Finding Medicare Plans in Pennsylvania
Whether you’ve been on Medicare for a while or it’s your first time enrolling, finding the right Medicare coverage may feel daunting. We don’t think it has to be! We’ll help you navigate the wide selection of Medicare plans in Pennsylvania to find the coverage that’s right for you.
Who’s Eligible for Medicare Plans in Pennsylvania?
Medicare is a government-sponsored health insurance program for people 65 or older and some people under 65 with a qualifying condition. People generally first become eligible for Medicare once they reach age 65. You may be eligible for Medicare under 65 if you have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). You may also be eligible if you’ve been a recipient of Social Security Disability Insurance (SSDI) for 2 years.
In order to qualify, you must be a citizen or permanent resident, having lived in the US for the past 5 years. Additionally, you or your spouse must have worked at least 10 years in a job that contributed to your Medicare coverage through Social Security deductions.
If you’re unsure about your eligibility or will be turning 65 in the next six months, we’re here to help. Call the number above to speak with a licensed insurance agent.
What are the Different Medicare Plans in Pennsylvania?
Original Medicare (Parts A and B)
Original Medicare is comprised of two parts:
Part A (Hospital Insurance) covers inpatient healthcare, like hospital care, hospice care, and nursing home care (as long as custodial care isn’t the only care needed).
Part B (Medical Insurance) covers outpatient healthcare, like ambulance services, durable medical equipment (walkers, canes, blood sugar monitors, etc.), and mental health care. Part B also covers some preventive services, like flu shots, cardiovascular screenings, and diabetes screenings.
Original Medicare doesn’t cover everything; Medicare beneficiaries still pay a portion of their medical bills through coinsurance, copays, and deductibles. For this reason, a variety of Medicare plans are available through Medicare-approved private insurance companies for more comprehensive coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage Plans offer an alternative to the coverage provided by Original Medicare (Parts A and B). These plans provide the same coverage as Original Medicare and often provide additional coverage, like dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug benefits are called Medicare Advantage Prescription Drug (MAPD) plans.
In order to enroll in a Medicare Advantage plan, you must first be enrolled in both parts of Original Medicare. Premiums can start as low as $0 and increase based on the level of coverage selected. You must continue paying your Part B premium in addition to your Part C premium. There are many different Medicare Advantage plans, offering varying degrees of coverage.
Medicare Prescription Drug Plans (Part D)
Working alongside your Original Medicare (Parts A and B), stand-alone Medicare Prescription Drug plans help to provide coverage for prescription medications. Prescription drugs generally aren’t covered by Original Medicare nor Medigap plans. Each medication covered by a Medicare Part D plan has a set cost in the form of a copay or coinsurance, according to a tiered system known as a formulary. A prescription drug formulary is available for your reference through your plan, showing the cost associated with each covered medication. Reviewing the formularies will allow you to pick the plan with the lowest cost for your medications. For those who want to remain on Original Medicare, you can add a stand-alone Medicare Prescription Drug Plan to help with your prescription drug costs.
Medicare Supplement Plans (Medigap)
Medicare Supplement Plans are designed to fill the gaps in coverage left by Original Medicare. Medigap plans work alongside your Original Medicare to provide more comprehensive coverage. Medigap plans can reduce your out-of-pocket costs by helping pay for things like coinsurance, deductibles, and copays.
When Can I Enroll In A Plan?
Medicare Advantage and Medicare Prescription Drug Plans
You’re first eligible to sign up for Medicare plans in Pennsylvania during your Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday month and continues for three month after that month. This means you have a total of seven months to enroll.
After this period, you can make changes to your Medicare Advantage or Prescription Drug coverage during the Annual Election Period. This period starts on October 15th and ends on December 7th every year.
Key Fact: The General Enrollment Period (GEP) provides another opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. You will then have an opportunity to select a Medicare Advantage plan from April 1st through June 30th.
Medicare Supplement Plans
Your first opportunity to enroll in a Medicare Supplement plan is during your Medigap Open Enrollment Period. This six month period begins the month you are both 65 or older and enrolled in Medicare Part B. If you enroll during this period, you are guaranteed the Medigap plan of your choice, even if you have a pre-existing condition.
Important Note: If you miss your Medigap Open Enrollment Period, carriers may charge higher premiums or deny you coverage altogether.
Special Enrollment Periods
Certain life events, including moving into or out of a care facility, losing your insurance, or moving outside of your current plan’s coverage area, may qualify you for a Special Enrollment Period. A Special Enrollment Period allows you to make changes to your Medicare coverage outside of the periods mentioned above. Our licensed insurance agents can help determine if you qualify for a Special Enrollment Period.
How Can I Compare Plans?
MedicareMatchup makes it convenient to explore the many Medicare plans in Pennsylvania to find the coverage you need. Working with trusted partners, we’ll help you find the coverage that fits your needs and budget.
If you’re unsure about your eligibility or will be turning 65 in the next 6 months, we’re happy to help you prepare for enrollment. Give us a call to speak to a licensed insurance agent or compare plans online by using our form below.