Medicare in Pennsylvania

Are you a Pennsylvania resident approaching their 65th birthday? If so, there’s likely only one thing on your mind; your Medicare enrollment. We’re here to help! Follow along with our complete guide to Pennsylvania Medicare in 2020, including pertinent information on the state’s Medicare Supplement Insurance and Medicare Advantage plans!

Overview of Medicare in Pennsylvania

If you’re considering becoming a Medicare beneficiary in Pennsylvania, know that you’re not alone! Last year, over 2.7 million people enjoyed the flexibility and peace of mind of Medicare. In addition, 1.2  million beneficiaries are enrolled in a Medicare Advantage plan, while 2.1 million beneficiaries are enrolled in a stand-alone prescription drug plan.

Pennsylvania Medicare Savings Program

For some Pennsylvania beneficiaries, the cost of a standard Medicare program is far too great. To help alleviate the burden, the state offers several Medicare Savings Programs (MSP) that can cover some of the costs associated with Medicare coverage. The level of assistance that these beneficiaries receive will depend on their income, as well as their resource level. 

Please note that all the programs listed below have a resource limit for applicants. To apply for MSPs, an individual’s asset cannot be worth more than $7,560. For married couples, the resource limit must not exceed $11,340. 

• Qualified Medicare Beneficiary (QMB): This program offers financial assistance for Medicare Part A and Part B, as well as deductibles, coinsurance, and copays. To qualify, an individual must earn less than $1,032 per month, while a married couple’s monthly income must not be greater than $1,392.
• Specified Low-Income Medicare Beneficiaries (SLMB): This program only offers financial assistance for Medicare Part B premiums. Individuals who apply must earn less than $1,234 per month, whereas couples must have a monthly income limit of $1,666. 
• Qualified Individuals (QI): Like SLMB programs, a QI program only covers Medicare Part B premiums. To be eligible, individual applicants cannot earn more than $1,386 per month, while couples cannot exceed a monthly income of $1,872. 
• Qualified Disabled and Working Individuals (QDWI): This program only offers financial assistance for the premiums associated with Medicare Part A coverage. If eligible to claim, an individual’s monthly income must also be limited to $4,132 and have assets worth less than $4,000. Meanwhile, married couples must earn less than $5,572 per month, and have a resource limit of $6,000.

Medicare Supplement Insurance in Pennsylvania

Original Medicare (Part A and Part B) comes with out-of-pocket costs⁠—including copayments, coinsurance, and deductibles—that the plan holder is responsible for. Medicare Supplement plans (Medigap) fill in these gaps, covering a portion of the expenses not included by Original Medicare. These plans are not connected with the U.S. government or the federal Medicare program; instead, they are offered by private insurance companies.

Top Pennsylvania Medigap Plans

Since some Medigap plans offer coverage beyond Original Medicare, Pennsylvania residents can find a plan that suits their specific needs. With plans varying in cost and coverage, residents must carefully compare plans to find the best option. 

In Pennsylvania, the three most popular plans are Plan F, Plan G, and Plan N, with each option offering a different set of benefits. Plan F is recognized for offering the most comprehensive coverage, while Plan G and Plan N provide fewer benefits and smaller premiums. In addition to comparing the prices and ratings of each option, Pennsylvania residents should also look into year-to-year rate increases for each plan. 

Dental Insurance for Seniors in Pennsylvania

Unfortunately, Original Medicare does not include dental, vision, or hearing coverage. However, there are some insurance companies that aim to fill these gaps; call us at 1-844-374-1950 and we will put you in touch with providers that offer dental insurance for seniors in Pennsylvania.

Medicare Advantage Plans in Pennsylvania

If Medicare Supplement plans in Pennsylvania are out of your budget range, it may be time to look into Medicare Advantage plans. Also referred to as Medicare Part C, these plans include the same coverage as Original Medicare, but may also cover other services, such as routine vision and dental services. Like with Medigap options, Medicare Advantage plans are offered through private insurance companies that have been approved by Medicare. 

Most Medicare Advantage plans use HMO or PPO networks; as such, beneficiaries who enroll in these plans must agree to use those networks when seeking medicare care. 

Finally, it is vital to note that, while Pennsylvania Medicare Advantage plans feature copays that require individuals to pay for various services, including doctor visits and diagnostic tests. 

Part D Coverage with Pennsylvania Medicare Advantage

As is the case with other states, Original Medicare coverage is Pennsylvania does not offer Part D prescription drug benefits. Fortunately, most Pennsylvania Medicare Advantage options do include a comprehensive plan for those who require prescription drugs. Also, some Medicare Advantage plans in Pennsylvania boast other minor benefits, including dental oral exams and vision tests. 

Pennsylvania Medicare FAQ

How are Medicare Supplement Plans Rated in Pennsylvania?

Medicare Supplement plans in Pennsylvania are rated based on community, age, and issue. In addition, an individual’s rating will depend on their zip code, as well as the insurance company they have enrolled with. 

How Many Medicare Beneficiaries in Pennsylvania Have a Medicare Supplement Plan?

In Pennsylvania, about 1 out of 4 Medicare beneficiaries are enrolled in a Medicare Supplement plan. 

If you have any questions about Pennsylvania Medicare in 2020, and your eligibility for financial assistance, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you. Call us today at 1-844-236-0228.

Interested in a quote for Pennsylvania Medicare Insurance? Call 1-844-236-0228 to speak with a licensed agent.