Introduction to Medicare Part C in Pennsylvania (Medicare Part C)

Medicare Advantage (a.k.a. Medicare Part C, or Medicare “replacement”) is a comprehensive form of Medicare supplement insurance which aims to protect you from all of the known gaps in Medicare Parts A and B. While an Advantage policy will cover your Medicare benefits, coverage gaps, and allow you to add additional coverages all under the same policy, you will have to deal with provider network restrictions. We’ll discuss the details of Medicare Part C here in this article.

Federal Regulations for Medicare Advantage

One of the reasons people refer to Medicare Advantage as Medicare “replacement” is because it will, essentially, replace your federal Medicare benefits. Advantage plans are regulated by the government and, by law, must provide you with a minimum level of coverage. But your claims will be paid out by a private company – not the government. Usually, though, you won’t have to worry about a company trying to sell you insufficient coverage. The appeal of an Advantage policy for many seniors is the fact that many plans provide more coverage than Medicare Parts A and B.

Medicare Advantage Enrollment In Pennsylvania

Medicare Advantage is fairly popular within the state of Pennsylvania. Right around 39% of Medicare-qualified seniors have currently replaced their federal Medicare benefits with Medicare Advantage. Below, you can see a chart which ranks Pennsylvania Medicare Advantage plans from most to least popular:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

The amount of coverage you purchase, as well as your age and location, will make a significant impact on your monthly premiums. Below is a list of approximate quotes for seniors in your area. Remember, though, that these are estimates. You have to contact a licensed insurance agent in order to get the most accurate quote.

Most Popular Medicare Advantage Plans in Pennsylvania

Medicare Advantage plans offer you the freedom to customize your coverage options. One of the major factors which determines your plan type is your provider network. Provider networks are differentiated by prize, and size/restrictions. There is an inverse relationship between the two. This means that smaller, more restrictive networks are cheaper, whereas larger, open networks are more costly.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Almost all doctors and hospitals will accept Medicare – but that is not the same for Medicare Advantage. Your Advantage plan, as mentioned earlier, will come with a network of doctors and facilities which accept your insurance plan, called a provider network. Some of these networks are more restrictive than others. HMOs, for example, are smaller and have much higher restrictions when it comes to getting medical care. Other, larger networks may have several providers for you to choose from, or allow you to go out-of-network for a modest fee.

Doctor/Providers List

Drug, Vision and Dental Coverage

“Ancillary coverage” is a term for additional benefits which you have the option to add to an insurance policy. Unfortunately, most Medicare supplement insurance policies, in addition to Medicare itself, do not allow for ancillary coverage. Medicare Advantage, however, does. Vision and/or dental are very popular options, as well as prescription drug coverage (a.k.a. “MAPD” plans). And you get the convenience of having all of your benefits handled by a single policy. Just remember that your monthly premiums will be higher if you add more coverage.

Enrollment Options & Best Time To Enroll

To enroll in Medicare Advantage, you must first enroll in Medicare Parts A and B. After you are officially enrolled, and still within your IEP (see below), it will be much easier to qualify for a Medicare Advantage plan. You may even be automatically approved for coverage. However, waiting to enroll could make the process more complicated. You might have to answer questions about your health, or even take a physical exam. And you’re more likely to get rejected for coverage. In addition, people with serious pre-existing conditions (ESRD is among them) will have a harder struggle when seeking a Medicare Advantage plan. For more information on getting covered with a serious medical condition, talk to your state department of insurance, or a local insurance agent near you. Also, take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: Within your first 6 months of Medicare enrollment, you can enroll in a Medicare Advantage policy.
  • Annual Enrollment Period (AEP): From October 15th through December 7th each year, you are free to change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Any sort of special circumstance in which you may need to change or get new coverage outside of a regular enrollment period, such as moving out of your service area, losing your employer/plan coverage, or your provider ceasing coverage in your area.

What Medicare Advantage Plan Is Best For Me?

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