Medicare in Pennsylvania

Resources for Pennsylvania Medicare Beneficiaries 

Are you a Medicare nerd like we are, or just looking to see if you have all your Medicare questions answered correctly? Healthpilot is here to help you dive into our resources on the different parts of Medicare, enrollment, or tips on choosing a Medicare plan. 

Medicare Basics         Choosing the Right Medicare Plan         Enrolling in Medicare

Getting guidance might be beneficial while making Medicare decisions. As a Pennsylvanian, you have several places where you can get assistance, including the State Health Insurance Program (SHIP), known in your neck of the woods as the Pennsylvania Medicare Education and Decision Insight (PA MEDI). PA MEDI has counselors around the state who collaborate with local nonprofits, public health agencies, and Area Agencies on Aging (AAAs) specific to your county to provide individuals in Pennsylvania with Medicare information.  

Medicare Plan Options in Pennsylvania  

You can choose from various Medicare options if you live in Pennsylvania. Those 65 years of age or older, or those with a qualifying disability from the Social Security Administration (SSA), can apply for Original Medicare. With a variety of Medicare Advantage plans available in Pennsylvania, it may be a better choice than Original Medicare if you prefer more comprehensive coverage. However, depending on your specific healthcare needs, you may also want to consider prescription drug plans and/or Medicare Supplement Insurance. Medicare is never a one-size-fits-all situation. 

Original Medicare (Parts A & B)  

Your primary Medicare plan is Original Medicare. It is split into Part A, which covers hospital insurance, and Part B, which covers medical insurance. Hospital stays, stays in skilled nursing facilities, home health care, and hospice care are all covered under Medicare Part A. Doctor visits, outpatient care, lab tests, and preventative services like cancer screenings, flu vaccines, and yearly wellness exams are all covered by Medicare Part B. Please be aware that Medicare Parts A and Part B deductibles are different and apply to certain services. For instance, before Original Medicare begins to pay, Part A has an inpatient hospital deductible per benefit period (each time you are admitted), while Part B has an annual deductible.  

Considerations if retaining Original Medicare include: 

• Original Medicare in Pennsylvania is a great choice if you want to be able to choose your own doctor and see doctors who accept Medicare anywhere in the country. 
• There is no limit on what you can pay out of pocket if you don’t need a lot of health care services or prescription drugs. There are separate plans for prescription drugs that can be used in these situations. 

Medicare Advantage (Part C)  

Part C, another name for Medicare Advantage plans, is an alternative to Original Medicare coverage offered by private insurance companies. These plans cover at least what Medicare Parts A and B do, and the best part is that they often offer additional benefits. Most services are handled by a network of providers. Similar to how an HMO plan works, you may need a primary care doctor, a referral to see a specialist, and approval before getting certain services, treatments, or medications. Other types of insurance include PPO, HMO-POS (a mix of an HMO and a PPO), and PFFS (Private Fee for Service) plans. 

Check out our Medicare Part C Resource Page to find out more about Medicare Advantage. 

Medicare Prescription Drug Plan (Part D)  

A lot of Medicare Advantage plans automatically cover prescription drugs through Medicare Part D. You can also add a stand-alone Prescription Drug Plan (PDP) to Original Medicare or a Medicare Supplement Insurance policy if you don’t already have other creditable coverage. These Part D plans are offered by private insurance companies that have been approved by Medicare, and depending on the plan you choose, you may have to pay a deductible, copay, or coinsurance for your medications. 

Medicare Supplement Insurance (Medigap)  

Some Medicare beneficiaries in Pennsylvania buy Medigap, AKA Medicare Supplement Insurance. These plans aim to help cover what Original Medicare doesn’t provide coverage over. For example, a few of these gaps include coverage for medical care outside of the U.S., Medicare Part A and Medicare Part B deductibles, and coinsurance.  

You should know that Medigap doesn’t pay for anything related to Medicare Advantage. You cannot simultaneously have a Medigap policy and a Medicare Advantage Plan. If you currently have a Medicare Advantage plan and wish to purchase a Medigap policy, your effective date should start the day after your Medicare Advantage plan ends. 

Medicaid 

Medicaid is a public insurance program that has been around since 1965. The state and federal governments both pay for it. According to federal rules, each state runs its own Medicaid program. The federal rules are very broad, so states have a lot of room to make and run their own programs. Medicaid eligibility and benefits can and often do vary a lot from one state to the next. Medicaid helps low-income families and individuals get access to the health care they may need. This includes children, parents, pregnant women, seniors, and people with disabilities.

How and when to sign up for Medicare in Pennsylvania

Medicare is a government-run insurance program that is paid for by the federal government and is available to anyone who meets the eligibility requirements. Most people qualify when they turn 65, but Medicare eligibility is also triggered by the following: 

• You are under 65, permanently disabled, and have been getting disability benefits from Social Security for at least 24 months, or you get disability benefits from the Railroad Retirement Board if you were a railroad employee. 
• You have been diagnosed with End Stage Renal Disease (ESRD).  
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease. 

For more information on Original Medicare and Medicare Supplement Insurance periods, please visit our resource center Enrollment Periods Page.  

Medicare Advantage Enrollment Periods in Pennsylvania and nationwide  

Here is a quick overview of the Medicare enrollment periods and enrollment timeframes in which you can elect or change your Medicare Advantage plan.

Hold tight Key Stone Staters, we’re almost done. Healthpilot knows that figuring out Medicare can be tricky and that adding deadlines for enrollment can make things even more complex. 

The good news is we can stay on top of all the details for you. You just answer a few questions, then sit back and relax while we run the numbers and formulate a Medicare plan recommendation that is just right for you. And you can sign up online in a safe and easy way in just a few minutes. 

It gets better. We do this for you every year for as long as you are a Healthpilot customer.   

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Key Stats

Some interesting facts about Medicare coverage in Pennsylvania: 

• 22% of Pennsylvania’s population has some type of Medicare coverage, with 2,825,747 beneficiaries, beating the national average of 19%. 
• In Pennsylvania, about 48% of Medicare customers are enrolled in a private Medicare Advantage program. 
• A whopping 262 Medicare Advantage plans will be available in 2023, compared to 240 plans in 2022. This represents a 9.2% change in plan options.  
• As of 2022, Pennsylvania has around 65 different insurance providers providing Medical Supplement Insurance (Medigap) plans. 
• 26 stand-alone Medicare prescription drug plans are available to Pennsylvanians, providing all individuals with Medicare access to a Medicare prescription drug plan. 
• And because we promised you a fun fact about Pennsylvania: Due to numerous players being drafted during WWII, the Philadelphia Eagles and the Pittsburgh Steelers united to form the “Steagles” for one season in 1943. 

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