Best Medicare Advantage Plans in Pennsylvania for 2023
Find Plans in your area with your ZIP Code
Are you considering enrolling in a Medicare Advantage plan in Pennsylvania? You're in good company. In 2023, more than 31 million people are expected to get a private Medicare health plan. Some want lower costs. Some are looking for more benefits. Others need access to more healthcare providers and doctors.
Our online tools can help you find the best Medicare Advantage plans available that meet your needs. Below is a summary of the Pennsylvania market. This will allow you to get a clear idea of the top plan options available, the top-rated plan providers, and what you should expect to pay each month in premiumsA 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. .
Table of Contents
Key Takeaways
- 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). are available to U.S. citizens and legal U.S. residents living in Pennsylvania who are enrolled in Original 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..
- Insurance plans are offered by private health insurance companies and provide an alternative way to receive Medicare benefits in your Pennsylvania County.
- Medicare Advantage Plans in Pennsylvania are required to provide at least the same benefits as Original Medicare, but they may also provide additional benefits such as vision, dental, and hearing coverage.
- Plans may also offer prescription drug coverage, which is not available with Original Medicare. A stand-alone 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:Â deductible, initial coverage, coverage gap, and catastrophic. Each... plans available in Pennsylvania can be added if the health plan does not include Part D.
- Medicare Advantage Plans in Pennsylvania may have different cost-sharing requirements than Original Medicare, such as copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service., coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service. , and deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.. Be sure to compare plans, including prices, quality and affordable 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., to determine the best Medicare insurance for your situation.
- Medicare Advantage Plans in Pennsylvania may also have different provider networks than Original Medicare, so it is important to make sure that your preferred doctors and hospitals are in-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get....
- Medicare Advantage insurance has specific open enrollment periods. Unlike Medicare Supplement plans, you cannot join, switch, or drop a plan outside of an enrollment period.
Call 1-855-728-0510 (TTY 711) for assistance. There's no obligation.
Who Has The Best Plans in Pennsylvania?
Each year, the Centers for Medicare & Medicaid ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs. (CMS), reviews and rates Pennsylvania's Medicare Advantage plans based on a 5-star scale. The information used to create a plan's star rating comes from member input and data reported by the plan.
Pennsylvania has 5-star Medicare Advantage plans available in 2023. Not all states and locations do. This year, the highest rated Medicare plans available in Pennsylvania come from:
- Highmark
- UPMC for Life
- Independence Blue Cross
- UnitedHealthcare
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. recommends evaluating plans from these Pennsylvania health insurance companies first. Why? Because more stars mean a better plan. For instance, members may get better care, customer service, and phone support from a 5-star plan than from a 4-star one.
IMPORTANT: Depending on where you live in Pennsylvania, Medicare Advantage plans may have many valuable benefits (as compared to Original Medicare). But, before you choose, it's crucial that you understand the potential disadvantage of Medicare Advantage plans, as well as Medigap vs Advantage plans. Compare coverage and costs with care to find the plan best suited to your health and financial needs.
Complete List of Pennsylvania's 2023 Providers
Pennsylvania has 15 providers that offer Medicare Advantage plans. They include:
- Aetna Medicare
- Capital Advantage Insurance Company
- Capital Blue Cross Medicare
- Cigna
- Clover Health
- Geisinger Gold
- Health Partners Medicare
- Highmark
- Humana
- Independence Blue Cross
- Lasso Healthcare
- UnitedHealthcare
- UPMC for Life
- Wellcare
- Wellcare by Allwell
Top Pennsylvania Plans by CMS 5-Star Score in 2023
Here's a list of the best 2023 Medicare Advantage plans available in Pennsylvania, according to the Centers for Medicare & MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. Services:
Top Medicare Advantage Plans in Pennsylvania
| Provider | Plan ID | Plan Name | Premium | Limit | Stars |
|---|---|---|---|---|---|
| Highmark | H3957-039 | Community Blue Medicare HMO Prestige (HMO) | $50.00 | $5,500 | 5.0 |
| Highmark | H3916-035 | Complete Blue PPO Distinct (PPO) | $25.00 | $6,500 | 5.0 |
| Highmark | H3916-036 | Community Blue Medicare Plus PPO Distinct (PPO) | $25.00 | $6,000 | 5.0 |
| Highmark | H3916-041 | Complete Blue PPO Signature (PPO) | $0.00 | $7,550 | 5.0 |
| Highmark | H3916-039 | Community Blue Medicare Plus PPO Signature (PPO) | $0.00 | $8,300 | 5.0 |
| Highmark | H3916-001 | Freedom Blue PPO Classic (PPO) | $278.00 | $4,500 | 5.0 |
| Highmark | H3916-022 | Freedom Blue PPO Select (PPO) | $166.00 | $5,000 | 5.0 |
| Highmark | H3957-046 | Security Blue HMO-POS Deluxe (HMO-POS) | $256.00 | $4,500 | 5.0 |
| Highmark | H3957-045 | Security Blue HMO-POS Standard (HMO-POS) | $193.00 | $5,000 | 5.0 |
| Highmark | H3957-031 | Security Blue HMO-POS ValueRx (HMO-POS) | $59.00 | $5,500 | 5.0 |
| Highmark | H3957-048 | Together Blue Medicare HMO Signature (HMO) | $0.00 | $6,700 | 5.0 |
| Highmark | H3957-042 | Community Blue Medicare HMO Signature (HMO) | $0.00 | $6,700 | 5.0 |
| Highmark | H3916-034 | Community Blue Medicare PPO Distinct (PPO) | $25.00 | $6,000 | 5.0 |
| Highmark | H3916-037 | Community Blue Medicare PPO Signature (PPO) | $0.00 | $8,300 | 5.0 |
| Highmark | H3916-005 | Freedom Blue PPO Deluxe (PPO) | $285.00 | $4,500 | 5.0 |
| Highmark | H3916-015 | Freedom Blue PPO Standard (PPO) | $171.00 | $5,000 | 5.0 |
| Highmark | H3916-018 | Freedom Blue PPO ValueRx (PPO) | $66.00 | $5,500 | 5.0 |
| Independence Blue Cross | H3952-055 | Keystone 65 Basic Rx (HMO) | $0.00 | $7,550 | 5.0 |
| Independence Blue Cross | H3952-053 | Keystone 65 Focus Rx (HMO-POS) | $0.00 | $6,500 | 5.0 |
| Independence Blue Cross | H3952-020 | Keystone 65 Preferred Rx (HMO) | $214.00 | $3,800 | 5.0 |
| Independence Blue Cross | H3952-049 | Keystone 65 Select Rx (HMO) | $55.50 | $4,900 | 5.0 |
| UnitedHealthcare | H5652-006 | Erickson Advantage Freedom (HMO-POS) | $68.00 | $4,300 | 5.0 |
| UnitedHealthcare | H5652-008 | Erickson Advantage Liberty with Drugs (HMO-POS) | $0.00 | $7,550 | 5.0 |
| UnitedHealthcare | H5652-001 | Erickson Advantage Signature with Drugs (HMO-POS) | $197.00 | $2,600 | 5.0 |
| UPMC for Life | H3907-037 | UPMC for Life HMO Deductible Rx (HMO) | $22.00 | $6,000 | 5.0 |
| UPMC for Life | H3907-029 | UPMC for Life HMO Rx (HMO) | $81.00 | $5,500 | 5.0 |
| UPMC for Life | H3907-049 | UPMC for Life HMO Rx Choice (HMO) | $36.00 | $4,500 | 5.0 |
| UPMC for Life | H3907-006 | UPMC for Life HMO Rx Enhanced (HMO) | $295.00 | $7,550 | 5.0 |
| UPMC for Life | H5533-011 | UPMC for Life PPO Premier Rx (PPO) | $0.00 | $5,900 | 5.0 |
| UPMC for Life | H5533-009 | UPMC for Life PPO Rx Choice (PPO) | $23.00 | $4,900 | 5.0 |
| UPMC for Life | H5533-008 | UPMC for Life PPO Rx Enhanced (PPO) | $58.00 | $7,550 | 5.0 |
| UPMC for Life | H3907-046 | UPMC for Life HMO Premier Rx (HMO) | $0.00 | $5,500 | 5.0 |
| UPMC for Life | H5533-003 | UPMC for Life PPO High Deductible Rx (PPO) | $33.00 | $7,550 | 5.0 |
| Aetna Medicare | H5522-017 | Aetna Medicare Advantra Credit Value (PPO) | $0.00 | $7,550 | 4.5 |
| Aetna Medicare | H3959-039 | Aetna Medicare Advantra Premier (HMO-POS) | $23.00 | $7,550 | 4.5 |
| Aetna Medicare | H5522-002 | Aetna Medicare Advantra Premier Plus (PPO) | $77.00 | $6,500 | 4.5 |
| Aetna Medicare | H5522-004 | Aetna Medicare Advantra Silver (PPO) | $0.00 | $7,550 | 4.5 |
| Aetna Medicare | H3959-001 | Aetna Medicare Advantra Gold (HMO) | $35.00 | $5,500 | 4.5 |
| Aetna Medicare | H5522-013 | Aetna Medicare Advantra Silver Plus (PPO) | $18.00 | $7,000 | 4.5 |
| Aetna Medicare | H3959-010 | Aetna Medicare Advantra Silver (HMO-POS) | $0.00 | $5,900 | 4.5 |
| Aetna Medicare | H3959-047 | Aetna Medicare Advantra Butler Prime (HMO) | $0.00 | $5,500 | 4.5 |
| Aetna Medicare | H5522-022 | Aetna Medicare Silver Back (PPO) | $0.00 | $7,550 | 4.5 |
| Aetna Medicare | H3959-046 | Aetna Medicare Advantra Washington Prime (HMO) | $0.00 | $6,500 | 4.5 |
| Aetna Medicare | H3959-053 | Aetna Medicare Advantra Philly Prime (HMO) | $0.00 | $6,900 | 4.5 |
| Aetna Medicare | H3959-049 | Aetna Medicare Advantra Excela Prime (HMO-POS) | $0.00 | $6,500 | 4.5 |
| Aetna Medicare | H5522-020 | Aetna Medicare Advantra Central Value (PPO) | $0.00 | $7,550 | 4.5 |
| Aetna Medicare | H3959-051 | Aetna Medicare Beaver Valley Prime (HMO) | $0.00 | $6,500 | 4.5 |
| Aetna Medicare | H3959-037 | Aetna Medicare Advantra Gold (HMO-POS) | $0.00 | $7,550 | 4.5 |
| Aetna Medicare | H3959-045 | Aetna Medicare PennHighlands Prime (HMO) | $0.00 | $6,300 | 4.5 |
| Aetna Medicare | H3959-033 | Aetna Medicare Advantra Premier (HMO) | $27.00 | $7,550 | 4.5 |
| Aetna Medicare | H3959-052 | Aetna Medicare Advantra Value (HMO) | $0.00 | $7,550 | 4.5 |
| Aetna Medicare | H5522-021 | Aetna Medicare Value Plus (PPO) | $45.00 | $6,700 | 4.5 |
| Capital Advantage Insurance Company | H3923-013 | BlueJourney Classic (PPO) | $51.00 | $6,700 | 4.5 |
| Capital Advantage Insurance Company | H3923-017 | BlueJourney Prime (PPO) | $174.00 | $4,000 | 4.5 |
| Capital Advantage Insurance Company | H3923-029 | Capital Blue Cross | WellSpan Health Advantage (PPO) | $0.00 | $6,600 | 4.5 |
| Capital Advantage Insurance Company | H3923-030 | Capital Blue Cross | WellSpan Health AdvantagePlus (PPO) | $19.00 | $5,900 | 4.5 |
| Capital Advantage Insurance Company | H3923-031 | Capital Blue Cross | WellSpan Health Value (PPO) | $0.00 | $8,000 | 4.5 |
| Capital Advantage Insurance Company | H3923-028 | Capital Blue Cross Select (PPO) | $0.00 | $7,000 | 4.5 |
| Capital Advantage Insurance Company | H3923-037 | Capital Blue Cross Enhanced (PPO) | $20.00 | $6,000 | 4.5 |
| Capital Advantage Insurance Company | H3923-036 | Capital Blue Cross Value (PPO) | $0.00 | $8,000 | 4.5 |
| Geisinger Gold | H3954-160 | Geisinger Gold Classic 360 Rx (HMO) | $0.00 | $7,550 | 4.5 |
| Geisinger Gold | H3954-157 | Geisinger Gold Classic Advantage Rx (HMO) | $144.00 | $3,450 | 4.5 |
| Geisinger Gold | H3954-158 | Geisinger Gold Classic Complete Rx (HMO) | $34.00 | $4,900 | 4.5 |
| Geisinger Gold | H3954-161 | Geisinger Gold Classic Essential Rx (HMO) | $0.00 | $7,550 | 4.5 |
| Geisinger Gold | H3924-066 | Geisinger Gold Preferred 360 Rx (PPO) | $0.00 | $7,550 | 4.5 |
| Geisinger Gold | H3924-059 | Geisinger Gold Preferred Advantage Rx (PPO) | $84.00 | $4,000 | 4.5 |
| Geisinger Gold | H3924-065 | Geisinger Gold Preferred Complete Rx (PPO) | $0.00 | $6,700 | 4.5 |
| Geisinger Gold | H3924-062 | Geisinger Gold Preferred Enhanced Rx (PPO) | $45.00 | $7,550 | 4.5 |
| Humana | H6622-037 | Humana Gold Plus H6622-037 (HMO) | $0.00 | $6,900 | 4.5 |
| Humana | H6622-036 | Humana Gold Plus H6622-036 (HMO) | $0.00 | $6,700 | 4.5 |
| Humana | H5216-051 | HumanaChoice H5216-051 (PPO) | $43.00 | $6,300 | 4.5 |
| Humana | H6622-054 | Humana Gold Plus H6622-054 (HMO) | $0.00 | $6,700 | 4.5 |
| Humana | H6622-035 | Humana Gold Plus H6622-035 (HMO) | $0.00 | $6,700 | 4.5 |
| Humana | H6622-052 | Humana Gold Plus H6622-052 (HMO) | $0.00 | $7,200 | 4.5 |
| Humana | H5216-117 | Humana Value Plus H5216-117 (PPO) | $41.10 | $7,000 | 4.5 |
| Humana | H5216-120 | HumanaChoice H5216-120 (PPO) | $123.00 | $6,700 | 4.5 |
Interested in joining a plan from one of the top-rated providers? That has a lot to do with your Pennsylvania County. Medicare Advantage plans are regional, and you can't join a plan that isn't in your area.
Best Plans in Pennsylvania by County
Choose your Pennsylvania County below to see the best (and the worst) 2023 plans.
For fast, friendly assistance call 1-855-728-0510 (TTY 711) .
How to Select The Best Plan
There are various reasons you might be considering a plan change, such as turning 65 or the 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.. You might also be navigating a special enrollment event, such as moving into a new region. There are some important details to consider in all these situations.
1. Consider Your Expected Utilization
Do you believe that you will get the most out of your plan's benefits, including hospital inpatient careInpatient care refers to care provided in a hospital or other inpatient facility. Inpatients are admitted and stay at least one night depending on their condition.? If you do, evaluate plans with higher monthly premiums, low copayments, and low maximum out-of-pocket limits. Conversely, if your health is good and you rarely use services, look for plans with low premiums or a zero-dollar premium. These plans may have high out-of-pocket maximums and high deductibles, so weigh your risk carefully.
2. Evaluate Your Prescription Costs
For many seniors, prescription drugs are what drive up their healthcare costs the most. And, because most Medicare Advantage plans include Part D benefits for your regular prescriptions, you need to make sure the plan you choose covers your drugs at a price you can afford.
3. Understand Your Additional Coverage Needs
Original Medicare does not all health care costs. It covers your major medical and some preventive care services, but it does not cover dental, vision, hearing, or prescriptions. A growing number of Medicare Advantage plans cover many of the essential services that your Part A and 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 do not.
4. Consider Your Healthcare Providers
Medicare Advantage plans use healthcare provider networks, and not all primary care doctors and specialists accept all plans. For many Pennsylvania shoppers, finding a plan that their doctors accept is exhausting. We can help!
Should I Choose an HMO or PPO plan?
There are many plan options available when shopping for Medicare Advantage plans in Pennsylvania, including HMO and PPO options. These are some of the differences you should consider before making a plan selection.
- With an HMO you may pay less out-of-pocket, but you will need to choose a primary physician to coordinate your care. Referrals for specialists are often required. Except in an emergency, you must remain within the provider network.
- With a PPO you are not required to get referrals for specialty care. You have the option to get health care outside of the plan's provider network. However, typically you will pay more and the out-of-pocket maximum for out-of-network care will be higher.
Need help choosing? Call 1-855-728-0510 (TTY 711) for plan assistance. There's no obligation.
Find Plans in your area with your ZIP Code
Eligibility
Medicare Advantage plans are available to people ages 65 and older. They are also available to individuals with certain disabilities. When eligible, you can generally join one of these Medicare Advantage Plans:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Medical Savings Account (MSA) Plan
You must live in the service area (i.e., County) of the plan you want to join. If you reside outside the plan's service area for part of the year, ask if the plan will cover you there. You must also 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 Part B and be a U.S. citizen or a legal resident.
Alternatives
Medicare Advantage Plans are an alternative to Original Medicare coverage. However, there is another option. You can keep your Original Medicare benefits and add one of the best Medicare Supplement plans in Pennsylvania for additional coverage. And, there are Pennsylvania Medicare Part D plans for coverage of prescription drugs.
Many experts feel 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. plans offer superior financial coverage and the most flexibility. Plus, benefits rarely change and you can get a policy outside of a Medicare enrollment period. However, plans may not be affordable for all Pennsylvania seniors.
Due to the fact that Medicare Supplement plans cover more costs than Medicare Advantage Plans, their monthly premiums are generally higher. If you cannot afford Medicare's out-of-pocket costs, another alternative is a dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... Medicare Special Needs Plan in Pennsylvania. D-SNP plans help Pennsylvania seniors who qualify for both Medicare and Medicaid. D-SNP plans offer quality care at very affordable prices.
Next Steps
Call 1-855-728-0510 (TTY 711) for assistance. There's no obligation.
Frequently Asked Questions
Still have questions? These common questions and answers might help.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage plans can have some potential drawbacks. Many plans require members to use their provider network. Costs are also heavily influenced by how you use healthcare services. This makes it difficult to budget for healthcare expenses. Most plans require members to get referrals for specialists or authorization before they can receive healthcare services. Learn more about the pros and cons of Medicare Advantage plans.
How much does Medicare Advantage cost in Pennsylvania?
The average cost of a Medicare Advantage plan in Pennsylvania is $39.11. But that's just the monthly premium. If you have one or more chronic health conditions, a plan's out-of-pocket costs (e.g. deductibles and copays) are also a factor to consider. Plus, most Medicare Advantage plans include prescription drug benefits, which have their own out-of-pocket costs.
What do Medicare Advantage plans include?
All Medicare Advantage plans offered in Pennsylvania must cover all of the Original Medicare benefits. But, private Medicare plans are not required to provide healthcare services similarly. For instance, Medicare Part A covers 80% of hospital stays, skilled nursing, home care, hospiceHospice is a special way of caring for people who are terminally ill. Hospice care involves a team-oriented approach that addresses the medical, physical, social, emotional, and spiritual needs of the patient. care, and home health careHealth care services and supplies a doctor decides you may receive in your home under a plan of care established by your doctor. Medicare only covers home health care on a limited basis as ordered.... And Part B covers 80% of doctor visits, lab tests, and other outpatient services. However, Medicare Advantage plans are allowed to set their own copays and routinely charge more than 20%. That said, they do have an annual limit, whereas Original Medicare doesn't.
Methodology and Sources
Our analysis of the top-rated Medicare Advantage plans in Pennsylvania excludes employer group plans, Medicare-Medicaid Plans (MMPs), Medicare Savings Account Plans (MSAs), Special Needs Plans (SNPs), and plans that do not include Part D benefits.
CMS rates and reviews health plans in several categories, including delivery of health care, member experience and customer service. When comparing plan ratings, we use state-specific data, not CMS' nationwide figures.
Medicare Advantage plan data is sourced from CMS public use files (see: Citations & References). When needed, we combined affiliated companies to calculate insurer averages.
Our research does not include Pennsylvania's Medicare Advantage SNP Plans. We evaluate these plans separately. We also did not include plans without Part D benefits for prescription drugs, employer plans, or Medicare-Medicaid Plans (MMPs). If you're not looking for a Medicare Advantage plan but want to cover out-of-pocket costs that Original Medicare plan doesn't cover, MedicareWire also ranked the best Medigap Plans in Pennsylvania.
Citations & References
- CMS.gov, 2023 Medicare Part C Landscape Source Files, Last Accessed January 13, 2023
- CMS.gov, "5-STAR PLAN RATINGS", Last Accessed October 22, 2022
- Medicare.gov, "Explore your Medicare coverage options", Last Accessed October 27, 2022
- KFF.org, "Medicare Advantage 2022 Spotlight: First Look", Last Accessed November 2, 2022
- Medicare.gov, "How do Medicare Advantage Plans work?", Last Accessed October 13, 2022
- CMS.gov, Part C and D Performance Data, Last Accessed January 13, 2023
- CMS.gov, Monthly MA Enrollment by State/County/Contract, Last Accessed January 13, 2023
- CMS.gov, Biden-Harris Administration Announces Lower Premiums for Medicare Advantage and Prescription Drug Plans in 2023, Last Accessed September 29, 2022
- CMS.gov, Medicare Marketing Guidelines, Last Accessed February 2, 2023
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About
The Medicare Advantage information on the page was researched and published by David Bynon, and was last updated on .
Our content follows the guidance provided by the Medicare Marketing Guidelines on CMS.gov. If you believe the information on this page is inaccurate, please contact us.