Senior health insurance plans in Pa help you pay for many expenses that original Medicare does not cover. We show you how to find affordable options in Pennsylvania if you're age 50 or older. Medicare Supplement coverage is available if you have reached age 65 and signed up for Parts A and B. Typically, you have a 7-month window to enroll. Many private policies can also be found if you aren't quite eligible. You can often qualify for Medicaid if you meet the household income guidelines. Advantage and Part D prescription drug options are also available.
Millions of older individuals and families in the state are able to receive Medicare or Medicaid benefits. Often, these options are much cheaper than paying out-of-pocket for personal plans, that may contain high deductibles and copays. Medicaid eligibility is based upon household income while Medicare is not available if you are covered under a Marketplace plan. If you are between the ages of 50 and 65, but still need private coverage, several economical options are offered.
Are You Medicare-Eligible?
If you have reached age 65 and have worked 10 years or more, you should be entitled to Part A benefits. These federal benefits are completely free and would replace any existing hospital coverage you currently have. Part B (Medical) is not free, and if you elect benefits, you can pay for benefits from your Social Security checks. If you are disabled, you may not have to wait until age 65. It is possible to receive SSDI benefits and also qualify for Medicare. However, in some situations, there may be a waiting period.
Part B is completely optional, and if you have a working spouse, you may not need coverage right away. The premium is based on the income of you and your spouse. For instance, your cost is approximately $134 per month with a combined income of less than $170,000. For one person, the limit is $85,000. Naturally, larger household incomes generate a higher premium. Income between $170,000 and $214,000 will result in a monthly cost of $187.50. Income between $214,000 and $320,000 will result in a monthly premium of $267.90.
You can also purchase a "supplement" or "Medigap" plan from many carriers. Most Pennsylvania insurance companies offer a post-65 plan that will help you cover some of the out-of-pocket costs that Medicare doesn't cover. Premiums can vary quite a bit, so it's important to properly shop and compare different plans. Our website helps you review all Senior options in your area.
Also, your needs may change from one year to the next (change in health or switch from generic to non-generic medication) or different and perhaps more affordable options will become available. For that reason, during Open Enrollment, you can change plans and/or companies regardless of any current or past medical issues. It is also the most appropriate time to review your anticipated medical expenses for the upcoming year, and select a plan accordingly.
When choosing and comparing different options, one of the first tasks should be the verification of your physicians (and other facilities) as being active members of your provider network. Often, changes occur near the end of the year. For example, several years ago, UnitedHealthcare dropped thousands of doctors and specialists from their Medicare Advantage networks. Many industry analysts believe that if this trend continues, rationing could be the end result.
UnitedHealthcare Continues To Offer Senior Products
UnitedHealthcare also dramatically reduced its participation in the Marketplace in 2017. This impacted applicants under age 65, by leaving many areas (Philadelphia and Pittsburgh) with only one or two carrier choices. Although they continue to offer dental, vision, life, Senior, and other supplemental plans, their participation in the private under-65 market has substantially reduced. However, President Trump's healthcare options are expected to draw many carriers back to offering private coverage again. The anticipated date of UHC's return to the under age-65 market is 2018 or 2019. Pa Senior Medicare information is also available from many resources.
Below, we have illustrated a graphic of Medigap plan benefits (provided by the Pa Dept. Of Insurance). The table illustrates plans A-N and shows details of specific benefits in the standard plans. Contracts A and B offer the fewest benefits and are often the least expensive option to purchase. Since your budget and medical history is unique, naturally, the most appropriate plan for you may be completely different than someone else with the same age. A "high-deductible" Plan F is available. The current deductible is $2,200 and premiums are the lowest of any available plans.
Sometimes, an employer may provide post-retirement benefits to ex-workers under and over age 65. Although it's not a true supplement plan, it will still help pay for specific items such as dental or vision expenses. Life insurance, disability, and long-term care plans may also be included. Depending on the benefit contract that is negotiated for retirees, coverage can change each year. Feel free to ask us for a free unbiased comparison of policy options. With every new piece of legislation passed, it could impact which Medigap options are the most appropriate for you.
Pa Medicare Supplement Monthly Rate Ranges
$34-$67 - Plan F (High Deductible)
$45-$168 - Plan A
$53-$73 - Plan K
$56-$192 - Plan B
$67-$248 - Plan C
$70-$91 - Plan L
$83-$216 - Plan D
$108-$195 - Plan G
$111-$212 - Plan F
Medicaid may also be a possibility, depending on your income. An applicant would need to meet designated requirements to become eligible. The number of dependents you have will impact eligibility. Also, if you have children, or are pregnant, benefits may be affected. Documentation of previous federal tax returns may be required. An HHSC representative in your local area can provide additional information.NOTE: You may still apply for standard individual health insurance, although federal assistance would not be provided.
Meeting the Federal Poverty Limit test will quickly determine if you are Medicaid-eligible. If your household income substantially increases (or decreases) throughout the year, your options could be impacted. When determining eligibility of applicants, assets may be included or excluded. For instance, CDs, stocks, and investment property are counted, while your primary home and its contents are typically excluded. Federal poverty can be measured by either by "guidelines" or "thresholds." The "guideline" method is commonly used by the Department of Health and Human Services (HHS).
You Can Apply For Private Marketplace Medical Coverage If You Have Not Reached Age 65
Applications for plans are accepted by almost all of the top carriers. If you live in the Western part of the state, Highmark and UPMC are reputable regional companies. Capital BC, Highmark, and Geisinger in the Central portion will have many low cost options. And if you are in the Philadelphia area, Keystone (Independence Blue Cross) offers several popular HMO, high-deductible and comprehensive plans. However, IBX is the only company in the five-county area that offers private individual coverage. Aetna and other major companies offer Senior and Group plans. Short-term, dental, vision, and critical-illness plans are also available.
Regardless of where you live, Aetna, UnitedHealthOne and HealthAmerica (Coventry) have exited the Pa Marketplace, although it's possible they will return in 2018 or 2019, especially, after President Trump introduces his new healthcare ideas. Humana, Cigna, and Kaiser may offer policies in the future. Smaller carriers continue to offer short-term, dental, vision, and limited-benefit plans.
When applying for an individual Pa health insurance policy, medical questions do not have to be answered (our website can provide direct quotes) and your rate and eligibility will be determined by your age, where you live, and whether you smoke. If you have not reached age 65 yet, during Open Enrollment periods, your acceptance is not dependent on anticipated medical expenses to be paid. Of course, you must be a US citizen or legal resident of the state. You also must not be incarcerated, or Medicaid-eligible.
Open Enrollment is the best time to purchase a policy since you can not be turned down for medical reasons. Also, any treatment you are having (or have had in the past) will not have any impact on the price you pay for a policy. We can also help you decide which policy is best to apply for, by taking into consideration the amount of subsidy you are eligible for, and the policy that best fits your needs. "Silver" and "Bronze" Metal options are the most cost-effective, and so far, have been the most popular.
Although "Platinum" plans offer the lowest deductibles and copays, unless you are confident you will exceed the policy deductible and maximum out-of-pocket expenses, they should not be utilized. Also, many carriers do not offer Platinum-Tier or "catastrophic" plans. Although comparing deductibles is important, the maximum out-of-pocket expenses can have a substantial impact on your overall healthcare costs. Also, if you are currently prescribed Tier 3, Tier 4 or specialty drugs, closely examining the prescription copays is critical.
Your Spouse's Plan
If you are a married senior, you may be able to secure coverage under his/her policy. The annual Open Enrollment (which begins November 1) is a great time to request to be added to the policy, assuming it is through an employer. If your spouse is younger than yourself, there's a greater possibility you'll be able to keep that coverage until you're ready to enroll in Medicare. If your spouse leaves the employer or retires, COBRA or a policy extension may be possible. COBRA rates are generally high, since employer-contributions can no longer be utilized, and plan selection is also limited. However, dental and vision benefits are often included.
If you or your spouse have reached age 65, but your partner has not, a policy can be written separately on each. There would be no required physicals, and insurability would be guaranteed during designated times throughout the year. Federal subsidies through the ACA would be applied to applicants under age 65 that are not eligible for Medicaid and meet the Federal Poverty Level guidelines. However, the entire household income (including pension distributions) must be included in the subsidy calculation.
Thus, although a non-working spouse under age 65 may have limited income, the retired spouse's large income must be counted, with the possibility that a subsidy will be greatly reduced or eliminated. However, future Trump Administration plan options provide a greater benefit to persons between the ages of 50 and 64, so some financial relief may be offered in 2018 or 2019.
If you need help with determining your best choices, comparing our online rates will be a good start. We're always available to help you find the most suitable policy and qualify for the lowest rates.
Open Enrollment for Medicare begins on October 15th and ends on December 7th. Any changes made will be effective January 1, 2017. If you are presently enrolled in a plan, typically, if there is a change of coverage or price, you will receive a "Plan Annual Notice Of Change" (ANOC). Your policy will automatically renew unless you specify otherwise.
From January 1 to February 14, you can change to a regular Medicare if you currently have a Medicare Advantage contract. If you make this change, you can also switch your prescription coverage.
UnitedHealthcare entered the Medicare Advantage market in Western Pennsylvania. With UPMC and Highmark continuing to battle in and out of court, UHC immediately became an affordable option to consider. Two new plans (both HMO) were initially offered last year.
Most importantly, it appears that the UPMC and Allegheny Health Network hospitals and related facilities will be included in the network. This will provide thousands of consumers in Allegheny County (and other counties) an opportunity to keep their existing doctors when considering UnitedHealthcare for Advantage Plan coverage.
Humana, Aetna, UPMC, Highmark, and UnitedHealthcare are five of the major companies that offer Senior Advantage plans in Western Pa. Premiums are often very inexpensive (sometimes $0) compared to standard Medicare Supplement options.