The Best Medicare Supplement (Medigap) Plans in Pennsylvania
- Pennsylvania Medicare Supplement Insurance (Medigap) covers several out-of-pocket Medicare expenses. Check out our review of Medigap plans in Pennsylvania to learn how Medicare Supplement Insurance works.
Medicare Supplement Insurance (Medigap) is designed to work with Original Medicare, a government-managed insurance plan for senior citizens and some younger Americans with disabilities. Original Medicare has two components: Hospital Insurance (Part A) and Medical Insurance (Part B). Both parts cover a wide range of services, but they don't cover your costs in full.
If you're living on a fixed income, it can be difficult to pay your Medicare copays, coinsurance and deductibles. That's where Pennsylvania Medigap comes in. If you have Medigap, Original Medicare pays the agreed-upon amount first, and then, your Medigap plan picks up its share.
Although Medigap coverage can make medical care much more affordable, many Pennsylvania residents still haven't signed up. Roughly 46% of Pennsylvania's Original Medicare beneficiaries have a Medigap plan.1 If you live in Pennsylvania, have Original Medicare and aren't enrolled in Medicare Supplement Insurance, use the information below to choose a Medigap plan.
You can find Medicare Supplement plans where you live by comparing plans from several different insurance companies online.
What Are the Best Pennsylvania Medicare Supplement Plans?
The chart below lists each Pennsylvania Medigap plan and outlines the benefits included with each one. All states, with the exception of Minnesota, Massachusetts and Wisconsin, follow the same guidelines when standardizing their Medigap plans.
All Medigap plans include some of the same standard benefits, such as 365 days of hospital coverage in addition to what your Original Medicare plan offers. Once you get past those standard benefits, your coverage depends on which plan you choose. All Pennsylvania Medigap plans pay for the first three pints of blood for a blood transfusion, but only some plans cover 100% of the cost. Others cover a lower percentage, leaving you to pay the remaining balance. Some plans also have out-of-pocket limits to make your Medicare costs even more affordable.
In Pennsylvania, Plans F, G and N tend to be the most popular. Plan F isn't available to enrollees who became eligible for Medicare after January 1, 2020, but for individuals with earlier eligibility dates, what makes the plan so attractive is its low monthly premium.
Plan G also has affordable premiums. It doesn't cover the Part B deductible, but it does pay the coinsurance for hospice care, the Part A deductible and any Medicare excess charges. In Medicare terminology, an excess charge refers to the amount charged above the Medicare-approved amount for a service.
Plan N has higher premiums, but it also provides robust coverage. In many cases, Plan N pays 100% of your Medicare coinsurance. Even if you're required to pay a copay, it's typically a nominal amount, such as $20 for a doctor visit or $50 for treatment in an emergency department that doesn't result in an admission for inpatient care.
How Do I Enroll in a Pennsylvania Medigap Plan?
Time is of the essence when enrolling in Pennsylvania Medigap for the first time. Once you're enrolled in Medicare Part A and Part B, you'll have an initial Medigap enrollment period of six months. This enrollment period starts during the month you turn 65. The reason it's so important to enroll during this initial enrollment period is because it's one of the few times insurance companies are prohibited from using underwriting when considering your application for Medigap coverage.
Underwriting is a process in which the insurance company assesses your risk and determines if it's willing to give you coverage. During your initial Medigap open enrollment period, an insurer must issue you a Medigap policy, even if you have a pre-existing condition. Insurers are also prohibited from charging you more money based on your health status. This is known as guaranteed issue rights.
Once your initial Medigap enrollment period ends, these guaranteed issue rights typically go away, which means you may have to pay more for your coverage if you have a chronic health condition. Depending on the severity of any health conditions you have, you may not even be able to get Medigap coverage once your guaranteed issue rights expire.
There are some exceptions to these rules:
- If you have group health insurance or some other type of health coverage after you turn 65, your Pennsylvania Medigap open enrollment period doesn't begin until you enroll in Medicare Part B, provided you'll be losing your previous health coverage during the same month.
- Even though an insurance company can't deny your application or charge you more during your initial Medigap enrollment period, it may impose a six-month waiting period for any pre-existing conditions. If a waiting period is imposed, your Medigap plan won't pay any expenses relating to your pre-existing condition until six months after you purchase the coverage.
- If your current insurance plan has covered your pre-existing conditions for six months or more, you may be able to get Medigap coverage for those conditions without a waiting period.
- If you sign up for Medicare Advantage when you turn 65 and decide to switch to Original Medicare within a year, you'll have guaranteed issue rights for six months once you make the switch.
- If you lose your Medigap coverage due to circumstances outside your control, you can purchase Pennsylvania Medigap coverage without going through the underwriting process. An example would be if your Medigap provider went out of business and you had to choose a new Medigap plan offered by a different company.
Learn more about your Pennsylvania Medicare Supplement options by comparing your local plan options online or by calling to speak with a licensed insurance agent.
AHIP. (Mar. 2022). The State of Medicare Supplement Coverage: Trends in Enrollment and Demographics. https://ahiporg-production.s3.amazonaws.com/documents/202202-AHIP_MedicareSuppCvg-02_v03.pdf.