Compare Pa 2016 Medicare Supplement Plans And Rates

Medicare Supplement coverage in Pennsylvania is an affordable option to pay for healthcare expenses that are typically not covered by original 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. Many low-cost options are available to the elderly and disabled. Part D contracts cover drugs and prescriptions.

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. Ten available plan options are offered, although prices and availability will vary, depending on your county of residence. Benefits are standardized, although pricing is different.

Parts A (hospitalization)  and B (medical services) coverage are provided by the federal government. Part C is the privately-run Medicare Advantage plan options, which provide benefits for parts A and B, along with other coverage. Part D is your prescription drug coverage. Although Parts A and B deductibles and premiums have increased, many low-cost policies are still offered. NOTE: Once Open Enrollment has ended, although you can still apply for coverage, medical underwriting may be required.

Available Pa Senior Plans

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 the Part B deductible annual limit, 100% of covered benefits are paid. Premiums are based on either community-rated, issue-age rated, or attained-age rated underwriting. Unlike individual private medical coverage, prices tend to remain fairly stable, instead of increasing by 10% or more each year.

Generally, Plans F and G are the most comprehensive options. For example, F contracts cover all nine of the coverage gaps while G plans are similar, except for not providing excess charges above the Part B deductible. Plan C also is considered a “comprehensive” policy. Plan A provides the fewest benefits since only the four major gaps are covered. Plan B is similar to Plan A, although it adds the Part A deductible to its list of benefits.

All carriers that offer Medigap plans in the state, must offer both A and B contracts to be eligible to offer additional policies. NOTE: The majority of Americans do not pay for their Part A benefits. However, if you purchase coverage, the monthly rate is $411. Also, Medicare Advantage Options  are also issued by private carriers, but replace Parts And B as opposed to acting as a supplement. PPO Advantage contracts provide the most flexibility regarding choosing providers. HMO options are more restrictive since you must utilize the designated network, unless emergency treatment is needed.

Illustrated below are the specific plans offered by companies licensed and approved to offer coverage in Pa. UnitedHealthcare plans are issued through AARP. Also, Aetna and Humana are completing a merger that will create a single company.

 

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.

 

Missing Plans

Plans E,H,I, and J can no longer be purchased as new coverage. However, if you bought one of these plans (assuming it was issued before June 1, 2010), you are permitted to retain coverage. When the Medicare Modernization Act was passed, these three options were discontinued. The principal reason was that many of the benefits were duplicated on other plans, including comprehensive preventative coverage. The State DOI provides additional information regarding active and inactive plans.

Although you are not required to change from an existing E,H.I. or J plan, it is often beneficial to consider alternative policies since your rate may reduce, while additional benefits are added. However, it is very important to properly compare all differences (including the premium), to determine if an upgraded contract is cost-efficient. If you do choose to terminate one of the previously-mentioned four plans, you can not re-enroll in those options.

 

Sample Rates

Shown below are prices from selected major carriers for a non-smoking 65 year-old male residing in Allegheny County. Many plans are not offered in all Pa Counties, and costs may vary, depending where you live.

$49 – Medico High Deductible Plan F

$80 – Humana High Deductible Plan F

$108 – Manhattan Life Plan N

$112 – Aetna Plan N

$112 – Polish Falcons Of America Plan F

$115 – Medico Plan N

$117 – Cigna Plan N

$119 – CSI Life Plan N

$124 – Equitable Plan N

$130 – Mutual Of Omaha Plan A

$130 – Aetna Plan G

$140 – Cigna Plan A

 

Pricing

Company rates are determined in three distinct ways. Although smoking, type of plan, and where you live, impacts the premium, the following methods of rating can be used:

Attained Age – The cost of the plan is determined by your age at the time you apply. However, as you get older, the premium typically increases. Therefore, your rate at age 65 will be much less expensive than your rate at 85.

Issue Age – Rates are also based on your age at the time you apply for coverage. However, prices never increase, so the longer you keep coverage, the more cost-effective it becomes. However, initially, you pay more than a policy that used attained age rating.

Community Rated – All applicants pay the same premium, regardless of age.

 

Summary

Pennsylvania Medicare Supplement and Medicare Advantage plans are offered through top-rated companies. Shop for personalized 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. Plans are issued individually, so, for example, if both you and your spouse enroll, two separate policies will be issued. This does not result in higher premiums.

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. Each year, there is a new Open Enrollment that guarantees coverage regardless of your medical history.

Additional information is also provided by the various Departments of County Aging. There are eight separate Regions that each have between five and eight offices. For example, Region 1 serves the Philadelphia area with offices in the surrounding five counties. Region 5 services Franklin, Cumberland, Perry, and Adams Counties along with the Huntingdon, Bedford, Fulton, Mifflin, and Juniata areas.

UPDATES:

October 2015 – Open Enrollment began on October 15th and ended 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.

Pennsylvania Insurance Department Health Rate Filings

Individual and small group health insurance rates in Pennsylvania typically increase each year. The amount of the increase is determined by how much the insurer is requesting, and the amount that is ultimately approved after careful review by the Department (DOI). Any rate change must be fair and appropriate for both the carrier and consumer. Increased market share while retaining profitability and affordability for the consumer is the ultimate goal.

Prior to 2016, the general public could not view requests or findings unless the proposed increase was more than 10%. However, now you can view all results, regardless of the amount of change. And yes, sometimes, Pa health insurance prices reduce. Before a decision is made, several of the most important criteria include underwriting profits and losses, deducible and copay data, coverage changes, administrative fees, and historical and future predicted claim information.

Companies can choose weather to offer Exchange policies in specific states. Many carriers, such as Aetna, Cigna, and UnitedHealthcare, often provide plans is specific states, but also choose to “sit out” may others. Senior coverage, such as Medicare Supplement and Advantage plans, are treated separately.

We have listed below (courtesy of the DOI) the actual requested and approved changes submitted to the State Department of Insurance. These increases and decreases are reflected in 2016 Pa Marketplace plan coverage in the Keystone State.  Although many of the companies listed below, such as Highmark, Aetna, and UPMC write a large volume of business, many others issue a much lower number of policies, including Freedom Life and AmeriHealth.

Company                                   Requested Increase            Granted Increase

First Priority Life                           29.5%                                21.5%

Geisinger Health Plan                   40.6%                                20.0%

Geisinger Quality Options             58.4%                                20.0%

Highmark Individual                       25.5%                                20.1%

Highmark Small Group                  15.5%                                 9.9%

Highmark Benefits Group               13.5%                                9.9%

HM Health                                    35.9%                                26.2%

Keystone Health Plan West           36.6%                                26.7%

Aetna Individual                              5.6%                                 5.6%

Aetna Small Group                         6.1%                                 5.2%

AmeriHealth                                   6.77%                               6.88%

Capital Advantage Group                -2.4%                                -2.4%

Capital Advantage Ind.                    2.3%                                 1.6%

First Priority Life                             9.5%                                 9.5%

Freedom Life                                  9.9%                                 0.0%

Geisinger Small Group                    7.2%                                 7.2%

Geisinger Quality Options               9.88%                                9.88%

Health Assurance                           3.7%                                  1.9%

Highmark Advantage Group              9.7%                                 9.7%

HM Health                                      9.1%                                 9.1%

Inter-County Hospitalization             1.75%                               1.75%

Keystone Health Plan Central          -2.00%                              -2.00%

Keystone Health Plan East              2.8%                                 1.9%

Keystone Health Plan West             9.4%                                 9.4%

UnitedHealthcare Life                       9.1%                                3.5%

UPMC                                            0.0%                                0.0%

Same Sex Marriage Impact On Your Pa Health Insurance Plan

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

Same-sex health insurance plans in Pennsylvania

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. One policy and a single family deductible would, of course, be more desirable.

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. NOTE: Not all policies offer a single family deductible.

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. This is especially cost-effective when one person has significantly more medical expenses than the other covered person.

National Impact

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.

Open Enrollment

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.

UPDATES

April 2016 – Although Open Enrollment just ended, for 2017 effective dates, same-sex couples can apply for coverage under one policy. However, the filing status of your federal tax return could affect federal subsidy eligibility and the actual amount applied to the policy.