Medicare plays a key role in providing health and financial security to beneficiaries residing in Pennsylvania. With more than 2.7 million Pennsylvania beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Pennsylvania. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Pennsylvania?

Medicare covers most Pennsylvania residents who are 65 or older, and it also covers disabled Pennsylvania residents. In general, Medicare enrollment in Pennsylvania works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Pennsylvania Medicare Enrollments

1,530,812

Original Medicare Plans
(Part A and B)

1,232,427

Medicare Advantage & Other Health Plans

1,115,387

Stand-alone Medicare
Part D (Drug plans)

2,763,239

Total Medicare Beneficiaries
in Pennsylvania

Pennsylvania Medicare Advantage Plans (Part C)

More than 43% of Pennsylvania Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Pennsylvania who already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare.

Pennsylvania has one of the most robust Medicare Advantage markets in the United States. In fact, nearly every county in Pennsylvania has at least 30 Medicare Advantage plans available. $0 is the lowest monthly premium for a Medicare Advantage plan in Pennsylvania.

According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 1,232,427 beneficiaries enrolled in Medicare Advantage and other plans in Pennsylvania. More than 43% of Pennsylvania Medicare beneficiaries were enrolled in a private Medicare Advantage plan in 2019. 100% of people with Medicare have access to a Medicare Advantage plan.

Pennsylvania Medicare Supplement (Medigap) Insurance Plans

Pennsylvania ensures access to Medigap plans for people under age 65 who are eligible for Medicare due to a disability.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services. Pennsylvania has rules in place that ensure at least some access to Medigap plans for enrollees who are under the age of 65. The six-month open enrollment window for Pennsylvania Medigap plans starts once you’re enrolled in Medicare Part B. This applies regardless of age.

Pennsylvania Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of May 2020, There are 1,115,387 Medicare beneficiaries in Pennsylvania enrolled in stand-alone Part D prescription drug plans and 1,070,565 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 28 stand-alone Part D plans available in Pennsylvania, with premiums ranging from about $15 to $156 per month. About 24% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS). When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Pennsylvania

  • Pennsylvania’s APPRISE program offers free Medicare counseling to older Pennsylvanians. APPRISE counselors are specially trained to answer your questions and provide you with objective, easy-to-understand information about Medicare, Medicare Supplemental Insurance, Medicaid, and Long-Term Care Insurance.
    Contact: Call 1-800-783-7067 or contact your local Area Agency on Aging

  • The Pennsylvania Senior Medicare Patrol (PA-SMP) works to educate seniors and caregivers about Medicare Advantage scams, overbilling, and other issues that can decrease care quality and increase health care costs. The SMP also operates ScamWire, an alert service that notifies seniors, caregivers, and support agencies about emerging scams targeting older adults. PA-SMP services are delivered through a network of trained volunteers who give informational presentations to community, faith, and seniors groups throughout Pennsylvania.
    Contact: Call 1-800-356-3606 or complete an online report form

  • The Older Pennsylvanians Legal Assistance Program provides access to free legal services for older adults including counsel, advice, and representation in a case. The program is open to Pennsylvania residents age 60 and older with a specific focus on older adults with the greatest economic and/or social needs. Seniors who have concerns about Medicare Advantage, Social Security, guardianship, age discrimination, or elder abuse can use this program.
    Contact: Call 717-783-1550

  • The Pennsylvania Health Law Project or PHLP is a nonprofit organization that works to improve access to health care for the elderly, people with disabilities, and low-income adults. The PHLP operates a free helpline that seniors can call to connect with a legal advocate who will review the caller’s concerns and provide legal advice. The PHLP also provides free legal representation to clients who are struggling to pay health care costs, need support obtaining health care services, or who have been denied coverage.
    Contact: Call 1-800-274-3258

  • Pennsylvania Assistive Technology Foundation (PATF) is a statewide, non-profit organization that helps individuals with disabilities and older Pennsylvanians acquire the assistive technology devices and services they want. PATF is a state and federally-certified Community Development Financial Institution (CDFI) and is the Commonwealth’s designated Alternative Financing Program (AFP) under the federal Assistive Technology Act. PATF is one of 42 AFPs and state financing entities in the U.S. and territories.
    Contact: Call 484-674-0506 or toll-free at 1-888-774-1938.

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Pennsylvania. Our process makes it easier for you to access your Medicare eligibility in Pennsylvania so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 382-1192 anytime to get a free quote or to ask any questions.

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