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Medicare is a federal program to provide health insurance for people 65 and over. When you become eligible for Medicare, you can choose how to get coverage: either through Original Medicare or a Medicare Advantage Plan.
Medicare Advantage Plans, also referred to as Medicare Part C, are bundled plans that provide the same coverage as Original Medicare Parts A and B through private, Medicare-approved insurance companies. Since Medicare Advantage Plans are offered by private insurers, the scope of coverage and cost of plans varies. Most of these plans also include prescription drug coverage and some may offer even more benefits such as vision, dental and hearing coverage.
Read this article to learn everything you need to know about Medicare Advantage Plans in Pennsylvania.
Compare ratings of insurance companies offering Medicare Advantage Plans in Pennsylvania:
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 262 Medicare Advantage Plans available in Pennsylvania, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
Pennsylvania has 262 Medicare Advantage Plans available, including:
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Pennsylvania, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Pennsylvania Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|Pennsylvania Department of Aging||(717) 783-1550
|The Pennsylvania Department of Aging works to ensure that older adults across Pennsylvania have access to quality services and supports that help them age and live well|
|Pennsylvania Medicaid Department||(866) 550-4355||Medical Assistance (MA), also known as Medicaid, pays for health care services for eligible individuals|
|Pennsylvania Insurance Department||(877) 881-6388||This site is designed to be your resource to find out more information and help you make informed decisions about your insurance coverage|
|Pennsylvania Consumer Assistance||(877) 881-6388||The Pennsylvania Consumer Assistance Department provides assistance to consumers with health insurance questions or problems|
|Pennsylvania Medicare Savings Programs||(800) 783-7067||The Medicare Savings Programs help lower-income older adults and persons with disabilities pay
their Medicare Part B premium
|Pennsylvania Medicare Legal Help||(800) 274-3258||The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services|
|PA Health & Wellness||(844) 626-6813||PA Health & Wellness provides quality Medicaid & health insurance plans in Pennsylvania|
|Resource||Contact||How they help|
|Adams County Office for Aging||(800) 548-3240||The Adams County Office for Aging helps people maintain independence and dignity within their own homes and communities for as long as possible|
|Allegheny County Health Insurance Counseling||P(412) 661-1438
|Allegheny County Area Agency on Aging partners with other agencies to offer you FREE, completely confidential, expert health insurance counseling to answer your questions and address your concerns|
|Berks County Area on Aging||(610) 478-6500||The mission of the Berks County Area Agency on Aging is to provide services, based on need, to all older Berks County residents and those with disabilities|
|Bucks County Area Agency on Aging||(267) 880-5700
|The Mission of the Bucks County Area Agency on Aging (BCAAA) is to develop, coordinate and promote a continuum of quality services that supports, respects and advocates for older adults and their families|
|Butler County Agency on Aging||(888) 367-2434||Butler County Agency on Aging’s goal is to assist our county seniors to be safe and healthy and to age successfully in their communities with the supports they need|
|Cumberland County Aging & Community Services||(717) 240-6110
|The core focus of the Cumberland County Aging & Community Services is to support older adults, adults with disabilities and others who are at risk of losing their independence, to continue living in the community as long as possible|
|Dauphin County Area Agency on Aging||(717) 780-6130||The Dauphin County Area Agency on Aging provides essential services to residents of Dauphin County who are 60 years of age or older|
|Lehigh County Medicare Education and Decision Insight||(610) 782-3000||This site is an information guide on the Medicare program for those who live in Lehigh county|
|York County County of Human Services Medicare Savings Program||(800) 632-9073
|The primary focus of the York County Area Agency on Aging is to provide education, advocacy and coordination of community-based services to empower older adults to maximize their independence and quality of life|
|Resource||Contact||How they help|
|CMS Medicare Managed Care Appeals & Grievances||N/A||Provided by the CMS, this page provides information related to dealing with Medicare managed care plan grievances and appeals|
|CMS Medicare Managed Care Eligibility and Enrollment||N/A||Provided by the Centers for Medicare & Medicaid Services (CMS), this page offers information for contacting MAP organizations plus other health plans and related aspects to Medicare health plan enrollment|
|CMS Medicare Prescription Drug Eligibility and Enrollment||N/A||Provided by the CMS, this page details prescription drug eligibility and enrollment as it relates to MAP|
|Medicare.gov||(800) 633-4227||The homepage for the main Medicare website for the U.S|