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Medicare in Pennsylvania

GoHealth shares information that can save Pennsylvanians time and money

Reviewed by: Stephanie Demus, Licensed Insurance Agent. Written by: Bryan Strickland.

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 MedicareOriginal 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). and Medicare Advantage in Pennsylvania.

  • Medicare AdvantageMedicare 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 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.

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:

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?

  • You can enroll online with the Social Security Administration. [1]
  • 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. [2]

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, 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 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.

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 2,531,541 people are enrolled in Medicare in Pennsylvania. The total number of beneficiaries enrolled in Medicare Advantage in Pennsylvania is 1,170,574. The previous year, 1,132,209 enrolled in Medicare Advantage. Medicare Advantage participation in Pennsylvania went from 45.44% to 46.24% 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 Pennsylvania
2,531,541
Beneficiaries with Part A & Part B
1,170,574
Medicare Advantage Beneficiaries
46.24%
Medicare Advantage Participation Rate
55.23%
% Female
44.77%
% Male
1.01
Average HCC Score
$10,699.39
Actual Per Capita Costs
18.66%
% Eligible for Medicaid
31.43%
% of Beneficiaries with an Emergency Department Visit
18.17%
Hospital Readmission Rate
86.96%
% Non-Hispanic White
6.91%
% African American
2.31%
% Hispanic
3.82%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

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:

APPRISE - Medicare Counseling

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 free guidance to older Pennsylvanians with navigating Medicare.

COMPASS

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.

Pennie

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.

Department of Military and Veterans Affairs

1-800-547-2828

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

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

Dedicated to assuring the needs of Pennsylvania veterans and their families are met.

Nationwide Resources

Speak with an insurance agent that is licensed in Pennsylvania about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

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

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

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

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.

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New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.