Medicare Plans in Pennsylvania
Whether you’ve been on Medicare for a while or it’s your first time enrolling, finding the right Medicare coverage may feel daunting. We don’t think it has to be! We’ll help you navigate the wide selection of Medicare plans in Pennsylvania to find the coverage that’s right for you
Who’s eligible for a Pennsylvania?
Medicare is a government-sponsored health insurance program for people 65 or older and some people under 65 with a qualifying condition. People generally first become eligible for Medicare once they reach age 65. You may be eligible for Medicare under 65 if you have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). You may also be eligible if you’ve been a recipient of Social Security Disability Insurance (SSDI) for 2 years.
In order to qualify, you must be a citizen or permanent resident, having lived in the US for the past 5 years. Additionally, you or your spouse must have worked at least 10 years in a job that contributed to your Medicare coverage through Social Security deductions.
If you’re unsure about your eligibility or will be turning 65 in the next six months, we’re here to help. Call the number above to speak with a licensed insurance agent.
What are the Medicare Plans in Pennsylvania?
Orginial Medicare Part A & Part B
Original Medicare is made up of two parts:
Part A (Hospital Insurance) covers inpatient services, like hospital care, care received at a skilled nursing facility, and hospice care.
Part B (Medical Insurance) covers outpatient medical services and supplies that are considered medically necessary. Part B also covers some preventive care, like flu shots and cardiovascular screenings.
It’s important to recognize that Original Medicare does not cover everything. For example, it generally does not cover prescription medications, hearing exams/hearing aids, long term care, dental care, or eyeglasses. That’s why there is a wide variety of different types of Medicare plans available, to help obtain a more comprehensive coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage plans are provided by Medicare-approved private insurance companies and work as an alternative to Original Medicare (Parts A and B). These plans must provide the same coverage as Original Medicare (with the exception of hospice care, which remains covered by Part A). They can also provide additional benefits, such as dental, vision, and prescription drug coverage. Medicare Advantage plans with prescription drug coverage are called Medicare Advantage Prescription Drug (MAPD) plans.
To enroll in a Medicare Advantage plan, you must first be enrolled in both parts of Original Medicare. Premiums for these plans can start at $0, increasing with the level of coverage selected. You’ll need to continue paying your Part B premium in addition to your Part C premium.
Medicare Prescription Drug Plans (Part D)
Prescription Drug coverage is generally not covered by Original Medicare or Medigap Plans. Stand-alone Prescription Drug plans, offered by Medicare-approved private insurance companies, work alongside Original Medicare (Parts A and B) to add prescription drug coverage. With these plans, a tier system is used to grade medications, and copays/coinsurance for each medication are set in accordance with their tiers. Drugs graded in the lowest tiers have the lowest copays/coinsurance, and vice versa. Each plan provides a drug formulary for you to see which tier(s) your medications fall into. This allows you to compare plans and select one with the best overall value for your specific prescription needs.
Medicare Supplement Plans (Medigap)
Medicare Supplement plans add an additional layer of coverage to your Original Medicare by filling in coverage gaps. Medigap plans are provided by Medicare-approved private insurance companies and work alongside your Original Medicare to help reduce your out-of-pocket costs by paying certain healthcare costs, like copayments, coinsurance, and deductibles.
When Can I Enroll In A Plan?
Medicare Advantage and Medicare Prescription Drug Plans
You’re first eligible to sign up for Medicare plans in Pennsylvania during your Initial Enrollment Period (IEP). Your IEP starts three months before your 65th birthday month and continues for three month after that month. This means you have a total of seven months to enroll.
After this period, you can make changes to your Medicare Advantage or Prescription Drug coverage during the Annual Election Period. This period starts on October 15th and ends on December 7th every year.
Medicare Initial Enrollment Period
7-Month Initial Enrollment Period | Begins 3 months before the month you turn 65
*Signing up for Parts A and B during months 5,6, and 7 may result in delayed coverage.
KEY FACT: The General Enrollment Period provides you an opportunity to enroll in Original Medicare if you missed your IEP. This period occurs every year from January 1st to March 31st. Then, you’ll have an opportunity to select a Medicare Advantage Plan from April 1st through June 30th.
Additional Medicare Resources in Pennsylvania
If you’re unsure about your eligibility or will be turning 65 in the next 6 months, we’re happy to help you prepare for enrollment. Give us a call to speak to a licensed insurance agent or compare plans online by using our form below.