Medicare Advantage plans in Pennsylvania are sold to Medicare beneficiaries by private insurance companies. Also known as Medicare Part C, these policies bundle Original Medicare (Medicare Part A and Part B) coverage into one policy. The insurance company offering the plan is responsible for claims, customer service, administration, and more.
If you have healthcare coverage with a Medicare Advantage plan in Pennsylvania, you are still responsible for paying your Part B premium in addition to your Medicare Part C premium.
Here are some reasons to consider a Medicare Advantage plan for your 2022 health insurance:
- Medicare Advantage plans are becoming more and more popular every year
- Private insurance carriers provide benefits
- Most Medicare Advantage insurance plans and benefits involve specific network providers – like physicians, hospitals, pharmacies, and medical equipment suppliers.
- MAPD or Medicare Advantage prescription drug plans include prescription drug coverage together in one plan.
- Many plans include extra coverage options like vision, dental, and hearing care; memberships for wellness and fitness clubs like SilverSneakers; over-the-counter prescription allowances; transportation to and from medical appointments; and meal delivery services.
Best Medicare Advantage plan types in Pennsylvania
Here’s a look at the different types of Medicare Advantage health plans in Pennsylvania:
Best network freedom: Medicare Advantage PPO plans
- PPO plans offer a larger network of medical providers and facilities with no referral requirements.
- PPO premiums range between $0 and $100.00 per month.
Best for lowest out-of-pocket costs: Medicare Advantage HMO plans
- HMO premiums are generally $0 per month.
- These plans have lower out-of-pocket costs because they use the HMO referral network.
Best for low income or health conditions: Medicare Advantage D SNP
SNP, or Special Needs Plans, are best for beneficiaries who live on a limited income or have chronic health conditions. Eligibility for both Medicare and Medicaid coverage is possible for some beneficiaries. This dual coverage helps lower out-of-pocket expenses for copays, premiums, coinsurance, some deductibles, and other Medicare costs.
SNPs require that you use in-network providers unless:
- You need emergency or urgent care while outside the network
- You have end-stage renal disease and need out-of-network dialysis
Here are some statistics highlighting the growth of Medicare Part C plans:
- Number of lives enrolled in Medicare Advantage in Pennsylvania
- Statistics for 2021 show that there are just under 1.3 million Medicare Advantage beneficiaries in the state.
- Number of lives enrolled by plan type: (Based on 2018 statistics)
- *Local HMOs: 648,820
- *Local PPOs: 385,517
- *Regional PPOs: 4,798
How much does Medicare Advantage cost in 2022?
In Pennsylvania, as in most states, there are HMO plans available with a monthly premium of $0.00. While some states offer PPOs with no monthly premium, it is becoming more common for PPOs to carry a premium.
Which plans are available in Pennsylvania and how much they cost vary from county to county. However, the average monthly premium for Medicare Advantage prescription drug plans (MAPDs) is $52.70.
Pennsylvania ranks in the top 10 of the 50 states for MAPD coverage. This is due to low drug coverage deductibles, which average at $34.01, and high plan quality. 73 percent of the 126 plans available in Pennsylvania have a star rating of four or above.
When can I enroll in a Medicare Advantage plan in Pennsylvania?
You can enroll in a Medicare Advantage plan during the following periods:
Initial Enrollment Period (IEP)
When you enroll in Medicare Part B, your IEP begins, and you can enroll in Medicare Advantage.
If you qualify for Medicare because you are 65, your IEP begins three months before your 65th birthday, includes the entire month of your birth date, and extends for three months beyond your birth month. This is a total of seven months.
If you qualify for Medicare due to disability, end-stage renal disease, or ALS, your IEP begins three months before the 25th month of receiving disability benefits. It includes the 25th month and ends three months later.
Open Enrollment Period (OEP) or Annual Election Period (AEP)
During AEP, you can enroll in a Medicare Part C plan for the first time, switch to a different plan, or return to Medicare Part A and Medicare Part B coverage. You can also add Medicare Part D if you do not have prescription drug coverage. AEP runs from October 15th to December 7th, and your changes take effect on January 1st.
Medicare Advantage Open Enrollment Period
During the Medicare Advantage Open Enrollment Period, you can switch your Medicare coverage by returning to Original Medicare or purchasing a new Part C plan. This period runs from January 1st to March 31st, and changes take effect the first day of the month following the switch.
Special Enrollment Periods
In certain circumstances, the Centers for Medicare and Medicaid Services (CMS) allow Medicare Advantage beneficiaries to make changes to their coverage or purchase a new MA or Part D plan. Medicare may offer you a special enrollment period for situations such as:
- Moving out of your plan’s service area
- Moving back to the United States
- Moving in or out of a skilled nursing or long-term health care facility
- Being released from jail
- No longer eligible for Medicaid, or you are dual eligible for Medicare and Medicaid
- Medicare ends your plan, or the insurance agent does not renew it
- Dropping a Medigap policy to join Part C coverage
5-star Special Enrollment Period
If Medicare gives a 5-star rating to a plan within your service area, you can use a special enrollment period to switch to that plan.
Special Enrollment Period if you get “Extra Help”
If you have Medicaid or “Extra Help”, you can switch, join, or drop a Medicare Advantage or Part D plan once during the following periods:
- January – March
- April – June
- July – September
Pennsylvania Medicare Resources
Pennsylvania Medicare Resources
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