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Best Medicare Advantage Plans in Pennsylvania

If you want to simplify your healthcare while limiting your out-of-pocket expenses, consider signing up for one of the best 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.

Best 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 certain 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 are almost always limited to seeking services from in-network healthcare providers. You probably won’t have the option to use a hospital or doctor that is outside of your network service area 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 a plan that many people choose; in fact, it 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 cost-sharing 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 also sign up for a Medicare Part D Prescription Drug Plan in addition to this type of Medicare Advantage plan in Pennsylvania.

MSA Savings Account

  • This type of plan includes a stand-alone, high-deductible Medicare Advantage plan that might have a provider network.
  • In addition to your plan, you will have a savings account that is designed for use for healthcare purposes. You can use this money for healthcare expenses before you reach your deductible amount.

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 PlansSNPs. 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 your plan includes one of the Medicare prescription drug plans, you may have to stick within a certain pharmacy network, too.
  • If you qualify for a Special Needs Plan, you’re likely dual-eligible for Medicaid or a similar state program.

Be aware that no matter which of the plans above you choose, you will still be required to pay the Medicare Part B premium for coverage. In addition, you will probably have to pay a monthly premium for the additional Medicare benefits that you can enjoy with Medicare coverage like an Advantage plan.

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

  • The best 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 OrganizationHMO plans or Preferred Provider OrganizationPPO plans.

Network Restrictions on The Best Medicare Advantage plans in Pennsylvania

  • In-Network vs Out-of-Network  The type of Medicare Advantage plan selected in Pennsylvania 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 its important to compare policy details and premiums.

Pennsylvania Medicare Resources

After you explore the resources above, it’s time to start thinking seriously about your plan options. After all, as a senior, you have to worry about doctor’s office costs, costs for care in a skilled nursing facility, nursing home costs and more. Many Medicare beneficiaries choose to purchase one of the best Medicare Advantage health plans in Pennsylvania through a health insurance company. These Medicare plans are definitely worth exploring if you’re concerned about copays, deductibles and co-insurance costs from Medicare.

Medicare Supplement or Medigap plans are also worth looking into. Private insurance companies sell these plans to be used in addition to Original Medicare so that you’ll have more coverage.

A licensed insurance agent can talk to you about your options and about the companies that have top star ratings. Give us a call so that we can help you out.

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