Medicare Advantage Plans in Pennsylvania

If you don't like the coverage provided by Original Medicare, the alternative is a private health plan through the Medicare Advantage program. In most areas of Pennsylvania there are multiple options to choose from, but options vary between each Pennsylvania County. As a result, you can only choose a plan that's available where you live.

To compare the plans available in your area, you can use our zip code lookup tool above or click on your county below. If you'd like to learn more about how the Medicare Advantage program works in Pennsylvania and how it compares with other options, keep on reading.

Compare the Best Medicare Advantage Plans in Pennsylvania by County

Pennsylvania Medicare Advantage Plans Explained

Unlike Original Medicare, which only covers major medical costs, a Medicare Advantage plan, sometimes called Medicare Part CMedicare Part C is Medicare's private health plan option. Also known as Medicare Advantage, Medicare Part C plans are a type of Medicare health plan offered by companies that contract with Medicare to provide all..., can include many extras, including prescription drug coverage, vision, hearing, dental, and fitness, just to name a few. And, good news, they are available in Pennsylvania. But you must have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits to join a plan.

Many people love the extra benefits of their Medicare Advantage plan, particularly a prescription drug plan. However, before you jump in with both feet, take the time to understand the trade-offs fully. The extra benefits and perks are nice, but they come at a cost. Specifically, when you become a Medicare Advantage plan member in Pennsylvania you are agreeing to accept the plan's managed care health system. As an MA plan member, you agree to let the insurance plan be a gatekeeper and fully control your access to doctors and other healthcare providers.

Original Medicare vs. Medicare Advantage in Pennsylvania

One way to better understand how different Original Medicare coverage is from Medicare Advantage is to have a look at the pros and cons of each type of health insurance in Pennsylvania. So, let's do that.

The Pros and Cons of Medicare Advantage Plans vs Original Medicare

1. With Medicare Advantage you must use Pennsylvania healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved providers of your choice.
2. If you travel and have a medical emergencyWhen you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death., Medicare Advantage covers you (in the U.S and its territories only). However, if you are a snowbird and winter or summer in another state, a non-emergency doctor outside of your plan's network won't be covered.
3. All Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). sold in Pennsylvania protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
4. Most Medicare Advantage plans come bundled with a Pennsylvania Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
5. With Original Medicare, your costs (copays, coinsurance, etc.) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
6. There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.

Pennsylvania Medicare Advantage Plans vs. Medigap

Most Pennsylvania seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:

• Why are Medicare Advantage plans bad?
• What are the disadvantages of Medicare Advantage plans?
• Is it better to have Medicare Advantage or Medigap?

Let's take a minute or two to compare and contrast, shall we?

Why Pennsylvania Medicare Advantage Plans are Bad

First things first. Medicare Advantage plans are not bad. More than 26 million people have a Medicare plan. But, it's not for everyone. Before you enroll, learn the disadvantages of Medicare Advantage plans, particularly if you live in Pennsylvania.

MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. (dual eligible), for those with retiree healthcare benefits, and for extremely healthy, active seniors.

Similarly, traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage., plus Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., work best for people with chronic health conditions, as well as those who can afford a higher monthly premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . Most experts agree that this is the best health insurance seniors can get in Pennsylvania.

You can learn more about Medicare supplements in Pennsylvania on our Pennsylvania Medicare supplements page.

What are the Disadvantages of Pennsylvania Medicare Advantage Plans?

We have already highlighted the issue of doctor choice in Medicare Advantage. If this is not an issue for you, then consider the financial differences. These are the same regardless of the type of plan you're evaluating (e.g., HMO, PPO, PFFS, Cost, or HSA).

With Medicare Advantage, you pay a little each month (with some plans, you pay nothing). This is the monthly premium. But you also pay copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when you use most medical services, and they add up fast. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). The majority of your costs are due when you use health services.

However, with Original Medicare and a Medigap plan for supplemental coverage, you pay for most of your costs in advance with a higher premium. You control your costs by choosing a plan that pays the deductible(s) you want to be covered. This makes your health care costs predictable, and for most people on a fixed budget, that's very comforting.

Is it better to have Medicare Advantage in Pennsylvania or Medigap?

• If you can afford Medigap Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services., G, or N, keep Original Medicare and add one of these top 3 Medicare supplements. These plans help you manage your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. the best, giving you peace of mind.
• If you are a healthy senior and have good health in your family heritage, Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent, and you pay just a little to see your doctor (up to $25 per visit).
• If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is good. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
• If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
• If you qualify for both Medicare and Medicaid, Medicare Advantage is your best option regardless of your health condition.
• If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
• With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
• With Medicare supplement insurance, there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
• Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment periodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.

References

medicare.gov

• Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
• Find a Medicare plan https://www.medicare.gov/plan-compare/

ssa.gov

• Medicare Benefits | SSA https://www.ssa.gov/medicare/
• Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
• Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/

cms.gov

• Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf
• Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...

This Medicare Advantage state information page was last updated on June 29, 2022.