Know your options for Medicare plans in Pennsylvania, whether you’re looking for Original Medicare or Medicare Advantage.
Pennsylvania has more than 2.8 million people enrolled in Medicare – and the number of plan options is also growing. Comparing the different plans is key to finding the best plan for you.
Medicare plan options include:
You may also elect to add a Medicare Supplement Plan (Medigap) to go along with Original Medicare to help with additional out-of-pocket expenses.
Before you pick a plan, learn about your costs, coverage, and choosing the best Medicare plan for your needs.
To qualify for Medicare, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability and receive Social Security Disability Insurance (SSDI) benefits for at least 24 months. You may qualify for Medicare at a younger age if you have end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board (RRB) benefits at least four months before you turn 65, you’ll be enrolled in Medicare automatically. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Pennsylvania has several Medicare options available to U.S. citizens or permanent residents at least age 65. You are eligible if under age 65 and you have ESRD, ALS, or have been disabled for at least 24 months and draw SSDI.
Original Medicare is the standard coverage for Medicare beneficiaries and has two parts: Part A (hospital insurance) and Part B (medical insurance). Here’s a look at the details about Original Medicare:
Who Original Medicare is best for: Original Medicare is a good option if you want more flexibility. It has a broad coverage area throughout the U.S. If you have several health conditions, you may want to pair your Medicare with a Medigap. Because Original Medicare does not cover prescriptions, enrolling in a stand-alone drug plan is important. If not paired with a Medigap, the out-of-pocket cost is a drawback to the plan.
|Part A premium||Standard Part B premium|
|Usually free||$164.90 per month|
An alternative to Original Medicare, Medicare Advantage Plans – also known as Part C – cover everything Part A and Part B do, but typically offer additional coverage.
Pennsylvania Medicare Advantage programs have networks and may only be available in certain areas of Pennsylvania. Plan options are based on ZIP code. These plans usually consist of copayments, deductibles, and out-of-pocket maximums that you are responsible for. However, plans can start at a $0 premium and go up from there. The average monthly premium in Pennsylvania is $30.05 (in 2023).
The Pennsylvania Medicare Advantage Program is made up of four types of plans:
The best Medicare Advantage Plan is the one that meets your individual needs and matches what is most important to you in terms of costs, choice of providers, and ease of access. Pennsylvania has 240 plans available in 2022. Medicare Advantage has continued to rise in popularity with Pennsylvania residents.
Who Medicare Advantage Plans are best for: This type of plan is best if you are on a fixed income or you are in good health and don’t want to overpay for coverage you don’t use very often. Having one card to use and the additional benefits bundled in the plan can be attractive. To be eligible, you need to be enrolled in Medicare Part A and Part B.
The downsides to Medicare Advantage Plans are mostly related to a limited choice of providers and service areas. Prior authorizations and referrals may also be necessary before receiving certain procedures.
|Medicare Advantage insurance company||Medicare rating||A.M. Best rating||Better Business Bureau (BBB) rating||J.D. Power ranking|
|3.9 stars||A||A+||6th out of 9|
|3.9 stars||A||B||5th out of 9|
|4 stars||A||Not rated||8th out of 9|
|4.8 stars||A+||A-||3rd out of 9|
|4.2 stars||A-||A+||2nd out of 9|
|4.2 stars||A||Not rated||4th out of 9|
|3.7 stars||Not rated||A-||Not ranked in the top 9|
|Plan name||Monthly premium||Yearly drug and premium cost||Deductibles|
|UPMC for Life HMO No Rx (HMO)||$0||$0||Health: $0
|UPMC for Life HMO Premier Rx (HMO)||$0||$0||Health: $0
|Community Blue Medicare HMO Signature (HMO)||$0||$0||Health: $0
Plans calculated based on Harrisburg ZIP code 17112.
Medicare Part D is offered by private insurance but is regulated by Medicare. Part D can be purchased as a stand-alone PDP or as part of a Medicare Advantage Plan (MA-PD).
Pennsylvania Part D premiums start at $5.20 a month.
Currently, there are 26 stand-alone PDPs in Pennsylvania. Eight of the stand-alone plans and 107 Medicare Advantage Plans with prescription drug coverage participate in the Senior Savings Model, which lowers the cost of insulin out of pocket.
Who Part D plans are best for: PDPs are always best even if you don’t take any medications. If you do not enroll when becoming eligible, you will be penalized for every month you do not have one.
|Plan name||Monthly premium||Yearly drug and premium cost||Deductible|
|SilverScript SmartSaver (PDP)||$5.20||$62.40||$505|
|Wellcare Value Script (PDP)||$11.10||$133.20||$505|
|Humana Walmart Value RX (PDP)||$30.60||$367.20||$505|
Plans calculated based on Harrisburg ZIP code 17112.
Medigap plans are standardized plans sold by private insurance companies. These plans are designed to pick up costs where Original Medicare leaves off in coverage. There are 12 standardized plans available in Pennsylvania designated by different letters of the alphabet (A, B, C, D, F, G, K, L, M, and N). Plans C & F are only eligible to those who became eligible for Medicare prior to Jan. 1, 2020.
A Plan G for a 65-year-old nonsmoking female in Harrisburg ranges from $102 to $407 per month. You will also be responsible for the Part B deductible of $233.
Who Medigap plans are best for: Medigap is a good fit if you utilize benefits frequently, do not want to be restricted to a small coverage area, and prefer to choose your own provider. You should not choose a supplement if you cannot afford the monthly premium and you want extra benefits available with Medicare Advantage, such as having the PDP, dental, vision, and hearing benefits included.
If you are considering purchasing a supplement, always check to see if the company offers additional discounts for having people that live in your household or for nonsmoking.
|Plan name||Monthly premium range||Copays/coinsurance||Deductibles||Plan benefits|
|Plan F||$116 to $441||$0||$0 hospital (Part A)
$0 medical (Part B)
|Plan G||$102 to $407||$0||$0 hospital (Part A)
$233 medical (Part B)
|Plan N||$78 to $373||$0 Generally your cost for approved Part B services with some $20 and $50 copays||$0 hospital (Part A)
$233 medical (Part B)
Calculated based on a nonsmoking 65-year-old female in Harrisburg ZIP code 17112.
Pennsylvania residents have many plan options available. It is always good to make a list of pros and cons of the plans. Important things to consider are out-of-pocket costs, provider network, coverage area, insurance company ratings and the overall ability of the plan to meet your specific need.
|People enrolled in Original Medicare||Average plan cost||Annual Pennsylvania spending per beneficiary||Spending per beneficiary compared to the national average|
|1,539,889||Part A: $0 to $506 per month*
Part B: $164.90 **
*Most people pay no premium but this can vary depending on how long they paid Medicare taxes.
**This is the average number but it can vary based on income.
Making Medicare decisions can be overwhelming at times. It is good to utilize the resources and tools available in Pennsylvania. The organizations have people knowledgeable in the programs specific to your state. Most of the services provided are free. An example is Pennsylvania Medicare Education and Decision Insight (PA MEDI) that offers volunteer counselors who can provide free information, education, and guidance.
Never be afraid to ask questions. Get started with these Pennsylvania Medicare resources:
|Organization||How you can get help||Contact Information|
|PA MEDI||Free counselors are available to help with information, education, and guidance with Medicare and its programs.||Website | (800) 783-7067|
|Pennsylvania Department on Aging||Gain access to a wide range of senior services that promote independence, well-being, advocacy, service, and protection. Medicare enrollment and counseling are available.||Website | (717) 783-1550|
|Pennsylvania Insurance Department||Acts as an advocate to protect you from scams and helps with decisions about private insurance and Medicare plans.||Website | (877) 881-6388|
|PACE Prescription Assistance||Pennsylvania’s prescription assistance programs for older adults, PACE and PACENET, offer low-cost prescription medication to qualified residents, age 65 and older.||Website | (800) 225-7223|
|Department of Human Services||Services for people with disabilities including in-home care, advocacy, and employment, along with applying for assistive services and programs.||Website |(717) 783-1550|
|Pennsylvania Area Agencies on Aging (AAAs)||Locate a regional AAA that offers caregiver resources, Medicare support, and a full range of senior services.||Website | (717) 783-1550|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
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