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Get the Facts on Medicare Supplement Plans in Pennsylvania

Once you are eligible for Medicare, you will discover that Original Medicare benefits do not cover everything, but Medicare Supplement plans in Pennsylvania can be your solution.

Medicare Supplement insurance plans, also known as Medigap, refer to standardized policies that address out-of-pocket costs. As its name implies, Medigap policies close certain gaps in Original Medicare benefits. They also contain select benefit provisions excluded from Original Medicare.

What Medigap Plans Are Available in Pennsylvania?

Before we look at Medicare Supplement plans in Pennsylvania, let’s take a look at how Medicare Supplement insurance plans are standardized and sold by private insurance carriers across the United States.

States can have up to 10 different types of Medigap policies, identified in most states as A, B, C, D, F, G, K, L, M, and N. Two of these plans, Medicare Plan C and Medicare Plan F, are no longer available to new beneficiaries as of January 1, 2020. But if you were enrolled in one of these plans prior to the cutoff, you may retain the coverage.

Following are Medicare benefits available in various Medigap policies in most states.

  • Medicare Part A coinsurance plus hospital charges up to an additional 365 days after Medicare benefits have been exhausted
  • Medicare Part B coinsurance or copayments
  • First three pints of blood
  • Medicare Part A hospice coinsurance or copayments
  • Skilled nursing facility (SNF) coinsurance
  • Medicare Part A deductibles
  • Medicare Part B deductibles
  • Medicare Part B excess charges (the difference between doctor’s fee and Medicare-approved amount)
  • Foreign travel emergency within plan limitations

What Is the Best Medicare Supplement Plan in Pennsylvania?

You can find all 10 Medicare Supplement plans in Pennsylvania. Until 2020, the best Medigap plan in Pennsylvania in terms of full coverage was Plan F, followed by Plan G. For some beneficiaries, the monthly premium weighs heavily on their decision. Monthly premiums for Plan G are slightly lower than Plan F.   

Best Medigap Plan Coverage: Plan F

Prior to 01/01/2020,  Plan F the most popular plan because it offered “full coverage”. But this changed and was discontinued for new members on 01/01/2020. This means if you come on Medicare after this date, you cannot enroll in the Plan F, it is only available to members that were on Medicare prior to that date. Medicare Plan G became the up-and-rising star in Pennsylvania in terms of price and benefits after the Plan F changes. It is now considered the best in coverage Medicare Supplement plan in Pennsylvania in terms of the richest coverage. Anyone who currently has Plan F will be able to keep their coverage.

Second Best Medigap Plan Coverage: Plan G

Even prior to 2020, Medicare Plan G was desirable. The only difference between Plan F and Plan G, is the Medicare Part Deductible B is not covered on Plan G, the Part B deductible is $203.00 for 2021. According to America’s Health Insurance Plans (AHIP), enrollment in Plan G increased 39% between 2017 and 2018. Medicare Plan N is a favorite as well with benefits similar to Plan G.

Medigap policies must abide by state and federal laws for the protection of beneficiaries:

  • The Medicare insurance company needs to clearly identify Medigap insurance health plans as Medicare Supplement insurance.
  • All Medigap policies are required to provide identical basic benefits at a minimum. Some offer more than others.
  • Each plan is the same across states. Plan A, for example, in one state embodies the same benefits as Plan A in another state.
  • Though carriers are not required to sell Medigap policies, if they do, Plan A must be part of the offering. Other policies are sold at their discretion.

Do Medicare Supplements Cover Prescription Drugs?

Medicare Part D drug plans are not included in Medicare Supplement insurance plans in Pennsylvania or any state. There are two types of Medicare prescription drug plans available once you are enrolled in Medicare Part A and Part B:

  • Stand-alone prescription drug plan
  • Medicare Advantage plan that includes drug coverage

The official Medicare website presents a tool to search for plans available in your area. Compare benefits and rates to be sure you are getting the best value for your money. Be sure preventive care is included, and when you compare plans, avoid shopping based on rates alone. The lowest rates may not necessarily align with the best coverage for your individual needs.

What Is the Most Popular Medicare Supplement Plan in Pennsylvania for 2021?

Of the eight Medigap plans in Pennsylvania currently available to new beneficiaries, Plan G is the most in-demand. This is attributed to its rich coverage, affordable rates, and huge nationwide popularity. AHIP reported statistics from the National Association of Insurance Commissioners (NAIC) that show 111,214 Plan G members by the end of 2018. This surpassed all the other Medicare Supplement plans in Pennsylvania with the exception of Plan F.

How Much Do Medicare Supplements Cost in Pennsylvania?

The timing of your application for a Medicare Supplement plan in Pennsylvania factors into the cost. The Medicare open enrollment period is the six-month period that starts on the first day of the month you become 65. Enrollment in Medicare Part B is a prerequisite. If you have a disability or end-stage renal disease (ESRD), Medigap plans in Pennsylvania are available to you under age 65.

Apply during the Medigap Open Enrollment Period for the best rates. Beneficiaries who delay this process may be subject to higher premiums. Additionally, applications for Medicare Supplement insurance plans in Pennsylvania after the open enrollment window are sometimes declined by the insurance company based on health and prescription history.

When Can I Apply for a Medigap Plan in Pennsylvania?

Medigap plans in Pennsylvania are available to you once you are enrolled in Medicare Part A and Part B. Following are the enrollment periods you will want to track.

Initial Enrollment Period

The initial enrollment period, when you can apply for Original Medicare Part A and Part B, is during the seven-month period around your birthday. This encompasses the three months before your 65th birthday, the month of your 65th birthday, and the three months that follow. Once you are enrolled in Medicare Part A and Part B, you can explore Part D drug plans and Medicare Supplement plans in Pennsylvania.

Special Enrollment Period

A beneficiary who does not sign up for Original Medicare during the initial enrollment period may qualify for a special enrollment period. This applies if you have existing group health care coverage through an employer. This may be through the employment of your own, a spouse, or, in the case of disability, a family member. If you qualify for special enrollment, you can sign up while you are covered under the group plan. Or, if the employment or coverage terminates, you have eight months after the time your employment or coverage ends, whichever comes first.

AEP (Annual Election Period)

A beneficiary who wants to change plans can do so during the Annual Election Period (AEP). You are given this opportunity every year between October 15 and December 7. This does not apply to enrollment or changes to Medicare supplement plans, only to Medicare Advantage members and those who want to enroll in Medicare Part D drug plans.

Do I Have To Change Medicare Supplement Plans Every Year?

You do not need to change Medicare Supplement plans year after year as you do with Medicare Advantage plans. Once beneficiaries are enrolled in a Medicare Supplement insurance plan in Pennsylvania, they can keep the plan for as long as they pay the premiums. However, if you relocate and want to keep the same plan, your rate may change.

Pennsylvania Medicare Resources

From Pittsburgh to Philadelphia and beyond, Pennsylvania residents can use these resources to learn more about Medicare:

Pennsylvania Department of Aging

Pennsylvania Department of Human Services

Pennsylvania Health Law Project

Medicare.gov – The official United States site for the Medicare program

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