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Medicare Advantage Plans in Pennsylvania

If you want to simplify your healthcare while limiting your out-of-pocket expenses, consider signing up for Medicare Advantage plans in Pennsylvania. These comprehensive policies include all benefits guaranteed to those enrolled in Medicare Part A and Part B along with a variety of additional services.

For instance, your Medicare Advantage plan may include wellness programs, prescription drug coverage, hearing tests, or routine vision and dental services. You may even qualify for a policy with a $0 premium, but those policies aren’t necessarily the best deal.

When you sign up for a Medicare Advantage plan in Pennsylvania, you will use your Medicare Advantage card instead of the red, white and blue Original Medicare card. You should keep that card in a safe place in case you want to go back to standard Medicare Part A and Part B in the future.

Medicare Advantage Plans in Pennsylvania: When Can I enroll?

Once you’re enrolled in Medicare Part A and Part B, you’re qualified to sign up for Medicare Advantage Plans in Pennsylvania. If you decide to enroll in Part A but decline Part B due to the deductible, you will no longer qualify for enrollment in a Medicare Part C plan in Pennsylvania.

Your first opportunity to switch from Original Medicare to Medicare Part C is during the Initial Coverage Election Period, which is otherwise known as your ICEP. This is a seven-month enrollment period that starts three months prior to your 65th birthday and closes three months after.

The Annual Election Period, otherwise known as the AEP, allows each beneficiary to switch from Original Medicare to a Medicare Advantage plan between the 15th of October and the 7th of December each year. If you don’t enroll during your initial coverage election period and don’t want to wait for the Annual Election Period, you can see if you qualify for Special Election Periods (SEP). These periods are often offered to people who delay enrollment in Medicare Part A and Part B due to coverage through an employer, but there are other qualifying circumstances.

If you decide that you don’t want to participate in Medicare Part C in Pennsylvania and want to return to standard Medicare Part A and Part B, you can take advantage of the Medicare Advantage Disenrollment Period. It opens January 1 and ends February 14, allowing you each beneficiary to go back to Original Medicare without penalty.

Most Popular Types of Medicare Advantage Plans in Pennsylvania

Each insurance company has the freedom to determine what type of Medicare Advantage plans they want to offer, the rates charged and the benefits extended beyond the standard Medicare Part A and Part B coverage. Let’s take a look at the four most common plan types offered in Pennsylvania.

HMO – Health Maintenance Organization

  • HMOs come with strict rules that you must follow. Breaking a rule could leave you with a substantial bill that isn’t covered by the insurance company.
  • Subscribers almost always limited to in-network providers. You probably won’t have the option to use an out-of-network hospital or doctor unless it is an emergency.
  • You’re required to select a primary care physician, otherwise known as a PCP.
  • You will most likely need a referral to see a specialist.
  • This is the most popular type of Medicare Advantage plan in Pennsylvania.

PPO – Preferred Provider Organization

  • You pay less when using an in-network hospital or doctor, but out-of-network care is usually accepted.
  • You don’t need a referral to see a specialist with most PPO plans.
  • Prescription drug coverage is usually included, but it’s not guaranteed.

PFFS – Private Fee-for-Service

  • The terms of payment vary from one plan to another, and any included networks are optional.
  • You’re free to see any medical provider accepting Medicare as payment and willing to work within the terms of your policy.
  • Some doctors choose not to accept PFFS plans even from existing or prior patients. You should check with your preferred providers before enrolling.
  • No requirement for a specialist referral or a designated primary care doctor.
  • Plans may include prescription drug coverage, but you can sign up for a Medicare Part D Prescription Drug Plan in addition to this type of Medicare Advantage plan in Pennsylvania.

SNPs – Special Needs Medicare Advantage Plans in Pennsylvania

  • Special Needs Plans are designed to meet the unique needs of patients with chronic health conditions or End Stage Renal Disease ESRD.
  • Special enrollment qualifications apply for all Special Needs Plans SNPs. Only patients with chronic or institutional conditions are allowed to join SNPs.
  • Most plans require patients to see in-network medical providers. Out-of-network providers will cost more if allowed at all.
  • If you qualify for a Special Needs Plan, you’re likely dual-eligible for Medicaid or a similar state program.

How Does A Medicare Advantage Plan in Pennsylvania Cover Prescription Drugs?

  • Most Medicare Advantage plans in Pennsylvania include prescription drug coverage, freeing you from paying for a separate Medicare Part D Prescription Drug Plan premium. This is easier than trying to keep up with multiple premiums.
  • Policies that include drug benefits are known as Medicare Advantage Prescription Drug Plans (MAPDS). It’s important to select a MAPD policy because you cannot enroll in Medicare Part D if you participate in Health Maintenance Organization HMO plans or Preferred Provider Organization PPO plans.

Network Restrictions on a Medicare Advantage plan in Pennsylvania?

  • In-Network vs Out-of-Network – The type of Medicare Advantage plan selected determines the restrictions on approved medical providers. HMOs are the most restrictive.
  • Emergency Care While Traveling – The terms of your policy will determine how your emergency medical bills are covered while you’re traveling. HMO and PPO policies are required to offer coverage for urgent care and emergency services even if you’re outside of your network.
  • Coverage After a Move – You will need to select a new Medicare Advantage plan if you move to a new state. You will have the benefit of a special enrollment period.

In most cases, the financial value of these added benefits make Medicare Advantage plans in Pennsylvania a better deal than standard coverage through Medicare Part A and Part B. There are no formulary guidelines on how rates are determined for Advantage plans, so it’s important to compare policy details and premiums.

Pennsylvania Medicare Resources

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