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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
  • Run 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

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.

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 Keystone 65 Select Rx (HMO) Health and Drug $0.00 $280
$0 Aetna Medicare Basic Plan (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

In Pennsylvania, it’s just as important to understand the differences between these two plans as it is in any of the other 49 states. Below, this handy chart spells out those variances with some of the most frequently asked questions:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

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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