Pennsylvania Medicare Supplement Plans
New beneficiaries don’t always realize they’re still responsible for 20% of their medical costs that fall under Part B, plus the deductible. They’re also responsible for the Part A deductible if they end up in the hospital. The deductibles are enough to break the bank for some.
Our team of Medicare experts works hard to make sure our content is up-to-date and accurate. Below, you’ll find what you need to know about Pennsylvania Medicare plans for 2020.
Medicare Supplement Plans in Pennsylvania for 2020
Throughout our content, we’re going to refer to a client of ours named Kevin. This example will help you understand how each Medicare plan works.
Many clients of ours ask if Medicare Supplements are necessary. Hopefully, Kevin’s story will help you understand why they are necessary.
Kevin has always been healthy. He never had an issue with his heart. One day he was outside, and out of nowhere, he had a heart attack.
He went to the hospital, where the emergency doctors got him stable. Then he had to schedule many follow up visits and tests with his primary physician.
Not only did he receive a bill for the Part A deductible, but he also has a bill for 20% of all his follow up doctor visits and tests.
If Kevin had a Medigap plan, all of those expenses would’ve gone to the supplement insurance carrier.
Best Medicare Supplement Plans in Pennsylvania
As in all states, there are 10 Medigap Plans available in Pennslyvania. In recent years, Plan F has been a favorite for many beneficiaries.
However, that’s changing in 2020 due to MACRA. Any new beneficiaries won’t be eligible for Plan F.
The new top plan is Plan G, followed by Plan N. Plan G covers everything minus the Part B deductible. Plan N has the same coverage, with the only difference being your responsible for a small deductible when visiting the hospital and doctors.
The only other difference between Plan N and Plan G is that Plan N doesn’t cover excess charges. The good news is, Pennsylvania does not allow excess charges.
Average Cost for Medicare Supplements in Pennsylvania
If Kevin were to compare rates for Plan G in Pennsylvania, he would see the premiums average between $145-$220. The benefits are the same across all carriers.
The only difference is carriers use different rating methods to determine the premium they want to charge. That’s why once you know what letter plan you want, it’s crucial to compare rates across all carriers.
For the same benefits, TransAmerica may charge you only $145 in monthly premiums, while Bankers Fidelity may charge you over $215 in monthly premiums.
If Kevin was comfortable with paying small copays, he could compare rates for Plan N. Due to having higher out of pocket costs; the premium will be less. The average premium for Plan N in Pennsylvania will run somewhere between $110-$170.
Now, if Kevin wanted even lower premiums, he could consider High-Deductible Plan G. The high deductible version of Plan G has the same benefits as the standard Plan G.
The difference is you must meet the high deductible first before coverage kicks in. However, you have a significantly lower monthly premium. The average premium for High Deductible Plan G in Pennsylvania is around $60.
Excess Charges are Prohibited
Physicians that accept Medicare must sign a disclosure that prohibits them from charing beneficiaries’ excess charges. So you don’t have to worry about which plans allow excess charges and which don’t.
Most carriers do not have different rates for those who smoke in Pennsylvania. However, this can change at any time. That’s why it’s essential to have an agent to keep you informed of these changes.
Some carriers offer household discounts. In Pennsylvania, carriers may offer a 7% spousal discount. Only as long as the spouse has a policy with them as well.
If you’re on disability, you’re living in the right state! Pennsylvania is one of the few states that don’t charge significantly higher Medigap premiums when you’re under 65.
Most premiums triple for those with Medicare due to disability. For Pennsylvania Medicare beneficiaries under 65 on Medicare disability, you’ll pay about the same as those aging into Medicare.
Rules for Voluntary Group Termination
As long as your employer-sponsored plan is primary to Medicare, you’ll get granted Guaranteed Issue Rights when enrolling in a Medigap plan.
Make sure you understand how Medicare & employer coverage work together in your state when turning 65. In many cases, our clients find their group insurance is secondary to Medicare. Therefore, they have to answer health questions when enrolling.
Medicare Advantage Plans in Pennsylvania
If a Medigap Plan is entirely out of your price range, then an alternative is a Medicare Advantage Plan.
There is a lot of hype around Advantage plans, hype that misleads beneficiaries. It’s essential to understand the pros & cons of these plans before you enroll.
Yes, the premiums are cheaper. The reason being they come with copays and high Maximum Out of Pocket costs. They also have restricted networks. If you’re okay with staying within their local network, then this type of plan might work for you.
Some Medicare Advantage Plans in Pennsylvania come with prescription drug coverage. It’s also crucial to understand the total out of pocket costs with these types of drug plans.
Around 41% of Pennsylvania residents that are eligible for Medicare enroll in a Medicare Advantage plan.
If Kevin decided he wanted a Medicare Advantage plan, he has a few options available to compare.
He could go with a zero dollar premium HumanaChoice plan, which offers both a local PPO & regional PPO. The local PPO has a MOOP limit of $3,900, while the regional PPO has a MOOP limit of $4,900. Neither option has drug coverage benefits.
If you’re looking for drug coverage, then a local HMO plan with Aetna could be a good option. It also has a zero dollar premium. It does also have a zero dollar drug deductible. However, the MOOP limit is $6,700.
As you can see above, the MOOP limit significantly increases if you want drug coverage. For most, it makes more sense financially to enroll in a Medigap plan and add a stand-alone Part D plan for drug benefits.
In Pennsylvania, stand-alone Part D plans range from $13-$40 a month. Some do cost more, but the same coverage is usually available with another carrier with a lower premium.
Don’t be afraid to ask your agent to compare rates with other lesser well-known carriers.
A popular Part D plan in Pennsylvania is the Humana Walmart Value Rx Plan. It will cost you about $13 a month in premiums.
Or you could go with Silverscript. They offer a plan that has a lower deductible with a low-income subsidy option, but the premium will be over $30 a month.
As you can see, there are many options to compare. It’s impossible to do it by yourself. That’s where we can help.
Medicare Resources in Pennsylvania
Each state has a Medicare Savings Program that assists with Medicare costs. As a result, if you’re on a fixed income, disabled, or considered a low-income family, you may be eligible for financial assistance. This program is called SHIP.
You can find more information on the state SHIP program on the Pennsylvania Department of Aging. The official Pennsylvania Department of Aging also has a lot of valuable information about Medicaid & CHIP, the ACA.
Questions & Answers
How to apply for Medicare in PA?
What does Medicare cover in PA?
Medicare covers both inpatient and outpatient services. The coverage works the same across all states.
Compare Medicare Plans in Pennsylvania
We help beneficiaries make informed decisions on their healthcare coverage. Just like Kevin, we can help you compare all your Medicare options side by side.
You don’t have to do it alone. When you’re a client of ours, you get unlimited support from our Client Care Team. If you happen to have trouble with a claim, they can help.
Our services and expertise don’t cost you anything. We genuinely care about your coverage, and we always treat you like family.
Give us a call today, or you can complete our online rate form to see rates in your area now.