Senior health insurance plans in Pennsylvania help you pay for many expenses that original Medicare does not cover. View Pa Medicare Supplement rates and compare plans and pricing. We show you how you how to find affordable options if you’re age 50 or older. 2024 Coverage is available if you have reached age 65 and signed up for Parts A (hospital and skilled nursing facility) and B (doctors, specialists, outpatient care, and preventative benefits). All plans are approved by the Pa DOI.
Typically, there is a 7-month window to enroll. Copays, coinsurance, and deductibles can be covered. 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. Medigap options are offered in all counties by many national and local insurers. Many Advantage (MA) plans offer extra benefits
Millions of older individuals and families in the state can 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. Additional options are offered to disabled applicants, and low-income households.
SHIP (State Health Insurance Assistance Program) is a free counseling benefit service for Medicare-eligible individuals and their families. The organization is funded by government agencies and counselors are available by phone and through local workshops. The Keystone State program is APPRISE, and upon request, we will provide their contact information. The organization helps Seniors better understand the Medicare appeal process, long-term care coverage, financial assistance programs, and Part D benefits.
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 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. The cost is $174.70 per month with a combined income of less than $206,000. For one person, the limit is $103,000. Larger household incomes generate a higher premium. The Part B deductible is $240 (up from $226 last year).
Income between $206,000 and $258,000 results in a monthly premium of $244.60. Income between $258,000 and $322,000 results in a monthly premium of $349.40. Income between $322,000 and $386,000 resulted in a monthly premium of $454.20.
Income between $386,000 and $750,000 resulted in a monthly premium of $559.00. And income above $750,000 resulted in a monthly premium of $594. Married filing separately results in slightly different brackets. The Part A deductible is $1,632 for each benefit period, which covers the initial 60 days of inpatient hospital care. The deductible is not for the calendar year. The deductible is $0 for days 1-60, $408 coinsurance per day for days 61-90, and $816 for each lifetime reserve day after 91 days.
Changing Plans
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, and also provides resources to review specific details. If new plans become available, you can compare the most current prices with all other options.
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. A change in medications or treatment can impact which contract is the most cost-effective. Changing physicians may also effect your choices.
When choosing and comparing different options, one of the first tasks should be the verification of your physicians and specialists (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 eliminated Marketplace plans in Pennsylvania. This impacted applicants under age 65, by previously 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 may draw many carriers back to offering private coverage again. The possible date of UHC’s return to the under age-65 Pa market is 2023 or 2024.
Pa Senior Medicare information is also available from many resources. Note: Aetna, Cigna, and Humana have also withdrawn from most state Marketplace Exchanges, but continue to offer Medigap options. Kaiser, one of the nation’s largest insurers, and Humana, do not offer products in the Keystone State. Independence Blue Cross and Oscar underwrite plans in the Philadelphia area.
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 $2,800 and premiums are the lowest of any available plans.
Plan F (HD) can not be bought by newly eligible Medicare applicants. The new Plan G (HD), however can be purchased, by new and existing members. Plans C and F are no longer offered to new applicants. However, Plans D and G are available, and offer similar benefits except the Part B deductible.
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 Rates For 2024
Prices shown below are for 65-year-old males residing in selected counties. Changes to age, sex, plan, and county of residence, will impact rate. Non-smoker and household discounts are included.
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan A
$106 – Allstate
$115 – Medico
$122 – Ace Property And Casualty
$127 – Humana
$130 – American Home Life
$131 – AFLAC
$132 – AARP-UnitedHealthcare
$132 – American Benefit Life
$132 – Cigna
$133 – Elips Life
$134 – SBLI USA LIfe
$135 – Manhattan Life
$143 – Capitol Life
$143 – United States Fire
$146 – United Of Omaha
$153 – Aetna
$155 – Cigna
$160 – New Era Life
$165 – Highmark BCBS
$174 – Heartland National Life
$177 – Bankers Fidelity
$184 – GPM Health
$198 – Guarantee Trust Life
$212 – United American
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan B
$103 – Allstate
$103 – Cigna
$118 – Medico
$122 – Ace Property And Casualty
$126 – Humana
$131 – AARP-UnitedHealthcare
$131 – Woodman Of The World Life Insurance Society
$131 – American Benefit Life
$132 – Elips Life
$135 – American Home Life
$135 – Manhattan Life
$138 – AFLAC
$139 – New Era Life
$142 – United States Fire
$142 – Capitol Life
$152 – Aetna
$159 – SBLI USA Life
$159 – Highmark BCBS
$168 – Manhattan Life
$174 – Heartland National Life
$177 – Bankers Fidelity
$204 – GPM Health
$207 – United American
$216 – Guarantee Trust Life
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan C
$267 – Highmark BCBS
$280 – GPM Health
$328 – United American
$487 – AARP-UnitedHealthcare
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan D
$140 – New Era Life
$154 – Highmark BCBS
$182 – Central States
$183 – GPM Health
$201 – United American
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan F
$133 – Medico
$136 – Ace Property And Casualty
$143 – SBLI USA Life
$146 – Medico
$147 – Elips Life
$155 – Cigna
$157 – United States Fire
$159 – AFLAC
$162 – Central States
$162 – AARP-UnitedHealthcare
$164 – Manhattan Life
$168 – Humana
$169 – United Of Omaha
$170 – Accendo
$171 – Lumico Life
$171 – Great Southern Life
$174 – Capitol Life
$181 – Aetna
$182 – Cigna
$183 – New Era Life
$185 – Allstate
$192 – Union Security
$221 – Guarantee Trust Life
$224 – Highmark BCBS
$225 – Bankers Fidelity
$248 – GPM Health
$285 – United American
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan F (High Deductible)
$37 – United American
$40 – Medico
$42 – New Era Life
$46 – Great Southern Life
$59 – Allstate
$110 – Highmark BCBS
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan G
$115 – Medico
$117 – Ace Property And Casualty
$120 – Cigna
$125 – AARP-UnitedHealthcare
$128 – Elips Life
$130 – American Home Life
$131 – AFLAC
$133 – SBLI USA Life
$135 – United States Fire
$136 – Capitol Life
$139 – Humana
$139 – United Of Omaha
$141 – Aetna
$148 – New Era Life
$148 – Manhattan Life
$154 – Accendo
$155 – Allstate
$155 – Heartland National Life
$158 – Highmark
$162 – Union Security
$171 – Bankers Fidelity
$184 – GPM Health
$198 – Guarantee Trust Life
$202 – United American
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan G (High Deductible)
$37 – United American
$40 – Medico
$42 – New Era Life
$42 – Bankers Fidelity
$47 – Ace Property And Casualty
$47 – Humana
$50 – Elips Life
$50 – Aetna
$50 – United States Fire
$52 – United Of Omaha
Allegheny, Westmoreland, Washington, Greene, and Fayette Counties Plan N
$82 – Cigna
$89 – AARP-UnitedHealthcare
$89 – Medico
$89 – Ace Property And Casualty
$94 – American Home Life
$97 – AFLAC
$97 – SBLI USA Life
$97 – Elips Life
$97 – Capitol Life
$97 – United Of Omaha
$98 – Aetna
$99 – Capitol Life
$101 – Accendo
$101 – United States Fire
$101 – New Era Life
$101 – GPM Health
$104 – Humana
$108 – Manhattan Life
$119 – Heartland National Life
$120- Union Security
$127 – Allstate
$129 – Bankers Fidelity
$161 – Guarantee Trust Life
$164 – Highmark
$211 – United American
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan A
$87 – AARP/UnitedHealthcare
$121 – Cigna
$126 – Medico
$132 – Ace Property And Casualty
$137 – Aetna
$138 – Elips Life
$140 – United Of Omaha
$142 – American Home Life
$144 – United States Fire
$144 – Accendo
$145 – American Benefit Life
$146 – Humana
$146 – SBLI USA Life
$149 – AFLAC
$152 – Capitol Life
$152 – United American
$162 – Manhattan Life
$162 – New Era Life
$164 – Allstate
$171 – Heartland National Life
$182 – Union Security
$189 – Bankers Fidelity
$193 – GPM Health
$222 – Guarantee Trust Life
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan B
$126 – Medico
$133 – Ace Property And Casualty
$134 – AARP-UnitedHealthcare
$137 – Cigna
$140 – Elips Life
$143 – American Home Life
$144 – United Of Omaha
$146 – American Benefit Life
$147 – United States Fire
$147 – Humana
$147 – SBLI USA Life
$149 – AFLAC
$152 – Aetna
$154 – Capitol Life
$155 – Accendo
$162 – Manhattan Life
$164 – New Era Life
$166 – Allstate
$171 – Heartland National Life
$184 – Union Security
$194 – Bankers Fidelity
$197 – GPM Health
$197 – United American
$228 – Guarantee Trust Life
$259 – Independence Blue Cross
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan C
$199 – New Era Life
$201 – AARP-UnitedHealthcare
$218 – Heartland National Life
$270 – GPM Health
$328 – United American
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan D
$180 – New Era Life
$201 – GPM Health
$201 – United American
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan F
$155 – Ace Property And Casualty
$160 – Medico
$161 – SBLI USA LIfe
$162 – Elips Life
$174 – American Home Life
$177 – Cigna
$179 – Humana
$182 – AFLAC
$183 – United States Fire
$184 – AARP-UnitedHealthcare
$187 – American Benefit Life
$189 – Manhattan Life
$192 – United Of Omaha
$198 – Accendo
$198 – Capitol Life
$211 – Aetna
$244 – New Era Life
$245 – Union Security Life
$264 – Bankers Fidelity
$273 – GPM Health
$281 – Guaranteed Trust Life
$285 – United American
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan F (High Deductible)
$37 – United American
$48 – Medico
$52 – New Era Life
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan G
$132 – Medico
$138 – Cigna
$140 – Ace Property And Casualty
$142 – AARP-UnitedHealthcare
$144 – American Home Life
$146 – Medico
$146 – Elips Life
$149 – Humana
$149 – SBLI USA Life
$150 – AFLAC
$151 – American Benefit Life
$157 – United States Fire
$158 – United Of Omaha
$160 – New Era Life
$162 – Cigna
$163 – Manhattan Life
$164 – Capitol Life
$165 – Aetna
$167 – Accendo
$171 – Heartland National Life
$186 – Union Security
$194 – Bankers Fidelity
$198 – New Era Life
$203 – GPM Health
$212 – United American
$230 – Guarantee Trust Life
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan G (High Deductible)
$37 – United American
$42 – New Era Life
$46 – Medico
$46 – Bankers Fidelity
$51 – Humana
$54 – Aetna
$55 – United States Fire
$56 – Ace Property And Casualty
$57 – Elips Life
Philadelphia, Chester, Montgomery, Bucks, and Delaware Counties Plan N
$95 – Cigna
$106 – AARP-UnitedHealthcare
$103 – Medico
$104 – American Home Life
$105 – United Of Omaha
$106 – Ace Property And Casualty
$107 – New Era Life
$109 – SBLI USA Life
$110 – Aetna
$110 – AFLAC
$111 – Cigna
$111 – Humana
$111 – GPM Health
$113 – Medico
$114 – American Benefit Life
$109 – Accendo
$114 – Elips Life
$119 – Manhattan Life
$119 – Capitol Life
$115 – GPM Health
$131 – Heartland National Life
$137 – Union Security
$147 – Bankers Fidelity
$187 – Guarantee Trust Life
$221 – United American
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan A
$60 – AARP/UnitedHealthcare
$99 – Accendo
$101 – Cigna
$104 – Aetna
$106 – New Era Life
$110 – Manhattan Life
$111 – Great Southern Life
$111 – Capitol Life
$111 – United States Fire
$116 – Heartland National
$117 – Mutual Of Omaha
$118 – Highmark Blue Cross
$118 – Capital Blue Cross
$119 – Union Security
$120 – Humana
$125 – Medico
$131- United American
$132 – Sentinel Security
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan B
$106 – AARP-UnitedHealthcare
$107 – New Era Life
$110 – Manhattan Life
$111 – Great Southern Life
$112 – Capitol Life
$114 – United States Fire
$115 – Cigna
$115 – Accendo
$116 – Aetna
$120 – Highmark BS
$129 – Capital Blue Cross
$130 – Mutual Of Omaha
$139 – Medico
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan C
$143 – AARP-UnitedHealthcare
$146 – Capital Blue Cross
$151 – Heartland National
$162 – Highmark BS
$178 – GPM Health
$183 – Sentinel Security
$273 – United American
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan D
$129 – Highmark BS
$132 – GPM Health
$143 – Central States
$152 – Sentinel Security
$167 – United American
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan F
$134 – Central States
$134 – Manhattan Life
$137 – United States Fire
$138 – Accendo
$139 – Lumico Life
$140 – Great Southern Life
$140 – United Of Omaha
$141 – Capital Life
$142 – Humana
$143 – AARP-UnitedHealthcare
$145 – Aetna
$148 – Cigna
$149 – Capital Blue Cross
$157 – Union Security
$163 – Highmark BC
$164 – National Health
$180 – GPM Health
$211 – Medico
$237 – United American
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan F (High Deductible)
$32 – United American
$36 – New Era Life
$40 – Great Southern Life
$48 – Medico
$52 – Bankers Fidelity
$52 – National Health
$83 – Highmark
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan G
$108 – AARP-UnitedHealthcare
$110 – Manhattan Life
$115 – Lumico
$116 – Aetna
$117 – United States Fire
$117 – United Of Omaha
$118 – Capitol Life
$119 – Great Southern Life
$119 – Cigna
$120 – Humana
$120 – Accendo
$120 – New Era Life
$120 – Heartland National
$121 – Union Security
$131 – Highmark BS
$132 – Capital Blue Cross
$133 – GPM Health
$137 – National Health
$152 – Medico
$153 – Sentinel Security
$168 – United American
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan G (High Deductible)
$32 – United American
$36 – New Era Life
$44 – United States Fire
$44 – Aetna
$45 – Humana
$45 – United Of Omaha
Lancaster, Dauphin, Mifflin, Juniata, Cumberland, Adams, Franklin, Fulton, and York Counties Plan N
$82 – Cigna
$84 – United Of Omaha
$85 – Aetna
$87 – Manhattan Life
$88 – Capitol Life
$88 – Accendo
$88 – New Era Life
$89 – Lumico Life
$91 – Great Southern Life
$91 – United States Fire
$92 – Union Security
$92 – AARP-UnitedHealthcare
$94 – Central States
$94 – Humana
$95 – GPM Health
$96 – Heartland National
$101 – Capital Blue Cross
$108 – Medico
$112 – National Health
$104 – Western United Life
$118 – Highmark BS
$124 – Sentinel Security
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Warren, and Lawrence Counties Plan A
$60 – AARP-UnitedHealthcare
$99 – Accendo
$101 – Cigna
$104 – Aetna
$106 – New Era Lfe
$110 – Manhattan Life
$111 – Great Southern Life
$112 – Cigna
$112 – United Of Omaha
$113 – Lumico Life
$114 – United States Fire
$116 – Capitol Life
$118 – Highmark BCBS
$119 – Union Security
$119 – Heartland National
$120 – Humana
$126 – Medico
$127 – GPM Health
$132 – National Health
$134 – Central States
$138 – Bankers Fidelity
$147 – Guarantee Trust Life
$148 – United American
$152 – Cigna
$117 – Mutual Of Omaha
$119 – Western United Life
$118 – Highmark BCBS
$118 – Capital Blue Cross
$126 – Thrivent
$182 – Oxford Life
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan B
$97 – Cigna
$104 – AARP-UnitedHealthcare
$107 – New Era Life
$111 – Accendo
$112 – Lumico Life
$112 – Aetna
$112 – Capitol Life
$113 – Great Southern Life
$114 – United States Fire
$114 – Humana
$115 – Union Security
$122 – Transamerica Premier Life
$125 – Highmark BS
$128 – Thrivent
$130 – Mutual Of Omaha
$139 – Medico
$193 – Oxford Life
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan C
$140 – AARP-UnitedHealthcare
$152 – Western United Life
$164 – Highmark
$213 – Mutual Of Omaha
$247 – Oxford Life
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan D
$113 – New Era Life
$132 – Highmark BS
$133 – Mutual Of Omaha
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan F
$126 – Cigna
$133 – Accendo
$134 – Aetna
$135 – Humana
$137 – United States Fire
$139 – Lumico
$140 – AARP-UnitedHealthcare
$141 – Capitol Life
$143 – Great Southern Life
$148 – New Era Life
$150 – Union Security
$154 – Cigna
$162 – Thrivent
$165 – Highmark BCBS
$166 – Guarantee Trust Life
$166 – Western United Life
$192 – Transamerica
$198 – Medico
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan F (High Deductible)
$36 – New Era Life
$41 – Great Southern Life
$47 – Mutual Of Omaha
$47 – Great Southern Life
$48 – Medico
$81 – Highmark
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan G
$101 – Cigna
$106 – AARP-UnitedHealthcare
$113 – Lumico
$114 – Capitol Life
$114 – Great Southern Life
$114 – Humana
$115 – Accendo
$115 – United States Fire
$116 – Union Security
$116 – Aetna
$120 – New Era Life
$123 – Cigna
$124 – Western United Life
$128 – Thrivent
$129 – Transamerica
$136 – Guarantee Trust Life
$136 – Highmark BCBS
$152 – Mutual Of Omaha
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan G (High Deductible)
$38 – New Era Life
$45 – Humana
$47 – United States Fire
$47 – Aetna
$47 – Mutual Of Omaha
$81 – Highmark
Butler, Clarion, Armstrong, Mercer, Beaver, Crawford, Forest, Venango, McKean, Erie, Blair, and Lawrence Counties Plan N
$82 – Cigna
$89 – Humana
$91 – Aetna
$93 – Capitol Life
$95 – Transamerica
$98 – United States Fire
$98 – Accendo
$98 – Union Security
$98 – AARP- United Healthcare
$99 – New Era Life
$100 – Lumico
$102 – Thrivent
$107 – Great Southern Life
$112 – Western United Life
$115 – Medico
$121 – Highmark BCBS
$138 – Mutual Of Omaha
$174 – Oxford Life
Pennsylvania Medicare Advantage Plans
Listed below are many popular options offered by major carriers. Rates can vary, depending on your county of residence. Many plans are not offered in all areas of the state.
AARP Medicare Advantage Essential
AARP Medicare Advantage Plan 1
AARP Medicare Advantage Plan 2
Aetna Medicare Advantra Core
Aetna Medicare Advantra Credit Value
Aetna Medicare Advantra Silver
Aetna Medicare Advantra Premier
Aetna Medicare Advantra Premier Plus
Aetna Medicare Advantra Gold
Aetna Medicare Advantra Cares
Aetna Medicare Value
Allwell Medicare
Allwell Dual Medicare
Amerihealth Caritas VIP Care
Community Blue Medicare HMO Signature
Community Blue Medicare PPO Distinct
Gateway Health Medicare Assured Diamond
Gateway Health Medicare Assured Ruby
Geisinger Gold Classic Essential Rx
Geisinger Gold Preferred Complete Rx
Humana Honor
Humana Value Plus
HumanaChoice
Lasso Healthcare
Security Blue HMO-POS Basic
UnitedHealthcare Dual Complete
UPMC For Life HMO Premier Rx
UPMC For Life HMO Rx Choice
UPMC For Life HMO Deductible With Rx
UPMC For Life PPO High Deductible With Rx
UPMC For Life Dual
Vibra Health Plan Essential
Vibra Health Plan Enhanced Complete
Medicaid Eligibility
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). Required household income limits can change yearly.
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 eastern 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. If you reside in the Philadelphia area, Keystone (Independence Blue Cross) offers several popular HMO, high-deductible and comprehensive plans.
However, IBX and Ambetter are the only companies in the five-county area that offer 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, UnitedHealthcare and HealthAmerica (Coventry) have exited the Pa Under-65 Marketplace, although it’s possible they will return in the future. Humana, Cigna, and Kaiser are large carriers that don’t offer Pa under-65 plans. Smaller carriers continue to offer short-term, dental, vision, and limited-benefit plans. Ambetter began offering plans in the Philadelphia area last year. Oscar now offers plans in that area. Additional counties of coverage were added for 2023.
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. If Group coverage is provided, a federal subsidy probably will not be offered.
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. The carrier’s formulary drug list should always be reviewed,
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 Administration plan options may provide a greater benefit to persons between the ages of 50 and 64, so some financial relief may be offered in 2024.
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.
Past Information:
Open Enrollment for Medicare begins on October 15th and ends on December 7th. Any changes made will be effective for next year. 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.
