Medicare Supplement Plans in Pennsylvania

Summary: Medicare Supplement plans in PA help cut medical costs that Original Medicare doesn’t cover. Also known as Medigap plans, it’s important to compare your coverage options with a licensed Medicare agent to ensure you receive the best benefits for your healthcare needs and budget. Estimated Read Time: 13 min

Medicare Supplement (Medigap) plans in Pennsylvania (PA) help lower your out-of-pocket costs from Original Medicare (Medicare Part A and Part B). When choosing a Medicare Supplement plan, there are several factors to consider.

Medigap plans in PA supplement the benefits you receive with Original Medicare. There are several out-of-pocket expenses that you may face when receiving healthcare services using Medicare Part A and/or Part B alone. Working to “fill the gap” of these expenses, Medigap plans in Pennsylvania help you cover these costs.

Although Medicare Supplement plans in PA are standardized, your experience between carriers can differ for the same policy. Explore how a supplemental Medicare plan in PA can help you cover costs, the most popular plans available, average plan costs, and how to select the right coverage for your needs.

What is the Best Medicare Supplement Plan in Pennsylvania for 2023?

The best Medicare Supplement plans in PA are going to be the ones that fit your individual needs. Each of the Medicare Supplement plans in PA offers a different level of benefits, which is a good thing for several reasons:

• Everyone has different needs in terms of healthcare. More options mean you receive more personalized coverage to meet your health concerns.
• Similarly, everyone’s budget is different. Therefore, having more options means keeping you covered while protecting your immediate and future finances.
• Furthermore, some plans have enrollment restrictions that may hinder some Medicare beneficiaries from enrolling in their benefits.

It’s unfair to say any single option is one of the best Medigap plans in PA because each offers valuable benefits. What’s more important to focus on is your personal needs.

There are twelve available Medicare Supplement plans in PA. You’ll need to consider benefits and costs to determine the best Medicare Supplement plans in Pennsylvania for you. Three plans continue to emerge as the most popular options for doing so: Medicare Supplement Plan F, Plan G, and Plan N.

Overall, reviewing your options with a licensed Medicare agent is always best practice. Still, by looking at the most popular plans, you can better understand the coverages available to you and which best fits your needs. Below, we break down the most popular Medigap plans in PA and how they might be the best solution for your healthcare and budget.

Medigap Plan F in Pennsylvania

Due to its comprehensive coverage, Medicare Supplement Plan F in Pennsylvania is a longstanding favorite among residents of the Keystone State. You’ll find that your out-of-pocket expenses, including your deductibles and coinsurance or copayments for Medicare Part A and Part B, are covered. Beneficiaries also receive benefits covering Medicare Part B excess charges, skilled nursing facility coinsurance, and foreign travel emergency expenses, up to your plan’s limit, when enrolled in Medicare Supplement Plan F in Pennsylvania.

However, Medigap Plan F in Pennsylvania has been subject to changes in Medicare over recent years. While enrollees can enjoy no out-of-pocket costs, new Medicare beneficiaries – anyone eligible for Medicare after January 1, 2020 – are no longer eligible for Medigap Plan F in Pennsylvania.

Medigap Plan G in Pennsylvania

Medicare Supplement Plan G in Pennsylvania continues to grow in popularity because of the enrollment restrictions imposed on Plan F. Newly Medicare-eligible seniors are encouraged to enroll in Medigap Plan G in Pennsylvania when searching for the most comprehensive benefits available to them.

Medicare Supplement Plan G in Pennsylvania covers almost every benefit Plan F does, except for your Medicare Part B deductible. But even after meeting the deductible, eligible policyholders often see annual savings in their healthcare costs, making it a viable option for those seeking more benefits.

Medigap Plan N in Pennsylvania

Medicare Supplement Plan N in Pennsylvania is another top plan that does a great job of offering a solid foundation of benefits while cutting your monthly premium. In general, the more benefits you receive, the higher your monthly premium will be. This is where Medigap Plan N comes in.

When you choose Medicare Supplement Plan N in Pennsylvania, you are responsible for $20-$50 copayments at the doctor and emergency room, respectively. Additionally, these benefits do not cover your Medicare Part B excess charges. Luckily, while most states allow Medicare excess charges, Pennsylvania is one of the few prohibiting them. However, if you receive care in a state that has excess charges, you will need to pay them, and the fact that your primary residence is in Pennsylvania will not matter.

Each Medicare Supplemental plan in PA brings different value to each senior. The best plan for you depends on your health and budget needs. However, Medicare Supplement Plan N can make more sense if you seek lower premiums and have fewer medical needs.

Who Is Eligible for Medicare Supplement Plans in PA?

Anyone eligible for Original Medicare benefits is eligible for Medigap plans in PA. You’ll need to have Medicare Part A and Part B benefits because Medicare Supplement plans for PA residents are supplemental coverage. Costs left over after using Medicare Part A and/or Part B can be covered by supplemental coverage, helping you avoid paying out of pocket when receiving healthcare services.

Average Cost of Medicare Supplement in PA

The Medigap cost PA residents will pay will vary depending on many factors. On average, a Medicare Supplement plan in PA ranges between $50-$300 per month, but this depends on things such as your plan letter and many other factors.

Since Medigap plans in PA are standardized, the cost is one of the most critical elements to consider when choosing coverage. Because while you’ll enjoy the same level of coverage among different companies, the amount you pay can change drastically.

Monthly premium costs can vary from plan to plan and between carriers. Some of the most prominent factors affecting the amount you pay for coverage include age, tobacco usage, household discounts, location, and gender. Therefore, comparing Medicare plans in Pennsylvania and companies is essential to find the best option for your needs.

The charts below showcase the average cost of Medicare Supplement in PA using sample premium rates for a 65-year-old male and female compared to a 75-year-old male and female Medigap beneficiary in the same Pennsylvania ZIP Code.

* If on Medicare before 1/1/20

The sooner you sign up for a Medigap plan in PA, the lower your premium price will be. It’s always advised that seniors in Pennsylvania take advantage of their Medigap Open Enrollment Period rather than waiting.

Your costs include your premium and miscellaneous out-of-pocket expenses as required by your PA Medicare Supplement plan.

Medicare Companies in Pennsylvania

Residents of the Keystone State have plenty of options for their coverage. Top-rated Medicare companies in Pennsylvania offer many products through many choices to fit your coverage needs. If you’re looking for supplemental Medicare plans in Pennsylvania, here are some of the most popular companies providing coverage:

• Aetna
• Bankers Fidelity
• Blue Cross Blue Shield (BCBS) of Pennsylvania
• Capitol Life
• Cigna
• GPM (Government Personnel Mutual)
• Humana
• Lumico Life Insurance
• Manhattan Life
• Mutual of Omaha
• National General
• United American
• UnitedHealthcare

Under 65 Medigap Plans in PA

If an insurance carrier offers Medigap plans in PA, they must provide at least one Medicare Supplement option to Medicare beneficiaries under age 65 who qualify due to a disability. However, when you enroll in coverage under age 65, you can expect your premium to be much higher than if you age into Medicare at 65. Plan availability can vary from company to company.

Medicare Supplement Rating Method in Pennsylvania

Among the various factors that affect Medigap cost in PA, the rating method used by the company providing your benefits will determine how much you’ll pay in premiums.

Once calculated by private carriers, these prices are provided to the PA Insurance Department for approval. Here are the three methods that can apply to your plan in the Quaker State:

• Community-rated plans use pricing that doesn’t base your premium on your age but instead applies the same price to everyone that enrolls.
• Issue-age-rated plans base your premium on the age you purchase your coverage, and if you are younger when you do, you’ll pay a lower premium than those signing up at a more advanced age.
• Attained-age-rated coverage bases its premium on your current age and will increase as you get older.

The different rating methods available to private insurance companies are just another way to notice discrepancies in the price you pay for your benefits. It’s another reason to work with a licensed Medicare agent to shop and compare benefits in your area and identify the right plan for you.

Medigap Guaranteed Issue Protections in PA

If you sign up during your Medigap Open Enrollment Period, PA Medicare Supplement plans will not restrict your enrollment due to pre-existing conditions if you sign up during your Medigap Open Enrollment Period. During your Medicare Supplement Open Enrollment Period, you have guaranteed issue rights. Private insurance companies can neither deny Medigap coverage nor raise rates because of pre-existing health conditions.

Seniors who fail to sign up for Medigap during their Open Enrollment Period may be subject to higher premiums or denied coverage altogether because of pre-existing health conditions. A waiting period of up to six months before coverage begins may affect seniors in PA when enrolling outside of the Medigap Open Enrollment Period.

However, even though you can still enroll in PA Medicare Supplement plans, there are still some plans you may not have access to. This can be complex for residents of Pennsylvania, as eligibility depends on numerous scenarios that not only qualify you for guaranteed issue rights but also dictate how they apply.

Remember that for your guaranteed issue rights to apply, you’ll need to apply for coverage within each respective time frame. Typically, this means no later than 63 calendar days after your coverage ends. Furthermore, because of the enrollment restrictions for PA Medigap Plan F, if you are not eligible for this coverage, your guaranteed issue rights will apply to Plan G instead:

Scenario 1:

If you are a resident of PA and all of the following apply, you have guaranteed issue rights for PA Medigap Plans A, B, C, F, K, or L:

• You have a Medicare Advantage plan, but;
• Your plan is leaving the Medicare program or your area, or;
• You’re moving outside of your plan’s area of service.

It’s important to note that this only applies when switching to Original Medicare, not when switching to another Medicare Advantage plan. You can’t have a Medigap and Medicare Advantage plan at the same time.

Scenario 2:

Residents of Pennsylvania can gain guaranteed issue rights for PA Medicare Supplement Plans A, B, C, F, K, or L when the following apply:

• You’re enrolled in Original Medicare and an employer group health plan, which can include retiree or COBRA coverage, and;
• You also have Union coverage that pays after Medicare pays, but this plan is ending.

If you qualify under these circumstances, you should note that you may also have additional rights available. Furthermore, for those with COBRA coverage, you can wait until your COBRA coverage ends or purchase supplemental coverage immediately.

Scenario 3:

Residents meeting the following criteria enjoy protections for Medigap Plans in PA lettered A, B, C, F, K, or L. You can also apply your guaranteed issue rights to plans in the state you are moving to:

• You are enrolled in Original Medicare and a Medicare SELECT policy but move outside of the service area of the SELECT policy.

Scenario 4:

If you’re leaving a Medicare Advantage plan or decide to drop your supplemental Medicare plan in PA, you can enroll in PA Medicare Supplement Plans A, B, C, F, K, or L. This also applies if you have been misled by a company selling you Medicare Advantage or PA Medigap plans.

Scenario 5:

Should Medicare companies in Pennsylvania go bankrupt and your carrier is one of them, causing you to lose your coverage as a resident, you can enroll in PA Medigap Plans A, B, C, F, K, or L. The same applies if you were to lose your coverage through no fault of your own.

Scenario 6:

Suppose you are receiving coverage from either a Medicare Advantage plan or Programs of All-Inclusive Care for the Elderly (PACE) and were newly eligible for Medicare Part A (age 65) when enrolling. In that case, you can switch to Original Medicare within your first year of joining. Known as a trial right, you are eligible to enroll into any Medicare Supplement plans in PA as a result.

Scenario 7:

You can also benefit from your trial right if you drop coverage from Medigap plans in PA, coverage from a Medicare Advantage plan, or if you switch to a Medicare SELECT policy, but it must be the first time you are doing so. You must also have had your coverage for under a year.

Here are your options:

• You must switch back to your previous supplemental Medicare plan in PA.
• If your previous PA Medicare Supplement plan is unavailable, you can choose between PA Medigap Plans A, B, C, F, K, or L for your coverage.

Which Medicare Supplemental Plans Have SilverSneakers in PA?

Very few PA Medicare Supplement plans offer Medicare gym membership benefits. This is because gym benefits are a carrier perk and not a part of the actual Medigap plan. Therefore, whether you can find a Medicare Supplement plan in PA with SilverSneakers in Pennsylvania – or anywhere – depends on the plans available through carriers offering SilverSneakers in your ZIP Code.

However, SilverSneakers is not the only fitness and wellness program Medicare companies in Pennsylvania offer. There are different Medigap plans in PA that may offer different gym memberships, depending on the brand, your location, and other factors. Our licensed agents can help determine whether a plan near you offers this type of benefit.

Does Medigap Cover Psychologist Visits in PA?

Medigap plans in PA cover what Original Medicare covers, so your coverage will pick up the coinsurance balance of any mental healthcare services that Part A or Part B covers. What’s covered by Medicare Supplement plans in Pennsylvania is standardized. However, the plans available to you will vary from location to location.

Additional Medicare Coverage Options in PA

Even with Medicare Supplement plans in PA along with Original Medicare benefits, there can be healthcare costs that still remain. Thankfully, additional coverage options are available for those who enroll in Original Medicare.

This includes Medicare Part D policies for prescription drug coverage. Neither Original Medicare nor any currently available Medicare Supplement option provides this coverage, and each plan provides benefits that cover the cost of prescription drugs in accordance with its formulary.

Ancillary dental, vision, and hearing plans are also available to those on Medicare in Pennsylvania. Original Medicare does not include comprehensive coverage for these needs; thus, Medigap plans in PA do not either.

Furthermore, for some residents, Medicare Supplement plans in Pennsylvania aren’t the best option. Medicare Advantage plans are also available throughout the state and often include coverage for prescription drugs, dental, vision, and hearing – bundled under the same policy.

Due to higher premiums, many people enroll in a Medicare Advantage plan while under 65 and use their second Medicare Supplement Open Enrollment Period at age 65 to pick up a Medicare Supplement policy in PA once they qualify for lower premiums. However, it’s important to note that you cannot simultaneously have a Medigap plan in PA and a Medicare Advantage plan.