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Medicare in Pennsylvania

Key Takeaways

  • Applying for Medicare in Pennsylvania when you approach age 65 is easy, but it’s important that you understand the coverage and costs involved.
  • Supplemental insurance can help with out-of-pocket costs associated with both Original Medicare
    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).
    .
  • Medicare Advantage
    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 can help you get additional coverage like dental and vision plans.

Pennsylvania is a treasure trove of American symbols. The Liberty Bell. Independence Hall. The cheesesteak. Deciding between historic sites is as easy as crossing the street. It’s the same with deciding between Pat’s or Geno’s for lunch.

But deciding between healthcare insurance plans? That’s decidedly more difficult. That’s where GoHealth comes in.

How Do I Get Medicare in PA?

You are eligible to get Medicare in Pennsylvania if you’re a U.S. citizen or permanent resident age 65 or older. You can be eligible for Medicare before 65 if:

If you receive Social Security benefits before 65, you are automatically enrolled into Original Medicare in PA at age 65. If not, you can enroll during the seven-month Initial Enrollment Period that includes the month of your 65th birthday as well as the three months before and after your 65th birthday.

How to Enroll in Medicare in Pennsylvania

  • You can enroll online with the Social Security Administration.
  • You can enroll via phone by calling 1-800-772-1213 (TTY: 1-800-325-0778).
  • You can enroll by visiting a local Social Security office.

Start your Medicare PlanFit CheckUp today.

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What Does Medicare Cover in PA?

Medicare is a health insurance program that provides hospital and medical coverage for Americans ages 65 and over, and those under 65 with qualifying disabilities.

Medicare Part A and Part B


Part A of Original Medicare covers a portion of your hospital-related expenses, and Part B covers a portion of your other medical expenses.

Part D


Part D can be added to Original Medicare to cover a portion of your prescription expenses.

Part C


Medicare Advantage, also known as Part C, is available from private insurance companies and bundles those coverages while offering additional ones like dental and vision coverage.

How Much Does Medicare Cost in PA?

Premiums for Medicare in PA can vary. For most people who enroll in Medicare, Part A and Part B have standard costs that depend on your income and whether or not you’ve paid enough tax into Medicare and Social Security. Here’s a breakdown:

  • For most Americans who contribute to Medicare and Social Security for at least 10 years through payroll, you won’t pay a monthly premium for your Part A plan.
  • The standard Part B premium for 2024 is $174.70. Still, this monthly premium can increase based on individual or joint incomes.
  • Medicare Advantage (Part C), Part D, and Medicare Supplement plans can vary in cost and benefits from state to state.

My Medicare coverage doesn’t address all of my needs.

Find The Right Plan
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What Is the Best Medicare Supplement Plan in Pennsylvania?

Private insurance companies offer Medigap, supplemental plans that help fill cost gaps for Original Medicare. Whether a plan is right for you depends on what you need covered in terms deductibles, copays, and coinsurance.

Within the first six months of enrolling in a supplement plan, a carrier cannot deny coverage based on pre-existing conditions. Beyond the six-month window, coverage and costs are not standardized.

What Are the Parts of Medicare?

Medicare Advantage plans bundle services, and this is a fundamental difference between Medicare plans in Pennsylvania.

  • Medicare Advantage can substitute for Original Medicare. You get Part A and B benefits through a private insurance carrier. You also get drug coverage with most Medicare Advantage plans.
  • Medicare Advantage plans offer additional coverage options not offered by Original Medicare like dental and vision and a monthly stipend for purchasing over-the-counter supplies.
  • While Original Medicare can be used nationwide, Medicare Advantage is usually limited to a network of providers in your area. That distinction allows Medicare Advantage in Pennsylvania to often offer more affordable options.

What Is the Best Medicare Advantage Plan in Pennsylvania?

While there is a standard Original Medicare plan, Medicare Advantage in Pennsylvania offers multiple plan options to meet your needs. A GoHealth licensed insurance agent specializes in guiding you through the strengths of various plans, helping you make an educated decision.

Ready for a new Medicare Advantage plan?

Get Help Now
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Medicare in Pennsylvania by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 2,616,214 people are enrolled in Medicare Part A and B in Pennsylvania. The total number of beneficiaries enrolled in Medicare Advantage increased from 1,219,894 to 1,293,353 year over year. Medicare Advantage participation in Pennsylvania went from 47.46% to 49.44% year over year. If you’d like to dive deeper into how Medicare in Pennsylvania breaks down across the state, we provide a glance at who is using Medicare and how.

Outline of the state of Pennsylvania in light blue.
Medicare
Pennsylvania

2,616,214 Beneficiaries with Part A & Part B

1,293,353 Medicare Advantage Beneficiaries

49.44% Medicare Advantage Participation Rate

55.03% Female

44.97% Male

87.15% Non-Hispanic White

6.36% African American

2.28% Hispanic

4.20% Other/Unknown

16.24% Eligible for Medicaid

1 Average HCC Score

$10,405.70 Actual Per Capita Costs

18.09% Hospital Readmission Rate

26.49% % of Beneficiaries with an Emergency Department Visit

1,219,894 Medicare Advantage Beneficiaries, Previous Year

Increased Medicare Advantage, Year over year

47.46% Medicare Advantage Participation Rate, Previous Year

Show More

Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Pennsylvania Medicare Resources & Contacts

1-800-783-7067
Phone lines up M-F, 9 a.m. to 4 p.m.

https://www.aging.pa.gov/aging-services/medicare-counseling/Pages/default.aspx

What should I know about APPRISE?

Counselors on behalf of the Pennsylvania Department of Aging offer older Pennsylvanians free guidance to navigate Medicare.
1-800-692-7462 (TTY 1-800-451-5886)
Phone lines open M-F, 8:30 a.m. to 4:45 p.m.

https://www.compass.state.pa.us/compass.web/Public/CMPHome

What should I know about COMPASS?

The go-to source for Pennsylvanians looking to apply for Medicaid or other cost-saving services for those in need.
1-844-844-8040
Phone lines open M-F, 8 a.m. to 6 p.m.

https://pennie.com/

What should I know about Pennie?

Acts as the official Healthcare Marketplace for Pennsylvania residents.
1-800-547-2828

https://www.dmva.pa.gov/Veterans/Pages/default.aspx

What should I know about the Department of Military and Veterans Affairs?

Dedicated to meeting the needs of Pennsylvania veterans and their families.

Nationwide Resources

If you have general questions about Medicare in Pennsylvania, or need help with current Medicare benefits.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

1-800-722-1213
TTY 1-800-325-0778

Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET

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.

 

Two women laughing

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

People holding hands in support

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.