Medicare in Pennsylvania

In this article...
  • Get a head start on Medicare enrollment by learning what options you have. This guide to Medicare in Pennsylvania includes descriptions of Parts A, B, C and D.

What Pennsylvania Medicare Plans Are Available? 

If you are nearing the age of retirement and live in Pennsylvania, you might be wondering what Medicare plans will be available to you. Social Security will subsidize the cost of your medical care to help make it more affordable, but you do need to be aware of your own financial responsibility for your health care so that you may plan ahead.

The plans that are available are Medicare Part A, Part B, Medicare Advantage and Medicare Part D. You are also able to enroll in Medicare Supplement plans offered by insurance companies to help with your copayments and out-of-pocket expenses. 

Here are the available plans and what they cover:

  • Medicare Part A
    This is considered Original Medicare and is used to cover the cost of your inpatient care, such as the need to stay at a hospital, be admitted into a nursing facility or receive hospice care. It will also cover home health care services. 

  • Medicare Part B
    This is the second part of Original Medicare and is used to cover the cost of preventative care. If you need medical supplies, machines and medical devices, medical transportation or diagnostic testing, it will be covered under Part B. This plan also covers your routine doctor appointments. 

  • Medicare Advantage
    This is a plan that is offered and administrated by a private health insurance company. Medicare Advantage plans cover all of the things you would receive under Original Medicare but may also offer additional coverage for dental, vision, prescription drugs and a number of other benefits. Because these plans are offered by private insurers, they will vary in scope and cost. 

  • Medicare Part D
    Your prescription drug coverage is offered through Medicare Part D and some Medicare Advantage plans that include Part D coverage. Medicare Part D covers most prescription drugs you can get at a retail pharmacy, which is something Original Medicare doesn't cover.

  • Medicare Supplement Plans
    A Medicare supplement plan can cover the cost of your copayments and other out-of-pocket expenses. For example, if you receive certain care that's covered under Medicare Part B, you typically will be responsible for 20% of your bill after meeting your deductible for the year. A Medicare Supplement plan can help cover coinsurance or copay costs, as well as certain other Medicare out-of-pocket costs. 

Medicare Advantage is almost as popular as Medicare Part A and B in Pennsylvania. In 2020, about 1.2 million residents enrolled in an Advantage plan compared to 1.5 million who enrolled in traditional Medicare coverage.

You may find it difficult to decide which plan you wish to enroll in, so think about your health conditions, financial health and what level of coverage you truly need before making your choice. If you believe you will need assistance covering your copays, research available Medicare Supplement policies. 

Who Is Eligible for Pennsylvania Medicare? 

Chances are that unless you take action to opt-out of Original Medicare and into another plan, you will be enrolled in Original Medicare automatically. The only reasons you would not be enrolled automatically are that you did not contribute enough to Social Security or you have not been collecting your benefits for at least four months before your 65th birthday. Everyone is eligible to enroll in Medicare at 65 years of age, but some people may need to pay more for their benefits. 

Medicare Part A is a part of your Social Security benefit and is free of charge as long as you contributed to Social Security for 10 years of your life. Medicare Part B does charge a premium of up to $150 at the moment, but this premium could rise in the future. Your Medicare Part B premiums are taken from your retirement benefits so that you do not need to pay a monthly bill. 

Medicare Advantage gives you more options because you are able to be insured by a private company instead of the government. You can also add options to your plan that are not available with traditional Medicare plans. You will receive a subsidy for your coverage, however, so a large portion of your premium may be reduced. Medicare Part D also charges a monthly premium, and your cost will depend on the type and level of prescription drug coverage that you select. 

If you wish to avoid penalties that can increase your rates, you need to enroll during your initial enrollment period, which is the time between three months prior to your birthday until three months afterward. If you cannot enroll during your initial enrollment period because you or a loved one is disabled, you were covered by your employer’s health care plan past the age of 65 or you volunteered or served outside of the country, there is a way to avoid the penalty. 

There are special enrollment periods that allow people meeting these criteria to enroll without being penalized. If you miss the initial enrollment deadline and do not qualify for a special enrollment period, you can enroll during the general enrollment period each year from the beginning of January until the end of March. 

Medicare Supplement plan providers are required to offer coverage without raising your rates for preexisting conditions, your age or your health history. You are only given this protection for the six months following your birthday. If you are considering enrolling in one of these plans, it is best to do so within this timeframe because you cannot be denied coverage or charged excessively. 

How Do I Enroll for Medicare in Pennsylvania? 

The easiest way to enroll in Medicare is to visit Medicare.gov. The website will guide you through the process, and you can even enroll or change your plan online. During open enrollment periods, you are also able to make changes to your plans or move from a traditional plan to an Advantage plan. Medicare Supplement plans are only offered through private insurers, so you will need to work with an insurance company that offers one to enroll. 

Contact Information for Pennsylvania Medicare, Medicaid and Insurance Help 

If you would like more information or need further assistance with applying for aid, you can visit any of the following sites:

Pennsylvania Department of Aging 

Special Pharmaceuticals Benefits Program 

APPRISE- Pennsylvania State Health Assistance Program 

Pennsylvania Medicaid Eligibility and Enrollment 

Services for Persons with Disabilities

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