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 and Medicare Advantage in Pennsylvania.
Medicare Advantage plans also 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.
Find a local Medicare plan that fits your needs
How do I get Medicare in PA?
You are eligible to get Medicare in Pennsylvania if you’re a U.S. citizen age 65 or older. You can be eligible for Medicare before 65 if:
- You have received Social Security Disability Insurance payments or Railroad benefits payments for 24 months, regardless of your age.
- You have End Stage Renal Disease or Lou Gehrig’s disease (ALS).
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 the three months after your 65th birthday.
How to enroll in Medicare in Pennsylvania?
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.
Are you eligible for cost-saving Medicare subsidies?
How much does Medicare cost in PA?
Premiums for Medicare in PA can vary, regardless of whether you choose Parts A and B, Part C or D, or a supplement plan. For most people that enroll in Medicare in PA, 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 that 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 2021 is $148.50. 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.
What is the Best Medicare Supplement Plan in Pennsylvania?
Private insurance companies offer Medigap, a supplemental plan that helps fill cost gaps to Original Medicare. Whether or not 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 extra benefits and savings do you qualify for?
What are the Different Plans of Medicare?
Medicare Advantage plans bundle services, and this is a fundamental difference between Medicare plans in Pennsylvania.
- Medicare Advantage can replace Original Medicare, but you can still get Parts A and B through a private insurance carrier. You also get drug coverage with most Medicare Advantage plans.
- Medicare Advantage also offers additional coverage options not offered by Original Medicare like dental and vision coverage 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, but 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 and improve your coverage effectiveness. A GoHealth licensed insurance agent specializes in guiding you through the strengths of various plans, helping you make an educated decision.
Get real Medicare answers and guidance -- no strings attached.
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.
Medicare
Pennsylvania
2,616,214 Beneficiaries with Part A & Part B
1,293,353 Medicare Advantage Beneficiaries
49.44% Meducare 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% Meducare Advantage Participation Rate, Previous Year
See 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
Beneficiaries spend an average of $10,699.39 each year on Medicare in Pennsylvania. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Pennsylvania-based resources, like these, may be able to help:
Nationwide Resources
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.
Medicare guide
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare guide
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare guide
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Medicare guide
Low Income and Medicare Guide
For individuals with a qualifying income status
Medicare guide
A Caregiver’s Guide
For individuals with a qualifying income status
