Affordable Pa Medicare Advantage plans for Seniors are available. We review and compare the highest-rated policies from all major companies. Part C benefits provided by private carriers in Pennsylvania, provide high-quality coverage at extremely low rates. Premiums are typically much less than standard Supplement options, and often out-of-pocket expenses are lower, with dental and vision benefits included. The online quotes you view are the lowest available rates from each carrier.
As an alternative to traditional Medicare, plans cover preventive care, hospital and physician services, lab tests, x-rays, and conventional Medigap benefits. Part D prescription and drug coverage is also generally included. Top-rated companies offer policy options in Pittsburgh, Philadelphia, Harrisburg and all areas of the Keystone State. Applying and enrolling is quick and easy. And about half of all plans feature a $0 premium. You can’t get rates any lower!
Many policy options offer prescription benefits. Referred to as Medicare Advantage Prescription Drug Plans (MAPDS), your healthcare and drug coverage are included in one contract. NOTE: We also reviewed Medigap plans in Pennsylvania. Since these contracts do not replace original benefits, premiums are typically higher than Advantage plan options.
Different Types Of Available MA Plans
PPO – The Preferred Provider Organization concept is quite simple. If you utilize “in-network” physicians, specialists, and hospitals, you pay less. If you go “outside” the network, you pay more. Typically, there is a wide selection of doctors and other medical facilities, and a referral is not required to see a specialist. Many plans include drug benefits, and several additional optional riders are available.
HMO – Health Maintenance Organizations are more restrictive than a PPO, since you need a referral from your primary care physician (pcp) to see a specialist. Also, the list of available providers may be less extensive than a PPO, since the service area is smaller. Many qualified preventative expenses, such as mammograms, do not require a referral. NOTE: Occasionally, an HMO Point Of Service (HMOPOS) contract is available, that provides out-of-network services.
Private Fee-For-Service – PFFS plans are issued by private insurers. They are classified as a type of Medicare Advantage coverage (Part C). The dollar amount paid to doctors, specialists, and hospitals is per-determined along with the out-of-pocket costs you will pay. If prescription benefits are not included, you are permitted to obtain a Medicare drug plan.
Special Needs Plans – SNPs are designed to provide affordable coverage for persons with specific diseases, live in a nursing home, require home nursing care, or have certain disabling diseases. Several examples are chronic heart failure, dementia, HIV, or End-Stage Renal Disease (ESRD). Being enrolled in Medicare AND Medicaid also qualifies.
Medical Savings Account Plans – An MSA option allows you to pay qualified expenses from a separate account that receives deposits from Medicare. Two separate policies are included in coverage. The high deductible health plan (Part C) has a large deductible to meet. The “savings account” portion (similar to an HSA for persons under age 65) uses funds deposited into the account to pay for medical costs prior to reaching your deductible.
Companies Offering PA Advantage Coverage
Many highly-rated licensed and registered carriers offer policies for Keystone State residents. Shown below are reputable and reliable companies that feature popular and affordable policy options. Not every carrier is listed and many plans are not available in all counties. Additional Pa Medicare Advantage plan information is provided by the federal government through brochures and website data.
Highmark Senior Health
Keystone Health Plan Central
Although there are many available policies offered by major top-rated carriers in the Keystone State, many plans are offered only in specific regions. For example, UPMC contracts are available in the Western part of the state along with other nearby areas. Keystone contracts are offered in the five-county Philadelphia area. Upon request, we can provide the counties/zip codes that the options listed below are available.
Also, benefits discussed below are typically referring to “in-network” treatment. A separate list is shown further below for plans with prescription coverage. An additional resource is found here. The DOI helps protect consumers that are applying for Senior coverage.
Pa Advantage Plans Without Prescription Drugs
Highmark Freedom Blue PPO Basic – Unlimited days covered for an inpatient hospital stay with a single $351 copay. Customer pays nothing per day after first 90 days. Primary-care physician copay is $15 ($30 out-of network) while specialist copay is $35 ($45 out-of-network). MRIs and CT Scans are subject to only a $125 copay, and lab services are generally subject to only a $5-$15 copay.
The ER copay is $75, but is waived if admitted to the hospital within three days. The Urgent Care and ambulance service copays are $50 and $125 respectively. Eight chiropractic visits per year are covered with a $20 copay as well as 190 lifetime days of inpatient mental health treatment at a psychiatric hospital. 10 routine foot care visits are included in the policy along with limited dental services. Hearing ($35 copay for exams) and vision (annual routine eye exam) benefits are also included.
Geisinger Gold Classic Advantage – Available in Central Pennsylvania and several surrounding counties. Unlimited inpatient hospital stay coverage with $125 copay for first five days. Office visit copays are very low ($5 and $20) with diagnostic testing and x-ray copays only $5. Outpatient x-rays cost $25. Emergency care is subject to a $75 copay.
Urgent Care visits cost just $20 while ambulance services have a $100 copay. Occupational, physical, and speech/language therapy are subject to only a $10 copay. Four free foot care visits are provided at no charge. Limited dental services are provided and one hearing exam per year ($20 copay). Up to $800 every three years is available to purchase hearing aids. Annual vision exams have a $20 copay and $200 every two years is provided for glasses and contact lenses.
Keystone 65 Preferred Medical Only – Available on Bucks, Montgomery, Philadelphia, Chester, and Delaware counties. Bucks and Philadelphia county rates are lower than the other three counties. Inpatient hospital stay out-of-pocket expenses are $240 per day for the first six days. The primary-care physician copay is only $5, although the specialist copay is $40.
There is no out-of-pocket expense for lab fees, diagnostic tests, and x-rays, and the ER copay is $75. Urgent Care visit copays range from $5-$40. Outpatient individual and group therapy for mental health care expenses is $40. Limited dental services and one routine hearing exam every three years are covered. Vision benefits cover one exam ($40 copay) every two years with a pair of glasses or contact lenses (up to $100).
Erickson Advantage Signature Without Drugs – Available in Bucks and Delaware Counties, the Erickson plan is one of the highest-rated options in the Philadelphia area. Out-of-network hospital-care is subject to 30% copay. PCP visits are covered at 100% while specialist visits have a low $35 copay.
Diagnostic radiology services and emergency care subject to $50 copay and $150 copay for ambulance services. Chiropractic services are covered and each visit has an out-of-pocket cost of $20. Contact lenses and eyeglasses have no out-of-pocket expense, although are limited to one every two years. If following cataract surgery, also covered at 100%.
Highmark Security Blue HMO Basic – Available in many Western and nearby Pa Counties. Maximum out-of-pocket expenses of $6,700. $350 copay per hospital stay and office visit copays of $5 and $30. MRIs and CAT scans have $100 copay and $75 copay for ER visits. Ambulance and Urgent care have $125 and $50 copays.
Six chiropractic visits per year are allowed subject to a $20 copay. Outpatient group and individual substance abuse therapy visits are covered with only a $30 copay. Occupational, physical, and speech/language therapy are are subject to the same copay. Like most other companies, some dental, vision, and hearing services are provided.
UPMC For Life – Available in Western Pa, along with many other counties, such as Lancaster, McKean, Potter, Elk, and Cameron. There is no deductible to meet and the maximum out-of-pocket expenses are $3,400. Office visit copays are $5 and $45 with a $350 copay per stay for hospital visits. MRIs and CAT scans are subject to only a $110 copay.
Diagnostic tests, procedures, and lab tests are typically paid with a copay of $5 0r less and outpatient x-rays cost $30. The ER copay is $75, ambulance service copay is $125, and Urgent Care copay is $50. Outpatient therapy visits cost $40. Dental, vision, and hearing services are similar to other available plans.
HealthAmerica Advantra Basic Medical – Available in Western and Central Pa, this Advantra HMO plan features a $6,700 deductible with $10 and $50 office visit copays. A $295 copay applies to diagnostic radiology services with $25 and $35 copays applied to lab services and outpatient x-rays respectively.
Outpatient surgeries cost $350 at an ambulatory surgical center and $400 at a hospital. Urgent care and ER visits are subject to $50 and $75 copays. Inpatient hospital stays result in a $225 charge for the first seven days. Four routine foot-care visits are allowed per year ($50 copay) along with limited dental and hearing services (also a $50 copay). One free annual routine eye exam is also allowed.
Aetna Medicare Basic Plan – Maximum out-of-pocket expenses of $6,700 with $279 per day hospital co-pay for the first seven days. Office visit copays are $35 and $50. A $50 copay also applies to diagnostic tests, x-rays, and lab services.
$75 copay for emergency room visits and a $300 copay for ambulance services. Most outpatient therapy visits are subject to a $40 copay and some dental, vision, and hearing benefits are included.
Humana Gold Choice – Available in 33 counties with $6,200 maximum out-of-pocket expenses. $295 per day copay for six days for hospital visits. Office visit copays are $15 and $40, and diagnostic tests/x-rays will cost between $0 and $105, depending on the procedure.
ER copay is $75 with $300 copay for ambulance services. Typically, copay is $45 for basic vision, dental and hearing services. Like most other plans, home health services and hospice are fully covered.
Personal Choice 65 Medical Only – Available in Bucks and Philadelphia counties. $6,200 maximum out-of-pocket expenses with low $900 copay per hospital stay. Office visit copays are $15 and $40. In-network diagnostic tests and lab services are covered at 100%.
Urgent Care copay is generally between $15 and $40 with a $75 copay for ER visit. Dental, vision, and dental services are generally subject to a $40 copay.
Cigna-HealthSpring Advantage – Available in the following counties: Philadelphia, York, Northampton, Montgomery, Lehigh, Lancaster, Delaware, Chester, Berks, Cumberland, and Bucks. Policy offers a $0 deductible with $6,700 maximum out-of-pocket expenses.
The hospital copay is $279 for the first seven days and the office visit cops are $10 and $50. Lab services are covered at 100% and the Urgent care copay is $50.
Pa Advantage Plans With Prescription Drugs
Erickson Advantage Champion – Available in Bucks and Delaware counties. $0 deductible and no out-of-pocket expenses for in-network hospital care. Office visit copays are $0 and $35. ER and Urgent Care copays are $50 and $30 respectively. Tier 1 drugs are covered at 100% along with Tier 2 mail order. Tier 3 drugs (mail order) have a $125 copay (90 days).
Erickson Advantage Freedom – Less expensive than previous plan because of $3,400 maximum out-of-pocket expenses and $200 copay per day (seven days) for in-hospital visits. Office visit copays are also higher ($20 and $50), and drug coverage has slightly higher costs. NOTE: “Guardian” and “Signature With Drugs” plans also available from Erickson.
AARP (UnitedHealthcare) MedicareComplete Choice Plan 1 – Available in Erie, Lehigh, and Northampton counties. Deductibles are $230 and maximum out-of-pocket expenses are $6,700. In-hospital copay is $345 for the first five days, and office visit copays are $15 and $45. ER and Urgent Care copays are $75 and $40. Tier 1 and Tier 2 drugs have a $0 copay for mail-order. NOTE: AARP Plan 2, and Choice plans also available.
Aetna Medicare Premier – Available in Berks, Carbon, Lancaster, Lebanon, Lehigh, Monroe, Northampton, and Schuylkill counties. $0 deductible with $6,700 maximum out-of-pocket expenses. in-hospital copay is $275 for the first six days. Office visit copays are $5 and $35. A $35 copay also applies to diagnostic tests and procedures, although lab services are covered at 100%. ER copay is $75 and Urgent Care copay will vary. Tier 1 drug 90-day cost sharing copay is only $30, but Tier 2 is $141. Tier 3 is 50%.
Community Blue Medicare HMO Signature – Available in many counties, although rate varies. $0 deductible with $6,700 maximum out-of-pocket costs. In-hospital copays range from $200-$275 for the first 5-7 days. Office visit copays are $0 or $5 and $45. ER and Urgent Care copays are $75 and $50 respectively. Prescription drug copays vary. NOTE: The Community Blue HMO Prestige plan is also offered with much lower in-hospital copay ($100). However, premium is significantly higher.
Highmark Freedom Blue PPO Classic – Available in many counties, including Allegheny, Butler, Jefferson, Somerset, Warren and several others. $0 deductible with $6,700 maximum out-of-pocket expenses. In-hospital expenses of $15 per day for five days. Office visit copays are $5 and $25 while diagnostic tests and lab fees are covered at 100%. Drug standard mail-order cost-sharing copays (90 days) are $7.50, $37.50, and $117.50 for Tier 1, 2, and 3 prescriptions respectively. NOTE: Select, Standard, and ValueRX plans are also offered.
Geisinger Gold Classic Advantage Rx – Available in Central Pennsylvania and some surrounding areas. Six policy options are offered, depending upon where you live. Deductible is $0 with $3,400 maximum out-of-pocket expenses. In-hospital copay is $125 for five days. Office visit copays are only $5 and $20 while the ER and Urgent Care copays are $75 and $20. Chiropractic visits are also subject to only a $20 copay. Standard 90-day mail order cost-sharing drug copays are $9, $60, and $141 for Tiers 1, 2, and 3.
Geisinger Gold Complete Rx – $0 deductible with $5,900 maximum out-of-pocket expenses. Attractive $o premium although in-hospital expenses are $180 per day for the first nine days. Office visit copays are $5 and $30, while the ER and Urgent care copay are $75 and $30. Drug coverage is similar to prior Geisinger plan above.
Keystone 65 Select RX – Available in Bucks, Philadelphia, Chester, Delaware, and Montgomery Counties. Deductible is $320 with $5,500 maximum out-of-pocket expenses. In-hospital copay is $290 for the first six days while office visit copays are $20 and $45. Diagnostic tests/procedures and lab services are covered at 100%. The ER copay is $75 and the Urgent Care copay varies from $20-$45. Standard 90-day mail order cost-sharing drug copays are $6, $24, and $94.
Highmark Security Blue HMO Standard – $0 deductible and $6,700 maximum out-of-pocket expenses. The in-hospital copay is $325 per stay and office visit copays are $10 and $30. Diagnostic tests/procedures and lab services are covered at 100%. Outpatient x-rays are covered with a $25 copay. The ER and Urgent Care copays are $75 and $50. Standard 90-day mail order cost-sharing drug copays are $7.50, $37.50, and $112.50.