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Medicare Advantage Plans in Pennsylvania

Key Takeaways

  • Medicare Advantage (Part C)
    Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D).
    plans in Pennsylvania offer at least the same coverage as Original Medicare (Parts A and B)
    Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance).
    but may also include additional benefits like prescription drug coverage, as well as dental, vision, and hearing services.
  • Many Medicare Advantage plans in Pennsylvania also offer $0 premiums
    A premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost.
    .
  • If you have Original Medicare, or you want to switch to a new Part C plan, the most common time to do so is the Medicare Open Enrollment Period, help every year from October 15 to December 7.

With 281 Medicare Advantage plans available in Pennsylvania in 2024, pinpointing which one is right for you can be challenging. On this page we’ll help you understand how Medicare Advantage plans work and when and you can enroll.

Still have questions? GoHealth has the answers you need.

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Pennsylvania Medicare Advantage Plan Coverage

While there are hundreds of Medicare Advantage plans in Pennsylvania,  you won’t have quite that many to choose from. The availability of Medicare Advantage plans varies based on ZIP code. This is because many Medicare Advantage plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). These organizations create a network of local providers and facilities, negotiating to receive discounted rates.

When you look for a Medicare Advantage plan in Pennsylvania, you may have a range of plans to choose from. Most include Part D prescription drug plans, some may have a $0 premium, and others will provide extra benefits such as dental, vision or hearing coverage. The availability and choices allow you to prioritize what you’re willing to pay and what coverage you most need.

Regardless of plan type, Medicare requires all Medicare Advantage plans to offer at least the same coverage as Parts A and B of Original Medicare. Many offer expanded coverage.

PA Medicare Advantage Costs

The average Pennsylvania resident pays $27.94 for their monthly Medicare Advantage premium in 2024. However, 100% of Pennsylvanians have access to a Part C plan with a no-cost premium. However, a $0 premium plan may not be the right fit for you.

If you pay a premium, you may have a lower a deductible, copayment or coinsurance. You should also take into account each plan’s out-of-pocket maximum.

Find the Medicare Plan that works for you.

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Medicare Advantage Plan Eligibility and Enrollment in Pennsylvania

Qualifying for a Medicare Advantage plan is not too different from qualifying for Original Medicare, also referred to as Medicare Part A and Part B.

You must begin by enrolling in Original Medicare. If you’re an American citizen (or have been a permanent resident for at least five years) who is 65 or older, you’re eligible for Parts A and B. You can also qualify due to disability even if you’re under age 65.

In most cases, eligibility for Medicare Advantage is simple. First, you must be enrolled in Medicare Part A and Part B, or be eligible to enroll. Second, you must live in the area covered by the plan that you want. This is an essential detail because Medicare Advantage plans cover specific areas and are not portable. You may be able to see an out-of-network provider, but it will typically cost more.

You will have the opportunity to enroll in Medicare Advantage when you are initially enrolled in Medicare Parts A and B — called your Initial Coverage Election Period. Alternatively, if you’re already enrolled in Parts A and B, you can switch to a Medicare Advantage during the Medicare Open Enrollment Period, also called the Annual Enrollment Period, which runs from October 15 to December 7 each year. When you enroll in a new Medicare Advantage plan at this time, your coverage will begin January 1.

Medicare releases a Star Rating of Medicare plans no later than October 8. Their ratings system takes into account many factors, including customer reviews and complaints. If you’d like to see what plans are offered in your area, and what they cover, a GoHealth licensed insurance agent can assist you.

Are There Pennsylvania Medicare Advantage Plans With Prescription Drug Coverage?

Most Medicare Advantage plans in Pennsylvania include drug coverage. But not all drug plans are equal. If you sign up for Part C with drug coverage, you’ll want to make sure your new plan covers the medications you need.

When you compare prescription drug plan coverage, it’s important to review a plan’s formulary. This is the listing of medications a prescription drug plan covers. The insurance company will usually split the formulary into five categories. Generic medications are often Tier 1 medications and cost you the least. Tier 5 medications are specialty drugs that will usually cost you more. Medicare requires that all formularies include at least two medications in every major drug category.

The key is finding the right combination of covered prescription drugs with a monthly premium that’s affordable.

What Happens If I Don’t Like My Medicare Advantage Plan?

If you try a Medicare Advantage plan and you aren’t happy with it, there are some protections that allow you to make a switch. Like almost everything with Medicare, this must be accomplished within a certain timeframe. From January 1 through March 31, you can modify your Medicare Advantage coverage by switching to another Medicare Advantage plan, or you can go back to Original Medicare.

Let’s find your ideal Medicare Advantage plan.

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Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

 

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Before 65 Guide

Understanding health insurance before age 65, especially when considering early retirement

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Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan

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Medicare Beneficiary Guide

For those currently enrolled in Medicare

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Low Income and Medicare Guide

For individuals with a qualifying income status

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A Caregiver's Guide

For individuals with a qualifying income status

Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.