Understand Medicare Part C in Pennsylvania
Medicare Advantage Plans offer a few key differences that distinguish them from Parts A and B of the Original Medicare system managed by the federal government. While Part A pays for inpatient care at a hospital and Part B covers services and supplies used to treat or prevent medical conditions, Medicare Advantage Plans come with a few added benefits. Plans are required to offer the same level of care as Original Medicare and may include additional health care benefits, such as prescription drug coverage, routine hearing, vision, and dental exams, and fitness club memberships:
- In 2022, there are 240 Medicare Advantage Plans available in Pennsylvania.
- 100% of the total Medicare population in Pennsylvania has access to a Medicare Advantage Plan with a $0 monthly premium in 2022
- In 2022, the average monthly premium for a Medicare Advantage Plan in Pennsylvania is $32.79, a decrease from $38.72 in 2021
- Thirty-nine Medicare Advantage Plans offer innovative benefits, such as wellness and health care planning, reduced cost-sharing, and rewards and incentives programs in 2022
Designed to be an all-in-one solution, Medicare Advantage Plans are offered by Medicare-approved private insurance companies. There are several types of Medicare Advantage Plans available, depending on your insurance provider and location. Learn the differences between these plans and how they affect your coverage so that you can make the right choice for your medical situation.
Medicare Advantage Plans in Pennsylvania
Compare ratings of some of Pennsylvania’s Medicare Advantage Plan providers:
|Compare Medicare Advantage Plans in Pennsylvania|
|Insurance company||Medicare rating||A.M. Best rating||BBB rating||NCQA rating||J.D. Power ranking|
|Aetna||4 stars||A||A+||2.5 to 4.5 stars||Fifth out of 10|
|Cigna||4 stars||A-||Not rated||2.5 to 4.5 stars||Seventh out of 10|
|Highmark||4.5 stars||A||A-||2.5 to 4.5 stars||Second out of 10|
|Humana||4 stars||A-||A+||1.5 to 4.5 stars||Third out of 10|
|Kaiser||5||A||A-||4.5 to 5 stars||First out of 10|
|UnitedHealthcare||3.5 stars||A-||A-||4 stars||Fourth out of 10|
What Medicare Advantage Plans cover
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Medicare Advantage Plan Benefits|
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
Types of Medicare Advantage Plans in Pennsylvania
There are four types of plans available in Pennsylvania’s Medicare Advantage program: Health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS), and special needs plan (SNP). Each offers a different level of flexibility in your network of care providers and varies in price. All Medicare Advantage Plans provide the same coverage as Original Medicare, but additional benefits may come with an increased premium.
HMOs typically require that you receive all services from in network providers:
PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
PFFS plans don’t require a primary care physician or referrals for specialists:
SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
When to sign up for Medicare Advantage Plans in Pennsylvania
If you want to enroll in a Pennsylvania Medicare Advantage Plan, you need to be enrolled in Medicare Part A and Part B, and you cannot be enrolled in Medigap. Enrollment is available to seniors 65 and older and those with a qualifying disability.
Your disability typically qualifies if you’ve received at least 24 Social Security or Railroad Retirement Board (RRB) Disability Insurance payments. You can also enroll in Medicare Advantage Plans if you have End-Stage Renal Disease (ESRD) or amyotrophic lateral sclerosis (ALS).
There are three periods when you can enroll:
- The first is the Initial Coverage Election Period when you first become eligible. This period includes the three months before your 65th birthday, the month of your birthday, and the three months following. If you have a disability, this period will occur three months before or after your 25th month of receiving benefits.
- The Annual Election Period runs from October 15 to December 7. During this period, you can switch from Original Medicare to a Medicare Advantage Plan. If you’re already enrolled in Medicare Advantage, you can switch between plans during this period.
- The Open Enrollment Period takes place between January 1 and March 31. You can switch between Medicare Advantage Plans or go back to Original Medicare during this period.
Medicare provides special enrollment periods for unusual life circumstances, such as losing your job (and health coverage) and moving out of the area your insurance carrier services.
How to Choose a Medicare Advantage Plan in Pennsylvania
Consider these factors as you compare Medicare Advantage Plans available in your area:
|How to compare Medicare Advantage Plans in Pennsylvania|
|Monthly premium||This is in addition to your Part B monthly premium. so it affects your monthly cash flow. You pay whether or not you access your benefits. You should have access to at least one zero premium plan with drug coverage in your area.|
|Provider network||Check to make sure your doctors, hospitals, and pharmacies are in network to keep costs as low as possible.|
|Out-of-pocket max||This is the most you’ll spend ― not including your premium, deductible, and drug costs ― for Medicare-covered services as long as you follow the plan’s rules for in and out of network coverage.|
|Deductibles, coinsurance & copays||Also known as cost-sharing, these expenses apply when you access your benefits. Check to see what your plan charges for doctor’s visits, services, treatments, and prescription drugs.|
|Drug coverage/formulary||See if your drugs are on the plan’s formulary and how much they cost each time you fill a prescription. You may want to talk with your doctor about a generic or alternative version of a drug you need.|
|Additional benefits||Consider which additional benefits are important to you. Most plans require you to use network providers and may charge extra premiums for more comprehensive coverage.|
Medicare Advantage Resources in Pennsylvania
If you’re feeling confused by the multitude of plan options available, getting in touch with trained, unbiased counselors can be a good first step. Pennsylvania is home to several organizations that can help you make an informed decision.
|Pennsylvania Medicare Advantage Resources|
|Pennsylvania Department of Aging||Website | 717-783-1550||The Department of Aging administers the state’s Area Agencies on Aging, which provide many services to Pennsylvania seniors, including Medicare Advantage Plan counseling..|
|Pennsylvania Department of Health||Website | 888-466-2787||The Pennsylvania Department of Health offers health-related programs, services and information in its effort to promote a healthy, disease-free Pennsylvania. Hotlines are available to report home health aid and nursing home complaints.|
|Pennsylvania Insurance Department||Website | 717 787-7000||The Pennsylvania Insurance Department oversees insurance brokers who sell Medicare Advantage Plans and can tell you who is licensed to sell plans in your area..|
|Pennsylvania Medicare Education and Decision Insight (PA MEDI)||Website | 503-945-5600||PA MEDI provides Pennsylvania’s seniors with free Medicare counseling. Counselors are trained to provide objective, easy-to-understand information about Medicare-related questions and long-term care insurance.|
|Pennsylvania Medicare Rights Center||Website | 800-333-4114||The Pennsylvania Medicare Rights Center provides consumers with third-party information on Medicare Advantage Plans and Medicare, as well as counseling for seniors and their families and caregivers.|
Learn More From Our Sources
- Medicare | Health Maintenance Organization (HMO) | Last accessed January 2022
- Medicare | How do Medicare Advantage Plans work? | Last accessed January 2022
- Medicare | How Original Medicare works | Last accessed January 2022
- Medicare | Joining a Health or Drug Plan | Last accessed January 2022
- Medicare | Preferred Provider Organization (PPO) | Last accessed January 2022
- Medicare | Private Fee-for-Service (PFFS) Plans | Last accessed January 2022
- Medicare | Special Needs Plans (SNP) | Last accessed January 2022