Pennsylvania Medicare Plan Options

With the constant changes in Medicare, it is easy to be confused about your coverage. In fact, lots of people are often confused about the many Pennsylvania Medicare plans available.

There are particular health care costs that the Original Medicare plan does not cover such as deductibles, co-pays, and co-insurance which results in out-of-pocket expenses. People enroll in supplemental insurance to help cover those gaps.

Medicare beneficiaries in Pennsylvania have two types of supplemental coverage to select from - Medicare Advantage and Medicare Supplement plans. Both of these types of plans are purchased from private insurance companies but are government regulated. Each insurance company sets its own prices for the Medicare plans that it offers.

Pennsylvania Medicare Supplements 

Pennsylvania Medicare Supplements are standardized by the federal government. They cover a wide variety of medical costs but they have the same basic benefits structure in that Medicare pays first, and your supplement pays second. Pennsylvania Medicare Supplements plans are also guaranteed renewable every year after enrollment, and they allow you to see any provider that accepts Original Medicare.

The ten Pennsylvania Medigap plans are A, B, C, D, F, G, K, L, M and N. There is also a high deductible version of Plan F. Each plan covers a different set of benefits.

For example, Plan A offers coverage for just basic benefits while Plan F fills in all the gaps in Medicare. The most popular plans are F, G, and N, especially when paired with Part D prescription drug coverage.

Plan F is the most comprehensive plan. It pays all the of the things that Medicare doesn’t. Because it has the most coverage, it is usually higher-priced.

Many agree that Plan G has perhaps the best overall value for premiums and benefits. Plan G is typically less expensive than Plan F but covers almost as much, with the exception that you pay the Part B deductible. In addition, Plan G premiums have had a tendency to have lower rate increases than Plan F in recent years.

Plan N is another common plan with usually lower premiums than Plan G or F. You pay the Part B deductible and any excess charges on your own.  You also pay co-pays which are up to $50 for the ER and $20 for a doctor visit.

If you like the idea of lower premiums in exchange for having a higher deductible, there is a high deductible version of Plan F.  The annual deductible is $2,200  in 2017. Medicare will pay its portion first. Then you pay the remainder of the charges until you satisfy the deductible.  Rates for High Deductible Plan F are very competitive and often well under $100/month.

Pennsylvania Medicare Advantage plans

For some, it is not affordable to select a Medicare supplement. For people on a limited budget, the Medicare Advantage plans are a newer option.

Pennsylvania Medicare Advantage plans are private plans that pay instead of having Medicare pay. The premiums are much cheaper, but you will need to use a network of providers. The most common network types are PPO and HMO. PPO plans have some out-of-network benefits. HMO plans usually do not except in emergencies.

You can see then that it’s important to make sure your doctors are in the network before enrolling in a plan.

Many Advantage plans offer a built-in Part D drug plan. This is not only cost-effective but convenient because the same card can be presented to your physician and at the pharmacy. 

Medicare Advantage plans sometimes also offer extra benefits like routine vision, hearing or dental services. This makes them attractive to many Medicare Advantage plan.

Comparing Rates for Pennsylvania Medicare Plans

Although the numerous plans may seem a bit overwhelming, there are agents who can assist in helping you select the ideal plan for your needs. Whether you need a stand-alone plan or something more complex, there are a wide variety of options that will give you the best coverage for the right price.