Pennsylvania Medicare Supplement Plans
Pennsylvania Medicare Supplement plans were specifically created to provide extra coverage for the expensive out-of-pocket cost associated with copayments, deductibles, and coinsurance.
New beneficiaries don’t always realize they’re still responsible for 20% of their medical costs that fall under Part B, plus the deductible of $185. There also responsible for the Part A deductible if they end up in the hospital, which is $1,364 for 2019.
Kevin has always been healthy, he never expected there was an issue with his heart. One day he was outside and out of nowhere, he had a heart attack.
He was rushed to the hospital, where the emergency doctors got him stable. Then had to schedule many follow up visits and tests with his primary physician.
Not only was he billed the Part A deductible, but he was also billed for 20% of all his follow up doctors visits and tests.
If Kevin has a Medigap plan, all of those expenses out of pocket costs would’ve been billed to the supplement insurance carrier.
Medicare Supplement Plans in Pennsylvania (PA)
Medicare Supplement plans are also known as Medigap insurance policies. These plans assist in healthcare costs not covered by Medicare Parts A and B.
The policies include coverage on copayments, deductibles, and coinsurance. They’re sold by most private insurance carriers.
Pennsylvania Part A & Part B
Part A Hospital coverage includes:
- Inpatient hospital care
- Skilled nursing facility admissions
- Hospice Care
Part B Medical coverage includes:
- Doctors’ visits
- Some home health services like occupational and physical therapy
- Some preventative services
- Outpatient care
All of these services in both Parts A and B are covered at 80%. This leaves the 20% leftover, in addition to any out of pocket costs left to the beneficiary to pay. Having a Medigap plan can help the insured cover these remaining costs.
2019 Eligibility for Medicare Supplement Plans in PA
Beneficiaries can apply for Medigap plans as long as they’re currently enrolled in Part B and over the age of 65.
Make sure to enroll in Part B upon eligibility to avoid getting a late penalty fee.
Once enrolled in Part B, you’re eligible for a Medigap plan during the six months Open Enrollment Period (OEP).
During this time, you’re free to enroll in any policy you like without a premium increase or coverage exclusion.
If you receive Railroad Retirement Benefits, have End Stage Renal Disease or have had social security benefits for 24 months, you’re automatically eligible for Part A and Part B.
Pennsylvania does offer Medigap plans to those on disability. The cost will differ from those who qualify and are over the age of 65.
How to Apply for a Pennsylvania Medicare Supplement Plans
As stated above, everyone has a guaranteed issue right for a six-month period. You’re given guaranteed issue for coverage if you apply during your Open Enrollment Period.
Your OEP begins the first day of the month after you turn 65 years old and are enrolled in Part B. Furthermore, with guaranteed issuance, you cannot be denied or charged any more based on your:
- health status
- previous claim history
- any pre-existing medical condition(s)
- if you’re currently undergoing healthcare treatment
Additionally, you also have guaranteed issue rights for two months after the termination of employer-sponsored health insurance.
If you purchase a Medigap plan at any other time, you may have a hard time finding insurance coverage or be required to pay more based on the circumstances. Also, insurance companies have the right to deny coverage if you have certain pre-existing conditions.
Please note, you can still apply for a plan at any time of the year. You just won’t be granted guaranteed issue and may have to go through medical underwriting.
Medigap Costs in Pennsylvania
Each individual insurance company offering a supplemental plan determines its own monthly premium. Many factors go into this determination including age, sex, and location.
Insurance premiums quoted in Philadelphia will be different from those quoted in Pittsburgh. Therefore, your premiums will vary based on what pricing method your insurance company chooses to use.
The three methods used:
- Community-rated: meaning everyone pays the same amount, regardless of age.
- Issue-Age rated: meaning your premium will be based on the age you were when you first purchased your policy. The older you are, the more you will pay. However, once your premium has been set, it will never increase due to you getting older.
- Attained-Age rated: meaning your premium is based off your current age when you “attained” your policy. It will increase each year as you age.
Medigap Plans in Pennsylvania
The top supplement plans in Pennsylvania are Plans F, G and N. All benefits are standardized, that means they will be the same no matter what company you choose to enroll with.
The important difference between policies is the monthly premium the carrier charges and the factors that determine the premium. What one pays in Hershey, PA will likely differ what another pays in Gettysburg, PA.
Pennsylvania is one of the few states that prohibit doctors from charging excess charges.
Plan F is considered the most popular plan, as it provides the most benefits with the least amount of out-of-pocket expenses.
It also covers any remaining hospital or physician’s costs not covered by Medicare. These costs include any coinsurance or copayments that fall under Part B.
Plan G is the second most picked plan. The only difference between Plan F and Plan G is that Plan G does NOT cover the Medicare Part B deductible, which is $185 as of 2019.
Plan N is considered to be “cost-sharing”. The difference between Plan N is that it pays 100% of the Part B coinsurance minus:
- a copay of $20 for some physician’s office visits
- copay of $50 for ER visits that don’t result in a hospital admission
No Part B Excess Charges in Pennsylvania
There are a few states that do not allow excess charges. Excess charges are an extra 15% that healthcare providers are allowed to charge above the Medicare allowable.
It’s important to keep this in mind when choosing your Supplemental Plan. Therefore, you may want to go with Supplement Plan F or N, depending on your healthcare needs.
Pennsylvania Medicare Advantage Plans
Medicare Advantage plans come in HMO or PPO form. This plan is known as a Medicare replacement plan. It takes over as your primary insurance coverage.
Some people choose Medicare Advantage plans over Medigap plans due to the cheaper premiums. What they don’t realize is what they save in premiums, they’ll end paying on all the out-of-pocket expenses that add up.
With supplemental Medicare insurance, you may end up spending less money and end up with better coverage. If it’s important for you to keep your current doctor, then you should go with a Medigap policy.
Prescription Drug Plans in Pennsylvania
Part D is coverage for your prescription medications. Traditional Medicare, as well as Medigap plans, have no prescription benefits.
Part D does come with a late enrollment penalty for not enrolling when first eligible. The penalty will be applied to your monthly premium.
It’s important to sign up for Part D coverage during your Initial Enrollment Period to avoid this extra charge.
Medicare Resources in Pennsylvania
Each state has a Medicare Savings Program that provides assistance towards Medicare costs. As a result, if you’re on a fixed income, disabled or considered a low income working for a family, you may be eligible for financial assistance, or SHIP.
Compare Medigap Plans in Pennsylvania
Policies are available through private insurance companies. They cover out-of-pocket costs like copayments, coinsurance, deductibles and more.
Furthermore, plan availability will vary in each state. We can help guide you towards the best plan to fit your individual budget and healthcare needs.
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