You might be under the impression that Medicare covers all of your health care. While it does help, Medicare leaves some significant gaps. Many people buy plans that work with Medicare to help keep their out-of-pocket costs down. Here’s everything you need to know about Medicare Advantage and Medicare Supplement Plans in PA.
The Best Medicare Supplement Plans in Pennsylvania:
- Best Overall in PA: UPMC for Life
- Most Affordable in PA: Aetna
- Best for Perks: UnitedHealthcare
- Best for PPOs: Humana
- Best for Dual Eligible: Allwell
- The Best Medicare Supplement Plans in Pennsylvania:
- What is Medicare?
- Legalities of Medicare in PA
- Types of Medicare Supplement Plans
- How to Sign Up for Medicare in PA
- Average Cost of Medicare Advantage Plans in PA
- Best Medicare Insurance Providers in PA
- Choosing the Right PA Medicare Plan
- Frequently Asked Questions
What is Medicare?
Medicare is a federal health insurance plan. It primarily serves those 65 and older. Younger people on Social Security disability can also qualify for Medicare. People with end-stage renal disease also automatically qualify.
One of the more confusing aspects of Medicare is that it has several parts. Each part covers a different aspect of care.
Part A: Part A of Medicare covers in-patient care. This includes inpatient care in a hospital or in a skilled nursing facility. It doesn’t cover nursing home care. Part A also covers hospice care and some home health care. Most people don’t pay a premium for Part A.
Part B: Part B of Medicare covers outpatient care and doctors’ services. It also covers durable medical equipment like wheelchairs or CPAP machines, home health care and mental health services. Most people pay a premium for Part B.
Part C: Medicare Advantage plans are Part C of Medicare. Medicare Advantage plans are a way to receive your Part A and Part B benefits. Some plans also include prescription coverage, which is Part D of Medicare. Medicare Advantage insurance plans lower your out-of-pocket costs. These plans may offer additional benefits like dental or vision coverage.
Part D: Part D of Medicare offers prescription coverage. Medicare beneficiaries can purchase standalone Medicare Part D plans. Many Medicare Advantage plans also offer Part D benefits as a part of their coverage.
Medicare Supplemental Insurance is a different type of plan. As a Medicare Advantage plan, Medicare Supplements help to pay for Medicare out-of-pocket costs. With a Medicare Advantage plan, your health care providers bill your insurance company. With a Medicare Supplement, your health care providers bill Medicare and your Medicare Supplemental insurance provider. This means you can see any provider that accepts Medicare.
Legalities of Medicare in PA
The Department of Health and Human Services oversees Medicare. Medicare offers rights and protections to its members. These include:
- The right to be treated with respect and dignity
- The right to have your health and personal information kept private
- The right to get information in a way you understand
- The right to ask questions about Medicare and get clear answers
- The right to request a review if Medicare declines payment for a service
- The right to file a complaint
If you have an issue with your Medicare, contact Medicare or file a complaint online.
The Pennsylvania Insurance Department oversees Medicare Advantage and Medicare Supplement plans. If you have an issue with your plan, you can file a complaint with the Insurance department.
If you aren’t sure who to talk to about a Medicare-related issue, contact your Area Agency on Aging. They can help you navigate Medicare and review your plan options.
Types of Medicare Supplement Plans
Medicare Parts A and B have significant out-of-pocket costs on their own. These costs include:
Part A deductible: Inpatient hospital stays have a deductible for each benefit period. A benefit period starts when a hospital or skilled nursing facility admits you. It ends when you haven’t needed inpatient care for 60 consecutive days. This means you can have multiple benefit periods each year. The deductible for each benefit period is $1,408 in 2020.
Part B deductible and coinsurance: You must pay the first $198 of Part B covered services each year. After you meet your deductible, you’re responsible for 20% of the Medicare-approved amount for Part B services.
Medicare Supplement plans help with most of these costs. Medicare has standardized each plan. This means that a Medicare Supplement Plan G covers the same services no matter which company you purchase it from. Not every company offers every plan, but all companies that sell Medicare Supplements offer Plan A.
Here’s an overview of what each plan covers:
Plan A: Covers 100% of your Part A coinsurance, your Part B coinsurance and the first 3 pints of blood if you need a transfusion.
Plan B: Covers everything Plan A covers. It also covers your Part A deductible.
Plan C: Covers everything Plans A and B cover. It also covers your Part B deductible and 80% of your costs if there’s an emergency while traveling overseas (subject to plan limits).
Plan D: Covers everything Plans A and B cover. It also has 80% foreign travel emergency coverage. Foreign travel coverage limits may apply.
Plan F: Covers everything Plans A, B and C cover. It also covers Part B excess charges. If doctors don’t accept Medicare assignment, they can charge up to 15% more of the Medicare-approved amount. This plan covers that 15% difference.
Plan G: Covers everything Plan F does. The only difference is that it does not cover your Part B deductible.
Plan K: Covers 100% of your Part A coinsurance. It covers 50% of your Part B coinsurance, your first 3 pints of blood and your Part A deductible. It has an out-of-pocket limit of $5,880 in 2020.
Plan L: Covers 100% of your Part A coinsurance. It covers 75% of your Part B coinsurance, your first 3 pints of blood and your Part A deductible. It has an out-of-pocket limit of $2,940 in 2020.
Plan M: Covers 100% of your Part A coinsurance, your Part B coinsurance and the first 3 pints of blood. It covers 50% of your Part A deductible and has 80% foreign travel emergency coverage.
Plan N: Covers everything Plan M does, but it also covers 100% of your Part A deductible. Plan N is unique in that it has copays. You may have a copay of up to $20 for an office visit and up to $50 for an emergency room visit that doesn’t involve an inpatient admission.
If you started Medicare on or after January 1, 2020, you can’t purchase Plans C or F.
How to Sign Up for Medicare in PA
If you’re 65 or older and receiving Social Security benefits, you’ll receive Parts A and B of Medicare automatically. If you aren’t receiving Social Security benefits, you’ll need to contact Social Security to enroll.
If you’re younger than 65 and on Social Security disability, you’re eligible for Medicare after 24 months of benefits. Social Security automatically enrolls you starting your 25th month of benefits. If you’re receiving Social Security disability due to ALS, Social Security will enroll you in Medicare as soon as your benefits begin.
If you have end-stage renal disease, you will need to contact Social Security to enroll in Medicare.
Average Cost of Medicare Advantage Plans in PA
What costs should you expect from a Medicare Advantage plan? Let’s take a look at some of Pennsylvania’s plans.
|Plan Name||Company||Plan Type||Health Plan Deductible||Drug Deductible|
|UPMC for Life HMO Premier Rx||UPMC for Life||HMO||$0||$0|
|Aetna Medicare Value||Aetna||PPO||$1,000||$0|
|AARP Medicare Advantage Plan 1||UnitedHealthcare||HMO||$0||$0|
Best Medicare Insurance Providers in PA
Ready to get quotes and find the best Medicare plan? Here are our top 5 picks for Pennsylvania, based on our research.
1. Best Overall in PA: UPMC for Life
U.S. News and World Report named UPMC for Life the best Medicare Advantage plan in the state. Medicare has awarded UPMC for LIfe 4.5 out of 5 stars for quality. It offers a range of PPO and HMO plans, so it’s easy to choose one that fits your budget.
UPMC for Life’s health care concierge team sets it apart. You can call a concierge to find a provider, check your benefits, schedule appointments and more.
2. Most Affordable in PA: Aetna
Aetna has a $0 premium PPO plan. This means you have low monthly costs and the flexibility to see out-of-network providers. Medicare rated Aetna 4.5 out of 5 stars. Aetna offers a fitness membership, hearing aid coverage and prescription home delivery. If you have questions about your plan, you can reach out to its concierge service.
3. Best for Perks: UnitedHealthcare
UnitedHealthcare has partnered with AARP to offer Medicare plans to its members and the general public. Most Medicare Advantage plans have extra benefits like fitness plans and dental coverage.
Select UnitedHealthcare plans also include a Fitbit to help you achieve your health goals. UnitedHealthcare offers Medicare Advantage plans and Medicare Supplement plans.
4. Best for PPOs: Humana
PPOs allow you to see doctors outside of your network, and you typically don’t need a referral to see a specialist. All of Humana’s Medicare Advantage plans are PPOs.
Its plans cover vision and dental care and include a fitness membership. Humana also offers an over-the-counter allowance, which you can use to buy non-prescription medicines and supplies. Humana also offers Medicare Supplement plans.
5. Best for Dual Eligible: Allwell
Allwell offers a Special Needs Plan for those enrolled in Medicare and Medicaid. It includes prescription coverage and care coordination. You don’t pay a copay to see your primary doctor or specialists.
Allwell’s Dual Medicare plan also includes comprehensive dental coverage, eyewear for coverage and hearing aids. It also provides and over-the-counter benefit and transportation to medical appointments.
Choosing the Right PA Medicare Plan
Which Medicare plan is right for you? If you want total flexibility when it comes to your providers, a Medicare Supplement plan might be the best fit. If you want affordability and extra benefits like vision and dental care, a Medicare Advantage plan might be a good option. If you’re not sure, your local Area Agency on Aging can help.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.