Pennsylvania Medicare includes supplements that help lower out of pocket expenses. These include Medigap, Medicare Advantage, and Part D prescription plans. New beneficiaries may not realize they’re still responsible for cost-sharing. 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.
Medicare Supplement Plans in Pennsylvania
There are over 2.6 million Medicare beneficiaries in Pennsylvania. Of them all, over 660,000 are enrolled in a Medigap plan. It’s important to know the difference between all of your Medicare options. If you make the wrong choice now, it could negatively impact you for the rest of your life.
What is the Best Medicare Supplement Plan in Pennsylvania?
In all states, there are 10 Medigap Plans available in Pennslyvania. In recent years, Plan F has been a favorite for many beneficiaries.
However, Medicare is changing because of 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.
What is the cost of Medicare Supplements in Pennsylvania?
Medigap premiums in Pennsylvania 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.
Excess Charges are Prohibited
Physicians that accept Medicare must sign a disclosure that prohibits them from charging beneficiaries’ excess charges. So you don’t have to worry about which plans allow excess charges and which don’t.
Tobacco Rates
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.
Household Discounts
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.
Disability
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 due to a 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 46% of Pennsylvania residents that are eligible for Medicare enroll in a Medicare Advantage plan.
Part D in Pennsylvania
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.
Top-Rated Part D Plans in Pennsylvania:
- SilverScript Choice
- SecureRx
- Blue Rx PDP Plus
FAQs
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I make too much on SS disability and pension to qualift for ANY extra help from anywhere: Ss, PA medicaid, etc. I am 63, have had original Medicare A and B for a fewcyears, but was just diagnosed with breast cancer in April, 2021. I guess finding an affordable Medigap policy now is out of the question, huh?
Elaine, unfortunately at this time, a cancer diagnosis will cause you to be denied with any supplemental carrier unless you qualify for a Special Enrollment Period. However, when you turn 65, you will be eligible for a second Open Enrollment Period and will be eligible to enroll in a Medigap plan during this time.
I’m 66 living in Pennsylvania and been on ssi for 10+ yrs. I also get $144.00 from the VA, a 10% disability for a TBI. I currently pay $144.00/ mo for “part B” If I get an “advantage plan” will I still have to pay $144.00 for Part B?
Hi Brian! Yes, you will still have to pay the Part B premium since you have to be enrolled in Part B in order to enroll in Medicare Advantage.
My brother is 75, living on SS, barely making ends meet. I live in fl and Mx so its hard for me to help him… but I have a supplemental plan that reimburses my part B. Is there anything like that in Pa?
Hi Donna! If you are getting any amount of your Part B premium reduced, you do not have a Medicare Supplement plan, you have a Medicare Advantage plan. There are some Medicare Advantange plans that offer the Part B give-back benefit. I would recommend calling your bother’s local SHIP department to see was free resources are available for him. He may be dual-eligible for Medicaid & Medicare and qualify for a low-income subsidy.