Medicare Supplement coverage in Pennsylvania is an affordable option to pay for healthcare expenses that are typically not covered by Medicare. The Keystone State features many low-cost Senior plans that reduce your out-of-pocket costs and include guaranteed enrollment. The best Pa Medigap policies are also very easy to apply for. Maximum benefits or exclusions may apply to specific plans.
If you are age 65 or older, our website allows you to easily view and compare the best available plans at the lowest available rates. All quotes are free (see top of page) and are provided without any cost or obligation. Supplement policies are designed to pay your coinsurance, copayments, deductibles, and other expenses that are not typically paid for. Parts A and B coverage are provided by the federal government.
Available plans are standardized in the following forms: A, B, C, D, f, G, K, L, M, and N. A “high-deductible” option is also offered for Plan F. K and L contracts put a maximum cap on your annual out-of-pocket expenses each year. Once you have satisfied Part B deductible an annual limit, 100% of covered benefits are paid. Premiums are based on either community-rated, issue-age rated, or attained-age rated underwriting.
Illustrated below are the specific plans offered by companies licensed and approved to offer coverage in Pa.
2016 Pennsylvania Medicare Supplement Plans
Aetna – A, B, F, F (High Deductible), G, N.
American Continental – A,B,F, F (High Deductible), G, N.
American Progressive Life – A,B,C,D, F (High Deductible, G.
American Republic – A,B,F, F (High Deductible), K, L.
American Retirement Life – A,B,F,G,N.
Avalon – A,B,C,F,N.
Bankers Fidelity Life – A,B,F, F (High Deductible), G,K.
Blue Cross of Northeastern Pa – A,B,C,F, F (High Deductible), N.
Capital Blue Cross – A,B,C,F,N.
Central States – A,B,C,D,F,G,N.
Colonial Penn Life – A,B,F,F (High Deductible),G,K,L,M,N.
Companion Life – A,B,F,G.
Equitable – A,B,F,N.
Forethought – A,B,C,G,F,N.
Geisinger – A,B,C,F,F (High Deductible),M,N.
Gerber – A,B,C,D,F,G.
Globe Life & Accident – A,B,C,F (High Deductible).
Government Personnel Mutual – A,B,C,D,F,G,N.
Highmark Blue Cross Blue Shield – A,B,C,F, F (High Deductible), N.
Highmark Blue Shield – A,B,C,F,F (High Deductible), N.
Humana Dental – A,B,F,F (High Deductible),K,N.
Humana – A,B,C,F,F (High Deductible), K,L,N.
Independence Blue Cross – A,B,C,F,F (High Deductible), N.
KSJK Life – A,B,C,D,F,G,M,N.
Liberty National – A,B,C,D,F,G,N.
Loyal American – A,B,C,D,F,G,N.
Manhattan Life – A,B,C,F,G,N.
Medico – A,B,F,F (High Deductible),G,N.
Mutual Of Omaha – A,B,C,D,F,G.
Oxford Life – A,B,C,N.
Philadelphia American Life – A,B,C,F,F (High Deductible),G,N.
Physicians Mutual – A,B,F,F (High Deductible),G.
Sentinel Security – A,B,C,D,F,G,N.
Standard Security Life – A,B,F,G,K,N.
State Farm – A,B,C,F.
Thrivent Financial – A,B,C,D,F, F (High Deductible),G,L,M.
Transamerica – A,B,C,D,F,G,K,L,M,N.
United American – A,B,C,D,F,F (High Deductible),N.
UnitedHealthcare (for AARP) – A,B,F,F (High Deductible),G,K,L,N.
United World Life – A,B,C,D,F,G,M.
UPMC – A,B,F.
Pennsylvania Medicare Supplement and Medicare Advantage plans are offered through top-rated companies. Shop for customized coverage that meets your benefit and budget needs. If you are a legal citizen and have been in the United States for at least five years, you are likely eligible for benefits.
Senior options can be fully-customized to help reduce out-of-pocket expenses. Free quotes are available at the top of this page. If you have not reached age 65 yet, it’s possible you may be eligible for Medicaid, or a subsidized Marketplace healthcare plan.
October 2015 – Open Enrollment begins on October 15th and ends on December 7th. 2016 prices and plan details have been published. If you are satisfied with your current plan, unless otherwise notified, you can renew it or shop for alternative coverage.
Although same-sex couples can now legally marry in all US states, here in Pennsylvania, gay and lesbian partners were already able to marry for the last year. But now, it is the “law of the land,” as the Supreme Court ruled 5-4 that 14 states will no longer be able to enforce their ban. It took about 20 years of litigation, but the fight appears to be over.
In the majority opinion, Justice Anthony Kennedy proclaimed “no union is more profound than marriage. In forming a marital union, two people become greater than once they were.” The number of same-sex married couples (currently around 400,000) is expected to substantially increase.
Self-insured and self-funded group health plans subject to ERISA requirements may now be forced to offer medical coverage to same-sex spouses. Although this segment of the legislation is a bit vague, employers may choose to avoid risky and expensive litigation and simply offer the benefits. Also, “domestic-partner” coverage may simply continue, since the cost and coverage would be identical.
Discrimination Not Allowed
Since the Keystone State allows these types of marriages already, an insurer can not discriminate against either partner when applying for a policy, or when a claim is paid. Premium tax-credits and potential out-of-pocket expenses must also be treated without discrimination. However, in order to take advantage of subsidies, the couple must file a joint tax return or state that they intend to file together.
NOTE: In 2014, in the US District Court (Middle District of Pennsylvania) overturned the Pa “Marriage Laws” which required marriages to only be between members of the opposite sex. The Judge was John E. Jones III, and an appeal was not filed. Details of the ruling can be found here. The ruling took effect immediately since there was no stay.
Effect On Pennsylvania Health Insurance Coverage
Pa Healthcare Benefits For Same-Sex Couples Is Available
One of the biggest changes will save time, but not necessarily money. Prior to the ruling, many insurers insisted that each person (husband and husband or wife and wife) must be covered separately under two different policies. Although the overall cost may not have been impacted, often the maximum out-of-pocket expense was higher, and billing was more inconvenient.
By consolidating both persons on one Pa health insurance policy, a single deductible will be available from many carriers, including Highmark, Aetna, Keystone, UnitedHealthcare, and many more. Thus, if one partner has a major illness or sickness, and meets the annual deductible and applicable coinsurance, the other partner will have no out-of-pocket expense on covered expenses. UPMC health plans (Western Pa) will also incorporate these changes into their policy designs.
For example, many existing Silver-tier plans have an individual deducible of $3,000 and a family deductible of $6,000. Thus, if one person is hospitalized and meets the $3,000 single deductible, an additional $3,000 deductible must be met. However, beginning in 2016, depending on the policy and carrier, in the previous scenario, the entire deductible will have been met.
Less than 50% of small and large businesses offer medical benefits to unmarried same-sex couples. However, more than 90% offer coverage to spouses. And although the Supreme Court ruling on same-sex marriages does not specifically state that this practice must end, there will undoubtedly be an increase in the number of spouses that can now purchase a group policy.
“Domestic Partner Benefits,” however, may reduce, especially if you wok for a large company. If two partners decide they don’t want to get married, it’s possible the coverage they currently receive, would be less comprehensive than if they married. It’s expected that a simple comparison tool will be offered so employees in this situation cam make an educated and informed analysis.
Social Security benefits will now also be affected. Typically, there are more advantages than disadvantages to being married. Spouses, children, and the estate of the deceased could end up with more funds. Of course, sudden illnesses, divorce, prenuptial agreements, and divorce will now also play a role.
With Open Enrollment beginning again in November (effective date of policies will be January, February, or March of 2016), newer plans and coverage descriptions may be tweaked to include any mandated benefits or required changes. Existing plans can also be adjusted to conform to updated requirements. However, “grandfathered” plans that are not required to adhere to Affordable Care Act legislation guidelines, may remain the same.
Platinum-tier Marketplace plans in Pa provide the best available coverage to individuals, families and small-business owners. The combination of low deductibles, copays and coinsurance, along with rich comprehensive benefits, makes these policies the “Cadillac” of Pennsylvania healthcare plans.
What Is A Platinum Plan?
When the “Patent, Protection And Affordable Care Act” (Obamacare) became law in 2010, (and upheld in a Supreme Cort ruling in 2012), a standardized method of comparing policies was enacted. “Metal” tiers were created, based on the actuarial value, or what percentage of your medical expenses were expected to be paid by the policy you were enrolling in.
Of all of the Metal tiers, the Platinum options offer the most complete coverage to pay for your medical expenses. Gold, Silver, Bronze, and Catastrophic contracts are also offered. 90% of your anticipated healthcare expenses (actuarial value) are expected to be paid, which included copays, coinsurance and deductibles.
Since it is the most expensive “Tier” option, often coinsurance is 0% and deductibles are $1,000 and below. “No deductible” options are also offered. Out-of-pocket expenses are the lowest of all policies, and thus, persons with expensive chronic conditions, ongoing treatment and counseling, or annual recurring surgeries, often find this type of plan the most cost-effective.
NOTE: Typically, these types of options are not the most appropriate for young adult medical coverage, unless there are severe chronic conditions present. If your child is under the age of 30, a more suitable plan may be a Catastrophic, Bronze, or Silver-tier contract because of lower cost and non-utilization of benefits.
Platinum Health Insurance Plans In Pa Are The Most Comprehensive
Plans, Benefits And Prices
Below, we have listed the most comprehensive medical plans in Pennsylvania. All policies are offered by major carriers that are approved for Marketplace business. Platinum-level contracts most closely approximate the best employer-sponsored group coverage that is offered through several large companies. NOTE: In many situations, choosing a Gold-tier or Silver-tier (with cost-sharing) will be a more cost-effective choice. For the purpose of this article, we are focusing only on Platinum plans.
Comprehensive Care Blue PPO 500 (Highmark) – $500 deductible with $1,650 maximum out-of-pocket maximum. Office visits are subject to the deductible and an additional 10% coinsurance. Generic, brand and specialty drugs only pay $5, $20 and $45 respectively.
Assurant Plan 002 (Assurant) – $0 Deductible (Can’t get any better!) with low $25 copay on office visits,including specialists. Fairly low $30 copay on brand name drugs. Maximum out-of-pocket maximum is an acceptable $2,000. This plan is also available in other parts of the state.
Advantage Platinum $250-$20 (UPMC) – $250 deductible with impressive $1,500 maximum out-of-pocket expense. $20 copay on primary care physicians, although deductible applies to specialists. $8 generic drug copay. “Partner,” “Premium” and “Select” networks available.
NOTE: Although Aetna/Coventry does not offer Platinum-tier plans in the Pittsburgh area, their Gold copay option is very attractive.
Marketplace Extra 10/50/0 (Geisinger) – No deductible and maximum $2,000 out-of-pocket maximum. Low $10 copy on pcp visits along with $3 generic drug copay. $250 per day hospital charge.
Healthy Benefits Value 0.0.10 (Keystone – Capital Blue Cross) – $0 Deductible, although $6,350 maximum out-of-pocket. $10 and $25 copays are nice but odd assortment of RX copys – $6, $42 and $275 copays on generic, brand and specialty drugs!
Comprehensive Care Blue PPO 500 (Highmark) – Low $500 deductible and only $1,650 maximum out-of-pocket. Office visits must meet deductible although prescription copays are only $5, $20 and $45.
Keystone HMO (Independence Blue Cross) – No deductible and $3,000 maximum out-of-pocket. Office visit copays are only $15 and $30 and all drugs avoid the deductible. Copays are $5, $30, and $40 on the three-tiers of drugs. This plan is one of the cheapest Platinum contracts in the Philadelphia area.
Personal Choice PPO (Independence Blue Cross) – No deductible and $2,500 maximum out-of-pocket. $10 and $40 office visit copays and identical drug coverage as previous plan.
Personal Choice PPO Complete (Independence Blue Cross) – No deductible with $2,000 maximum out-of-pocket. Smaller RX copays ($5, $20 and $30) than previous two plans.
BC of Northeastern Pa Provides Coverage In Scranton
myBlue Access $500 (BC of Northeastern Pa) – $500 deductible with low $1,500 out-of-pocket maximum. No coinsurance and copays on generic and preferred brand drugs.
myBlue Care (BC of Northeastern Pa) – $100 deductible with VERY low $500 out-of-pocket maximum. Copays on all prescriptions.
Marketplace HMO 15/30/0 (Geisinger) – Another $0 deductible plan with $3,000 maximum out-of-pocket cost. Low $15 and $30 office visit copays and lower $3 copay on generic prescriptions. The $3 is one of the lowest available copays for this type of drug.
Choosing The Best Plan…For You
Is a “Platinum” tier option the best choice for you? Not always. Since subsidized “Silver” tier plans feature cost-sharing, for many households, they may be a better fit since they can potentially reduce out-of-pocket expenses by thousands of dollars.
By reviewing your budget, existing medical conditions (if applicable), federal subsidy qualification, and list of doctors and hospitals you prefer, we can recommend the ideal coverage for you.