Medicare in Pennsylvania
GoHealth shares information that can save Pennsylvanians time and money
Reviewed by: Stephanie Demus, Licensed Insurance Agent. Written by: Bryan Strickland.
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 (Parts A and B) is fee-for-service health insurance available to all 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 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.
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 can be added to Original Medicare to cover a portion of your prescription expenses.
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.
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.
APPRISE - Medicare Counseling
Phone lines up M-F, 9 a.m. to 4 p.m.
What should I know about APPRISE?
Counselors on behalf of the Pennsylvania Department of Aging offer free guidance to older Pennsylvanians with navigating Medicare.
1-800-692-7462 (TTY 1-800-451-5886)
Phone lines open M-F, 8:30 a.m. to 4:45 p.m.
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.
Phone lines open M-F, 8 a.m. to 6 p.m.
What should I know about Pennie?
Acts as the official Healthcare Marketplace for Pennsylvania residents.
Department of Military and Veterans Affairs
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.
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