Medicare Plans in Pennsylvania

Coverage and Benefits

Any American senior 65 or older has the option to enroll in the federal Medicare program. And once you’re in, you can have the majority of your health care needs insured at a minimal cost. The basic plan, which may be referred to as Original or Traditional Medicare, includes two parts: Part A, and Part B. Together, these two parts provide coverage for nearly all of your hospital and outpatient treatments.

Original Medicare costs are designed to be as affordable as possible, because most senior citizens are living on a fixed retirement income and cannot afford exorbitant health care costs. Part B, which is the most commonly used part of Traditional Medicare, comes with its own income-based fees and premiums which can easily be calculated here. The cost for Part A, however, varies depending on your employment history. Seasoned employees with a minimum 10 year history of collecting a paycheck will get their Part A benefits free of charge. Anything less than 40 quarters, however, and you may be required to pay an upfront fee before your Part A benefits are accessible.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Offered by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Pennsylvania residents interested in Medicare are eligible from the time that they turn 65. If you’re interested in using Medicare, you need only enroll in the program and you’ll automatically receive Medicare Part A, the basic Medicare coverage. Part A is free to anyone that’s worked 10 years or more in their lifetime or to people that worked 40 quarters. Part A offers inpatient care, nursing home care, basic outpatient care and some home health services as well. For an added cost you can enhance your care each month by adding Medicare Part B. This includes some additional outpatient services, added doctor and hospital services and helps with getting higher quality tools and equipment for home use.

Beyond Medicare Parts A and B there are a few other options available to you for added coverage, but you must have A and B to qualify for them. Medicare Part C is a private insurance known as Medicare Advantage that offers the same Part A and Part B coverage plus extra. The extra that you get depends on the policy that you choose and can include all sorts of nice perks. And Medicare Part D is the other option that is just for prescription drug coverage.

Different Types of Medicare Plans in Pennsylvania

Pennsylvania is a large, populous state, so it should be no surprise that there are 2,350,558 seniors currently receiving Medicare benefits right now. Of those, 39% (or 916,719 people) are going above and beyond Traditional Medicare with a Medicare Advantage plan. And additional 26% (606,288 beneficiaries) are enhancing their Original Medicare coverage with a Medigap supplement policy. The remaining 822,695 seniors (35% of all beneficiaries) may be fully covered through an alternative supplement plan – or they might not have any protection at all from potentially costly gaps in Traditional Medicare coverage.

If you are one of the millions of seniors in Pennsylvania who are thinking about a Medicare supplement, make sure you are enrolled in Medicare Parts A and B first. You can enroll in Medicare or check your Medicare enrollment status here.

Because the cost of quality healthcare continues to go up in Pennsylvania, it’s more important than ever to look at alternative options to help you cover those costs. Some residents save for their insurance costs, but more and more are looking at supplemental insurance policies to fill the gaps and meet their needs.

It’s possible to get a supplemental health insurance policy that will offer added coverage on top of the basic Medicare Parts A and B policies. This coverage often comes at an added cost but can be a powerful tool to lower overall medical costs, especially for people with extensive healthcare needs.

By investing in a supplemental policy, you can get just what you need to help with filling your Medicare coverage gaps, so you spend less on healthcare. By spending a bit more on insurance you can lower your overall costs, making this a good investment for some. Medicare Advantage and Medicare Supplement are the two options available to you when you want to get added coverage for your insurance costs.

When you are looking for supplemental insurance in Pennsylvania to lower your medical costs, Medicare Advantage and Medigap (Medicare Supplement insurance) are your two options worth pursuing. Both options work well for what they are designed to do, which is help cover added medical costs. The plans work differently though, and you need to understand those differences to select the best policy for you.

What are Medicare Coverage Gaps? And Why Are They So Important?

Although Traditional Medicare aims to be as comprehensive as possible, it can’t provide for 100% of your medical needs. If you happen to fall through one of these “gaps” and require a medical treatment, procedure, or extended hospital stay which Original Medicare does not provide, your medical bills could pile up fast. Just look at some of the costs you could be expected to pay out of pocket for:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

For the sake of financial security (and peace of mind), many seniors turn to some form or another of supplemental health insurance to protect their finances from these gaps in coverage. Below, we’ll talk about the most popular – and affordable – supplement policies.

Coverage Option #1: Medicare Supplement Plans in Pennsylvania

For a small premium and minimal hassle, you can protect yourself from these coverage gaps with a Medigap – named for the “gaps” these policies are designed to cover – supplemental insurance policy. There are ten policies in total, and each one was constructed under a collaboration by federal Medicare experts and private health insurance companies to give you exactly what you need. Much like Medicare, the plans are labeled alphabetically. Another benefit is that each plan offers the same advertised benefits, regardless of what state you’re in. Therefore, the only variables that you have to worry about are your chosen provider, and the price they charge.

Below is a detailed explanation of what each plan covers:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $111 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $67 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $83 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $56 $0 $147 Not Covered Not Covered Not Covered Request Info
N $0 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $83 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $45 $1 $147 Not Covered Not Covered Not Covered Request Info
L $70 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $61 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $0 $608 $147 Not Covered 100% Covered 100% Covered Request Info

Coverage Option #2: Medicare Advantage Plans in Pennsylvania

For those who want their Medicare supplement policy to come with a lot of bells and whistles, there is Medicare Part C (a.k.a. Medicare Advantage). Advantage plans are health insurance policies offered by private insurance companies with the express goal of replacing your Traditional Medicare. Fortunately, they are required by law to offer you as good of a benefits package or better – they cannot offer you anything less than what Parts A and B of Original Medicare promise to cover. And you can also tack on extras – like vision, or prescription drugs – all onto one, single policy (provided you can afford the extra costs, of course).

However, it is important to weigh the cons as well as the pros when considering an Advantage health insurance policy. For starters, signing the dotted line on Medicare Advantage absolves the government of any responsibility for your health. You have to entrust your health care benefits to a private business, which comes with its own inherent set of risks. Additionally, provider networks are notoriously restricted in many local Medicare Advantage markets, and being forced to switch doctors isn’t uncommon. These are all important factors which must be considered when contemplating a Medicare Advantage policy.

An HMO is a Health Maintenance Organization, and a PPO is a Preferred Provider Organization. Both of these special types of health networks are used by various Medicare Advantage plans in order to provide their members with medical care.

Top HMO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$0 Advantra Silver (HMO) Health and Drug $0.00 $0
$0 Aetna Medicare Basic Plan (HMO) Health Only $0.00 $0
$0 Keystone 65 Select Medical Only (HMO) Health Only $0.00 $0

Top PPO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$804 HumanaChoice H5525-005 (PPO) Health and Drug $67.00 $0
$864 Advantra Gold (PPO) Health and Drug $72.00 $0
$1740 Personal Choice 65 Medical Only (PPO) Health Only $145.00 $0

Comparing Medigap and Medicare Advantage in Pennsylvania

The first and easiest way to distinguish between Medicare Advantage and Medicare Supplement is how the two policies pay for medical costs. With Medicare Advantage your Medicare policy kicks in toward the costs first, then the Medicare Supplement plan pays some of the cost and you are left with the remaining bill. This is how every single medical bill is handled with a supplement plan.

When you have Medicare Advantage, the Advantage plan picks up the entire bill, then Medicare pays the Advantage company and you pay added costs through co-pays, premiums and uncovered costs. A Medicare Advantage plan is much more like traditional.

The next way to distinguish between Medicare Advantage and Medicare Supplement (Medigap) plans is by what benefits they offer you. A Medigap plan solely offers you the benefits that are included in Medicare Parts A and B. But you get coverage towards the gaps in Medicare so you don’t pay as much out-of-pocket costs. Depending on how comprehensive, some policies take over all the costs for you so you don’t have any to deal with at all.

A Medicare Advantage plan is more flexible. You get Medicare Parts A and B, but you can get additional coverage added to your policy that you decide on. You can pick and choose the coverage you need such as prescription coverage or dental. You can’t add coverage to a Medigap plan.

The final difference is with how pricing works. A Medigap plan has you pay the premium and then the remaining balance. It’s a simple system and is easy to understand. A Medicare Advantage plan will have you pay co-pays, a premium, flexible medical costs and remaining balances that aren’t covered. It’s more complicated and tough to understand.

Those are the main differences between Medicare Advantage and Medicare Supplement. There are additional differences as well, and it’s vital that you understand them before making a decision on which is right for you. See our chart below for common questions. You can also speak with one of our representatives to learn more and get help choosing the right policy for you.

Questions Medicare Advantage Medicare Supplement
How does this plan cover medical expenses? Medicare Advantage covers all the costs initially. Medicare pays back some of the costs to the insurance company and you cover the remaining costs through premiums, co-pays and uncovered items. Medicare Supplement covers the remaining costs after Medicare pays your medical costs. You pay the remaining balance.
Do I need to pay for Part B with this policy? Yes Yes
What will I pay to have this? You pay co-pays, a premium, and uncovered costs with this plan. It’s tough to say what you pay because rates change based on location and healthcare needs. You pay a premium and uncovered costs with a Medigap policy.
What will the plan cover? You get Medicare Part A and Part B coverage and any added coverage you choose to add with a custom policies. You just get Medicare Part A and Part B coverage, there’s just less for you to pay in the end.
Is it easy to budget my healthcare expenses with this plan? Budgeting can be difficult with Medicare Advantage. There are many incidental costs that you won’t be able to predict until you need to pay them. Budgeting is simple with a Supplement plan if you have a comprehensive one. You only pay a premium each month and your medical costs are covered.
Am I guaranteed to be able to keep this policy? There is no guarantee with a Medicare Advantage policy. The insurance company can cancel your plan. If your insurer stays in business and you pay your monthly premium, you are guaranteed to keep your policy.
Do I need to go through a pre-approval process? Yes, there is usually a pre-approval process for you to go through for an Advantage plan. No, you only need to qualify for Medicare and you are approved.
Do I need to work within a specific care network? Yes, unfortunately you are limited to a specific network of care providers with Advantage. No, you are free to go to anywhere that accepts Medicare.
Which plan is right for me? Medicare Advantage might save you money if you have few medical costs and are in good health and if you live in a location with lots of healthcare providers to choose from. A Supplement plan is ideal if you have many medical costs or if you live in a location with little access to medical facilities.

Additional Pennsylvania Medicare Resources

Still have questions? We know just the people who can give you the answers you need. Your health is important, so getting as much information as possible from people who know about Medicare insurance supplements is essential when making such decisions. Please take advantage of our Medicare local directory right here on this page.

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Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

 

 

 

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