Pennsylvania Medicare Plans

Pennsylvania, the Keystone State, has a lot to offer! From Hershey Part to the Liberty Bell, there are numerous sites to see. It’s home where such documents as the Gettysburg Address, U.S. Constitution, and the Declaration of Independence were written. Whether you want to visit a chocolate factory or an Ivy League University, you’ll find a lot of history in Pennsylvania.

It comes as no surprise that many people have chosen the state of Pennsylvania as their retiree state. In fact, there are almost 3 million people enrolled in Medicare in the state of Pennsylvania alone. Luckily, no matter what part of Pennsylvania you reside in, the rules for Medicare plans are the same across the entire state! If you are coming into Medicare, you want to make sure you fully understand all of the rules, timelines, and options you have for your health insurance needs!

What are Medicare Options in Pennsylvania ?

Pennsylvania , like many states, offers the standard Medicare Supplement plans, also known as Medigap plans. If you are a resident, you can choose from the following plans: A, B, C, D, F, G, H, K, L, M, N, high-deductible Plan F, and high-deductible Plan G. You’re able to enroll during the year, but if you want your coverage to be guaranteed, you want to enroll during your open enrollment period in Pennsylvania .

What are the Most Popular Medicare Supplement Plans in Pennsylvania ?

  • Medicare Supplement Plan F
  • Medicare Supplement Plan G
  • Medicare Supplement Plan N

When is the Open Enrollment Period in Pennsylvania ?

As a Medicare beneficiary in Pennsylvania, you can enroll in any Medicare Supplement within your first six months of your Part B effective date. This is considered your open enrollment period. medicare-open-enrollmentDuring this time, insurance carriers are required to approve your MediGap application, and are prohibited from declining the coverage you need because you have a pre-existing condition. You can still apply outside of this window, but you will be required to go through medical underwriting, and could be denied coverage based on your health history.

Can I Change Medicare Supplement Plans in Pennsylvania ?

You can apply to change your Medicare Supplement during any month of the year in Pennsylvania , however there is one catch. Once you are more than 6 months past your Medicare Part B effective date, you must go through medical underwriting in order to be approved to enroll into, or change your Medicare Supplement plan. This means that insurance carriers are given the ability to assess your health history, prescriptions, height and weight, as well as other health-related factors to determine if you will be approved or denied coverage. During medical underwriting, insurance carriers have the ability to deny a Medicare Supplement plan application based on pre-existing conditions, so it is important to enroll in a MediGap plan during your open-enrollment period to guarantee your acceptance.

Medigap Plan F in Pennsylvania

Medicare Supplement Plan F has been a very popular plan with Medicare beneficiaries over time. The reason for the popularity of Plan F, is that it covers the gaps left by Medicare Part A and B with no out-of-pocket. However, if you became Medicare eligible after January 1st 2020, you are not eligible to enroll in MediGap Plan F. Luckily, there are other great Medicare Supplement plan options available.

Medigap Plan G in Pennsylvania

Medicare Supplement Plan G is a very comprehensive Medicare Supplement plan with very little out-of-pocket expense. Once you have met your Part B annual deductible, MediGap Plan G becomes a full coverage plan, covering all of the gaps left by Original Medicare, with no additional out-of-pocket expenses. Plan G is typically a very cost-efficient plan with an affordable monthly premium to ensure gold-standard coverage.

Plan G can be a very good choice in Pennsylvania . It's a great plan but we may also be able to find better value. Give us a call and we will look through all options.
Keith Armbrecht
Medicare on Video

Medigap Plan N in Pennsylvania

Medicare Supplement Plan N is also a great, comprehensive MediGap plan available in Pennsylvania. This plan has slightly more out-of-pocket cost than MediGap Plan G, but also comes with a lower monthly premium. As with Plan G, you are still responsible for the Medicare part B annual deductible. Once you have met this deductible, your Original Medicare coverage kicks in, but you still have some cost-share. With MediGap Plan N, you will pay copayments up to $20 for office visits, and up to $50 for ER visits that do not result in an inpatient admission. If the monthly premium difference between Plan G and Plan N is large enough, Plan N is often times a very attractive option for your Medicare Supplement plan.

In most states, Plan N also has the possibility of an excess charges (up to 15% above the Medicare-approved amount) if you use a doctor or healthcare provider that does not accept Medicare Assignment. In Pennsylvania, however, excess charges are not permitted, and providers are prohibited from charging Medicare beneficiaries over the Medicare-allowed amount for services.  This means that you will not have to worry about encountering an excess charge if using a doctor or healthcare provider in the state of Pennsylvania. If you do travel to another state, however, you will want to confirm that the doctor you are seeing does accept Medicare Assignment to avoid a possible excess charge. 

What is the Cost of a Medicare Supplement Plan in Pennsylvania ?

Monthly premiums for Medicare Supplement plans are based on three main factors- age, gender, and location. There are other things that may impact your premium such as tobacco use. The premium amounts will vary based on these factors, so it is important to receive a quote based on your specific demographic information.

Medicare Plans in Pennsylvania for Those Under 65

When it comes to Medicare in Pennsylvania, there a 6 month open enrollment for MediGap plans required by the state for those under 65. This means that Medicare beneficiaries under age 65 are given a one-time 6 month long window to apply for a Medicare Supplement plan with no health questions or medical underwriting. If you do not apply for a Medicare Supplement plan during this window, you will later be required to go through and pass any medical underwriting that is necessary for acceptance. If you’re under 65 and disabled but still qualify for Medicare, you may not pass this underwriting. If you fit within this category, there are Medicare Advantage Policies that you can look into.

Once you reach 65, more Medicare supplement plans will open up for enrollment in Pennsylvania  without any health questions. This period guarantees acceptance.

Medicare Advantage in Pennsylvania

Pennsylvania  also offers options for Medicare Advantage plans. In these plans you must live in your plan’s service area and enroll during an appropriate election period.  Medicare Advantage plans do not required medical underwriting if enrolling during an election period, but are also significantly different plans than Medicare Supplement plans.

Medicare and Medicaid in Pennsylvania

It is possible to qualify for both Medicare and Medicaid in the state of Pennsylvania . These two programs, however, are separate and have different qualifications you must meet in order to receive benefits. To qualify for Medicaid, you must meet  state income requirements. To qualify for Medicare, you must be either over the age of 65, or under 65 but receiving Social Security Disability Insurance for a minimum of 24 months before applying for Medicare. 

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