrivent | $87.36 | $25.00 | A++ |
| MassMutual | $94.98 | None | A++ |
| USAA Life | $97.75 | None | A++ |
| Reserve National | $99.87 | None | A- |
| Mutual of Omaha | $101.79 | None | A+ |
| Highmark Blue Cross Blue Shield | $109.05 | None | A- |
| United American | $136.00 | None | A+ |
Evaluating these providers based on their network, costs, and customer satisfaction ensures you can find a plan that aligns with your healthcare needs and financial situation.
How to Enroll in a Medicare Plan in Pennsylvania
To enroll in Medicare in Pennsylvania, you must be at least 65 years old or qualify at any age due to a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS).
- Choose Your Plan Type:
Decide whether Original Medicare, Medicare Advantage, Medigap, or a Part D prescription drug plan fits your healthcare needs and budget. - Know Your Enrollment Windows:
There are key periods when you can enroll or make changes: Initial Enrollment: Begins 3 months before your 65th birthday and ends 3 months after. Annual Enrollment: Runs from October 15 to December 7 each year. Special Enrollment: For changes in personal circumstances, such as losing employer coverage. - Gather the Required Documents:
To ensure a smooth enrollment, have your Medicare card (if you already have one), photo ID, and any relevant personal details ready. - Submit Your Enrollment:
You can enroll online at Medicare.gov, by phone at 1-800-MEDICARE, or with the help of a licensed insurance agent like CoverRight. - Get Support if Needed:
If you’re unsure which plan to choose, contact the State Health Insurance Assistance Program (SHIP) or a licensed agent for personalized guidance.
How to Choose the Right Medicare Plan in Pennsylvania
- Assess Your Healthcare Needs:
Review how often you see doctors, your specialist visits, and any prescriptions you take. This helps narrow down whether you need more comprehensive coverage or supplemental options like Medigap. - Compare Plan Options:
Explore Pennsylvania’s different Medicare Advantage, Medigap, and Part D plans. Consider how each plan aligns with your medical needs and budget. - Check Provider Networks:
Confirm whether your preferred doctors, hospitals, and pharmacies are included in the plan’s network to ensure you’ll have easy access to care. - Evaluate Costs and Benefits:
Consider premiums, deductibles, and out-of-pocket maximums to understand the plan’s total cost. Extra benefits like dental or vision coverage might add value. - Get Personalized Help if Needed:
If you’re unsure which plan is right for you, use Medicare’s Plan Finder tool or consult with a licensed insurance agent to receive expert advice.
Medicare Resources for Pennsylvania Residents
Several resources are available to help Pennsylvania residents navigate Medicare. The Pennslyvania Insurance Department offers Medicare beneficiaries free counseling and personalized advice. Local Area Agencies on Aging (AAA) provide additional support, including help accessing in-home care and community services for older adults. Medicare.gov also offers tools for comparing plans and finding providers to ensure beneficiaries choose the best coverage.
These resources are valuable for those seeking extra guidance beyond their initial enrollment and coverage selection.
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