Are you a Pennsylvania resident approaching your 65th birthday? If so, there should be Medicare enrollment on your mind. We’re here to help! Follow along with our complete guide to Pennsylvania Medicare in 2023, including information on the state’s Medicare Supplement Insurance and Medicare Advantage plans.
Pennsylvania Medicare Insurance Trends
The Centers for Medicare & Medicaid Services (CMS) reported the following information on 2023 Medicare trends in Pennsylvania:
- A total of 2,825,747 residents of Pennsylvanians have some form of Medicare.
- The average Medicare Advantage monthly premium decreased from $33.75 in 2022 to $30.05 in 2023.
- In 2023, there are 262 Medicare Advantage plans available in Pennsylvania.
- All Pennsylvania residents with Medicare have access to purchase a Medicare Advantage plan. This includes plans with $0 premiums.
- There are 26 different Medicare prescription drug plans currently offered in Pennsylvania.
- The lowest monthly premium for a Medicare prescription drug plan is $5.20.
Medicare Offered in Pennsylvania
When you turn 65, the federal government automatically enrolls you in Medicare. Medicare is also available to those with specific disabilities or medical conditions, even if they are under 65.
Two parts make up Original Medicare: Medicare Part A and Medicare Part B.
Medicare Part A, also known as hospital insurance, provides coverage for Medicare inpatient care; this may include care received during hospital admittance, a skilled nursing facility, and in specific situations, care received at home.
When most people turn 65, Medicare Part A eligibility is automatic if they receive retirement benefits from the Railroad Retirement Board or the Social Security Administration.
If you have amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD), you may qualify for Medicare Part A before age 65. Other eligibility requirements include being a citizen of the United States or maintaining five consecutive years of legal permanent residency.
If Medicare Supplement plans in Pennsylvania are out of your budget range, look into Medicare Advantage plans. Also referred to as Medicare Part C, these plans include the same coverage as Original Medicare but may also cover other services, such as routine vision and dental services. Like with Medigap options, Medicare Advantage plans are offered through private insurance companies that Medicare has approved.
Most Medicare Advantage plans use HMO or PPO networks; as such, beneficiaries who enroll in these plans must agree to use those networks when seeking medicare care.
Finally, it is vital to note that Pennsylvania Medicare Advantage plans feature copays that require individuals to pay for various services, including doctor visits and diagnostic tests.
Pennsylvania residents can choose from the following private insurance companies that offer Medicare Advantage plans, with ratings:
- Aetna Medicare – 5/5 stars
- Cigna – 4/5 stars
- Clover Health – 3.5/5 stars
- Health Partners – 4/5 stars
- Independence Blue Cross – 4.5/5 stars
- Keystone Health Plan Central – 5/5 stars
- Lasso Healthcare – 2/5 stars
- UnitedHealthcare – 4/5 stars
- WellCare – 3.5/5 stars
The Medicare Advantage plan offerings vary by county. Enter your specific ZIP code when searching for plans where you live, and find what’s best for you!
Medicare Supplement Plans
Original Medicare (Part A and Part B) comes with out-of-pocket costs—including copayments, coinsurance, and deductibles—that the plan holder is responsible for. Medicare Supplement plans (Medigap) fill in these gaps, covering a portion of the expenses not included by Original Medicare. These plans are not connected with the U.S. government or the federal Medicare program; instead, they are offered by private insurance companies.
Pennsylvania Medicare Enrollment
For some Pennsylvania beneficiaries, the cost of a standard Medicare program is far too expensive. To help alleviate the burden, the state offers several Medicare Savings Programs (MSP) to cover some of the costs associated with Medicare coverage. The level of assistance that these beneficiaries receive will depend on their income and resource level.
Pennsylvanians are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis. Use Medicare’s online eligibility tool if you are unsure if you qualify.
- You are 65 or older, and you or your spouse worked and paid Medicare taxes for at least 40 quarters.
- You are under age 65 and collect benefits from Social Security or the Railroad Retirement Board for at least 24 consecutive months.
- You have ESRD or ALS.
Enrollment Period Dates
Initial Enrollment Period
This is a seven-month window that allows you to sign up for a plan
- Begins 3 months before the month you turn 65
- Ends 3 months after the month you turn 65
Medicare Open Enrollment Period
This is when you can sign up for a plan, switch a plan or leave a plan
- Begins Starts January 1st
- Ends March 31st
Special Enrollment Period
Special enrollment periods allow you to enroll outside the regular enrollment periods under specific circumstances.
General Enrollment Period
This is when you can sign up for Medicare Part A and/or Part B if you didn’t sign up when first eligible or if you’re not qualified for a Special Enrollment Period.
- Starts January 1st
- Ends March 31st
Medicare Advantage Open Enrollment Period
This is when you can switch or leave a Medicare Advantage Plan
- Starts January 1st
- Ends March 31st
Pennsylvania Enrollment Tips & Advice
Before enrolling in Medicare and Medicare Advantage in Pennsylvania, evaluate your options and weigh the pros and cons of price point, coverage, providers, and facilities in the plans’ networks, as well as ratings for Part C and Part D plans.
Other resources available to you include:
How Do I Enroll in a Medicare Plan?
Pennsylvanians are eligible for Medicare if they are a U.S. citizen and above 65 years old or are under 65 but are permanently disabled, have end-stage renal disease, or Amyotrophic Lateral Sclerosis.
If you have any questions about Pennsylvania Medicare and your eligibility for financial assistance, speak to one of our licensed agents today. Our agents will discuss your Medicare options and help find a plan that works for you.