Senior Medigap plans in Pennsylvania help you pay for many of the costs that Medicare does not cover, including deductibles, coinsurance, copays and other out-of-pocket expenses. We show you 2017 Supplement rates from the top insurance companies so you can make an informed decision whether you wish to purchase a plan. Of course, your quote is completely free when you provide your zip code above. Pa Advantage options and Part D prescription drug plans are also available.
Some Basic Facts:
To be eligible for a Pa supplemental plan, you must be enrolled in Part A AND B.
You can only purchase a plan from an insurer that is licensed in Pennsylvania. The Pa Department of Insurance makes the final determination. You can also view ratings and other financial data about each carrier. Network provider information is also provided.
There are state and federal laws that must be followed on every plan. Occasionally, legislative changes are introduced that can impact the price of your plan, benefits, and eligibility.
The premium you pay for your gap coverage is separate from the amount you are charged for the Part B benefits. It also is optional and not required.
You can not be terminated from your current policy because you developed a medical condition or submitted too many claims. You can also keep the plan, unless it is not offered in your service area, or the company no longer conducts business.
Unlike conventional healthcare policies, a family can not be covered under one contract. Each applicant must purchase their own policy, which means that two separate applications are processed. You can cancel at any time, and there is no extra cost for not combining policies.
If you have a Medical Savings Account (MSA), you can not purchase a Medigap policy. However, you can keep your HSA and use past deposits to pay out-of-pocket costs, such as copays, coinsurance, or deductibles. You can also switch HSA financial institutions from one bank to another. Limited-benefit coverage can also be purchased to cover specific gaps.
Many of the recent Affordable Care Act (ACA) and Exchange changes have no impact on your policy selection or pricing options. Most of the Obamacare legislation pertains to consumers under age 65. Also, Medicaid expansion generally does not affect your choices, unless you meet certain income requirements.
When Can You Buy A Policy?
The most popular (and perhaps the easiest) time to purchase Medicare Supplement coverage is the 7-month Open Enrollment period. It begins when you have initially signed up for Part B and have reached age 65. During this period of time, your application is guaranteed to be approved, regardless of any past or present medical issue. Your rate will be identical to the premium charged by the insurer to all persons. Even if you have a surgery scheduled or a condition that requires immediate treatment, it will not affect what you pay.
There will be no waiting periods, increased copays or deductibles, or special surcharges. Pre-existing conditions will be covered, and you are not excluded from applying from any plan that would ordinarily be offered. However, you must only consider options in your network service area. Therefore, it is possible that specific plans will either not be available, or will have different rates, depending upon your county of residence.
If you miss this 7-month window, you can still purchase a Medigap plan in Pennsylvania. However, if it is not during Open Enrollment (October 15th-December 7th), the health insurer can "underwrite" the application, meaning that it is possible that existing conditions could increase the cost. A denial of coverage is also possible. However, since each carrier has different underwriting guidelines, at least three different companies should be considered.
If you have not reached age 65 yet, there may not be a reason to own this type of coverage. However, it is prudent to start shopping and reviewing in advance. NOTE: Many of the companies that offer Under-65 Exchange plans, do not underwrite Senior coverage. Also, in many situations, the company that provides your benefits before you reach age 65, is not the ideal choice for MedSup coverage. For example, UnitedHealthcare, Aetna, Humana, USAA, and Bankers do not participate in the Pa Marketplace. However, they offer several Senior products.
When Can You Change An Existing Policy?
As previously mentioned, each year, there is a Fall Open Enrollment from October 15th to December 7th. If you already own an existing policy, you can freely shop and change to another plan. Of course, you can also keep the same contract you have. You are not obligated to stay with the same company. For instance, you could change from Aetna to Humana, from UPMC to Highmark, from AARP to Cigna, or completely drop coverage. You can also keep the same company, but change plans.
However, if you change carriers, it's important to verify that your physician, facility, and/or hospital is still "in-network." This would especially apply to specialists, and any type of mental or physical therapy you are receiving. It is also advisable to verify that your pharmacy will continue to work directly with your insurer when the new calendar year begins.
January 1 Starting Date
Your benefits (or changes) start on January 1 and generally, this window is the only opportunity to alter your Part D or Advantage policies. If you presently are covered under an "Advantage" plan, you can change back to original Medicare benefits. A factor in your decision to change (or not to change) could be an "Annual Notice Of Change" (ANOC) you receive. It will notify you of changes in rates, benefits and other items that could influence you to keep or adjust your existing policy. Typically, it is sent in September by your current company.
This time period also gives you the chance to review your Part D prescription drug benefits and price, and comparison-shop with other available options. You do not have to make any adjustments if you are happy with the plan you have. However, often, there may be another plan that covers your specific prescriptions less expensively with limited restrictions.
Understanding the exact prescriptions and dosage you take is very important, along with properly comparing Tier 1, 2, 3, and 4 drug costs. Tier 1 generally consists of the least expensive (and often generic) drugs. Tier 4 is the most expensive classification, and is typically specialty drugs. Whenever possible, your physician should prescribe a generic drug, if available.
Are The Quotes Provided On This Website Free?
Yes. After you enter your zip code, some additional simple information is needed. Once that is provided, very quickly, you can review multiple offers. You can also compare other Senior healthcare options in Pa if you have not reached age 65 yet. A private policy is available from most of the top carriers, although the OE period is different. For example, for 2017 plans, Open Enrollment ran from November 1 2016 to January 31 2017. Most applications are processed online, since it is the quickest option, and most efficient.
However, you can still apply for coverage outside of the OE period with a "qualifying event." Moving to a different service area, adopting a child, divorce, and losing credible coverage are four examples. When COBRA ends, you are not provided an SEP exception.
Can You Switch From One Plan To Another?
As we discussed earlier, you can often change or switch plans, but it's important to only change if there is a good reason. For example, if your current policy does not provide specific benefits you need, or you are paying for coverage that is never used, it may be worthwhile to consult us, or a licensed professional of your choice to review alternatives. And of course, affordability should always be considered.
But never cancel existing coverage before you secure alternative benefits. Also, if you have a strong preference for keeping your existing providers (primary-care physician, specialist, OBGYN, hospital, etc...) verify (we can help) that you will still be able to continue to use them. Network provider lists generally change each year, so it is possible that additional medical facilities could become available. Also, carriers will occasionally change their "service area," so specific counties may be added or deleted effective January 1.
What Type Of Benefits Are Covered?
"Basic" benefits must always be included. However, there can be differences, depending on the policy. Plans are designated by letters, starting at A and ending at N. More complete information can be obtained by contacting us or viewing the official 2017 US government handbook here. Many preventative services are covered at 100%, including annual physicals and screenings. NOTE: Electronic Medical Notices (eMSNs) can be requested so that you receive your "Medicare Summary Notice" monthly via email.
A quick synopsis: Part A is the hospital insurance benefit which includes inpatient, skilled nursing, home health, and hospice care. Part B includes treatment from physicians, medical equipment, outpatient care and some preventative benefits. Part C is the "Advantage" plan option which is offered by private insurers. Dental and vision benefits are often included. Part D is your drug coverage. Many Advantage plans include Part D benefits. However, several Advantage contracts are also offered without prescription drug benefits.
Is Long-Term Care Covered?
Although some plans may offer some very basic benefits, typically, long-term health care is not provided on most Medigap plans. And when benefits are provided, they are very limited. Since facility treatment can be incredibly expensive without this type of policy, you may wish to request a quote, and we will help you find and compare the most affordable plans. Since they are underwritten, you may have to medically qualify.
Several of the larger carriers that offer this type of plan include John Hancock, Mutual Of Omaha, MassMutual, New York Life, Northwestern, and Genworth. Many large companies previously offered this type of policy, but no longer allow you to purchase new plans. MetLife, for instance, continues to service in-force contracts, but will not issue a new policy.
How Are Rates Determined?
Each company decides the premium they will charge based on anticipated revenue and expenses. Shown below are the three methods that the carrier can use to determine rates.
Issue Age - Your price is based on how old you are at the time you buy the policy. Naturally, someone who purchases coverage at age 65 will pay a lower premium than a 75 year-old. However, price differences between ages 65 and 66 are not significant.
Community-Rated - Also referred to as "No-Age-Rated-Pricing." All persons pay the same rate regardless of age, medical status or pre-existing conditions. Sometimes older applicants can receive favorable pricing. Premiums can increase due to increased costs and inflation.
Attained-Age - You pay a rate based on your age at the time of purchase. However, as you get older, the premium increases. Initially, you'll pay less than a policy that is based on "Issue-Age." But the longer you live, the higher the premium becomes.
What Are Some Common Exclusions?
Dental-related expenses such as checkups, extractions and dentures are not covered. Also, eye exams, glasses and contact lenses are excluded. Private duty nurses and long-term care are typically not included in benefits. Acupuncture and cosmetic procedures and surgeries are also typically not covered. However, you can separately purchase dental and vision policies through many of the top-rated carriers. Also, many Advantage plans provide dental, vision, and hearing benefits.
Are AARP Plans Offered In Pennsylvania?
Yes. For example, in most areas, Plans A, B, C, F, K, L, and N are available. A is the least expensive option, although it may not be the most cost-effective solution in many situations. UnitedHealthcare underwrites all AARP plans.
What Are Some Of The Companies That Offer Medigap Plans In Pennsylvania?
There many participating companies, but listed below are some of the major carriers. Please keep in mind that this is only a partial list, and they are listed in alphabetical order and not in the order of rate competitiveness. The DOI also dedicates a page with some free information.
Capital Blue Cross
Independence Blue Cross
Mutual Of Omaha
Which Plans Cover BOTH The Part A and Part B Deductibles?
C and F cover both deductibles. Both of these options also cover the Part A and B coinsurance (for an additional 365 days) along with hospice care and skilled nursing facility coinsurance. Some other plans only cover 50% or 75% of these expenses. Also, the F plan pays excess B charges while C does not. Although not usually needed, both provide foreign travel benefits.
Of course, there are many other Pa Medicare Supplement plan provisions. To review specific prices and/or benefits, simply contact us or review the free quotes that we provide. Our goal is to provide the most helpful unbiased expertise so you can view the lowest Supplement prices in Pennsylvania.
Is a Stand-Alone Prescription Drug Plan In Pa Available?
Yes. There are many comparison tools that allow you to calculate the best option, based on the specific prescriptions you take, which pharmacies you prefer, and the actual price of the drugs you are prescribed. Most importantly, it's critical to ensure that any drugs you are taking are covered under this stand-alone policy. Also, this option is typically not offered if you have an Advantage plan. These contracts must include comparable Part A and B benefits, and typically drug coverage is also included. Several Part D plans (PDP) are listed below:
Avalon SecureRx Options 1 and 3
Highmark Blue Rx PDP Complete and PDP Plus
Express Scripts Medicare - Choice and Value
AARP MedicareRx Preferred
AARP MedicareRx Saver Plus
AARP MedicareRx Walgreens
First Health Part D Premier Plus and Value Plus
UnitedHealthcare Symphonix Value Rx
Humana WalMart Rx Plan
Humana Preferred Rx Plan
Aetna Medicare Rx Saver
Cigna-HealthSpring Rx Secure-Extra
WellCare Classic And Extra
Magellan Rx Medicare Basic (This is a new plan)
What Is A Part C Plan?
These are "Medicare Advantage" plans and are operated by private insurance companies. Many of these carriers also offer Medigap coverage, which does not involve Plan C. These policies are government-regulated and typically offer very low premiums. Sometimes, the premium is $0. Plan availability can vary, depending on your county of residence. Benefits and out-of-pocket costs can also vary. You can not have a supplement AND an Advantage plan. We have listed several of the highest-rated (US News And World Report) options below:
Erickson Advantage Signature, Advantage Guardian, Advantage Champion, Advantage Freedom.
AARP MedicareComplete Choice Plan 1 and 2, MedicareComplete, MedicareComplete Plans 1, 2, and 3.
Highmark Senior Health Community Blue Medicare HMO Prestige, HMO Signature, Freedom Blue PPO Classic, Freedom Blue PPO Deluxe, Freedom Blue PPO Select, Freedom Blue PPO Standard, Freedom Blue PPO ValueRx,
Highmark Choice Security Blue HMO Deluxe, Security Blue HMO Standard, Security Blue HMO ValueRx,
Geisinger Gold Classic Advantage Rx, Gold Classic Complete Rx, Gold Secure Rx.
UPMC for Life HMO Deductible With Rx, HMO Rx Enhanced, HMO Rx, Options, PPO High Deductible with Rx, PPO Rx Enhanced, For Life Dual.
HealthAmerica Advantra Butler Prime, Advantra Cares, Advantra Choice Plan, Advantra Fayette Advantra Prime, Gold, Advantra Northern Pennsylvania Gold, AdvantraOne, Advantra Penn Highlands Prime, Advantra Silver, Advantra Silver Plus, Advantra Washington Prime.
Aetna Medicare Choice Plan, Gold Plan, Main Line Health Prime Plan, PinnicleHealth Prime Plan, Premier Plan, Standard Plan.
Capital Advantage BlueJourney Classic, BlueJourney Prime.
Keystone Health Plan Central BlueJourney Essential, BlueJourney Essential, BlueJourney Premier, BlueJourney Value.
Geisinger Gold Preferred Advantage Rx, Gold Preferred Complete Rx.
UnitedHealthcare Assisted Living Plan, Nursing Home Plan.
Cigna-HealthSpring Achieve, Preferred, Preferred Plus, PreventiveCare, TotalCare, Traditions.
What Are Pennsylvania Public School Employees Retirement System (PSERS) Options?
PSERS offers choices through the "Health Options Program." The employee, spouse,other dependents, and survivors are eligible for benefits before and after Medicare-eligibility. Eligibility is required, and plan participating is voluntary. Supplement options are "HOP" and "Value" medical plans. Prescription drug plan options (Part D) are "Enhanced", "Basic," and "Value" Medicare RX. Dental coverage provided by MetLife is also offered along with Advantage plans. For persons under age 65, HOP Pre-65 and a Managed-Care plan can be considered. A "Substantial Premium Subsidy" of $100 per month can be used to lower premiums for qualified applicants.
Independence Blue Cross will not be increasing premiums on most of its Medicare Advantage plans. In specific counties (Philadelphia and Bucks), rates for Personal Choice 65 PPO plans will substantially decrease. The SilverSneakers fitness benefit will remain on the Advantage plans and the list of network providers will remain very large.
For New Jersey residents that move from Pennsylvania, changing Med-Supp plans is not needed. However, contacting the current carrier is needed so future billing, plan changes and any other information can be sent to the correct location. However, your Part D must be changed since it is based on the zip code or county where you live. Often, you can remain with the same company.
Fall Open Enrollment, which began in October, ends in six days (December 7th). If you become newly-eligible throughout the year, you also can enroll.
Fall Open Enrollment for Medicare begins on October 15th and continues through December 7th. During this time, you can change to or from a Medicare Advantage Plan (including an MSA). For 2017 effective dates, several of the available Advantage policies in Allegheny County that feature no premium include:
Coventry: Advantra Basic Medical, Advantra Gold, Advantra Silver, AdvantraOne.
HealthSpring: Bravo-HealthSpring Classic, Bravo-HealthSpring Premier.
Highmark - Community Blue Medicare Signature and Prestige, Freedom Blue PPO Classic, Freedom Blue PPO ValueRX, Freedon Blue PPO Select, Security Blue Deluxe, Security Blue Value, Security Blue Standard.
Humana - Gold Choice, Choice H5525-029, Choice R5826-062, Choice R5826-002, Choice R5826-081.
UnitedHealthcare - MedicareComplete.