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. View 2021 Supplement rates from the top insurance companies so you can make an informed decision whether you wish to purchase a plan. Your personalized quote is completely free when you provide your zip code above. Easily see prices, reviews, and detailed plan information from Blue Cross Blue Shield, Geisinger, Allwell, WellCare, and all carriers.
Pa Advantage options and Part D prescription drug plans (PDP) are also available. If your income or health change throughout the year, reviewing and comparing carrier options may save money. Coverage is available through AARP (UnitedHealthcare), Humana, Aetna, Cigna, UPMC, Blue Cross, and many additional carriers. Many Advantage contracts include dental, vision, and hearing benefits, along with other perks, including fitness club memberships.
Some Basic Facts:
To be eligible for a Pa supplemental plan, you must be enrolled in Parts A AND B. If you have already signed up for Part A, but not Part B, form CMS 40-B should be completed. Part D prescription drug benefits are also available at reduced costs, if your income is limited. The “Medicare Prescription Drug Program” can help if your combined assets are less than $29,160 (married) or $14,610 (single). A $1,500 burial exclusion was included. An application must be completed and submitted. These asset limits include the $1,500 burial exclusion. Many pharmaceutical companies also offer financial assistance for their own drugs.
If you qualify for “Extra Help,” you do not have to submit an application to receive benefits. A purple “Deemed Status Notices” form is mailed to Seniors that qualify. Receiving SSI Benefits, full Medicaid eligibility, and or medical assistance from Medicare for an MSA will automatically qualify.
To receive assistance, you must be enrolled in Medicare. Resources and income are counted when determining eligibility. Married couples must include both incomes, regardless if only one spouse is applying for assistance. If your spouse does not reside in your household, then his/her income and resources are not considered.
Items counted as income include pensions, annuities, alimony, earned income, social security benefits, rental income, and worker’s compensation. Resources include cash, checking accounts, savings accounts, stocks, bonds, mutual funds, IRAs, and rental properties. Resources are not counted include your primary residence, vehicles, personal possessions, jewelry, furniture, life insurance policies, and burial plots.
If you have a Medicare Savings Program or Medicare and Medicaid, the monthly income limit is $1,083 for single persons, and $1,457 for couples. Generic drug copays are $1.30 or $3.60, and brand-name copays are $3.90 and $8.95.
Part D Prescription Drug Plans In Pennsylvania
All plans are required to have a standard level of benefits, although the cost of coverage, copays, deductibles, and formulary lists can differ. A lifetime enrollment penalty could be assessed if you do not enroll in a qualified plan when first eligible. The penalty would be added to the premium of the policy you ultimately select. The “Medicare Plan Finder” (online) can help with the comparison process, and identifying pharmacies that can provide your needed prescriptions.
The five most popular Pa Part D plans are WellCare Classic, Humana Premier Rx, EnvisionRxPlus, AARP MedicareRx Preferred, and SilverScript Choice. The 10 plans with the lowest monthly premiums are listed below:
$7.30 – SilverScript SmartRx
$13.60 – Clear Spring Health Premier Rx
$15.60 – Elixir RxPlus
$15.70 – WellCare WellnessRx
$17.20 – Humana Walmart Value Rx
$17.80 – WellCare Value Script
$24.00- Cigna Secure-Essential Rx
$24.80 – Mutual Of Omaha Rx Premier
$25.90 – Express-Scripts Medicare-Saver
$26.40 – WellCare Medicare Rx Select
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. Additional doctors and hospitals may become available each year. The six-month OEP (Open Enrollment Period) is provided for all eligible persons.
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. These changes typically impact all plans in the same category, instead of just selected plans. Also, a new Administration can repeal or change prior legislation.
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. Part B covers medically necessary services and supplies. Outpatient care, preventative expenses, and the cost of an ambulance may be part of these benefits. If you delay the Part B enrollment, you may have to permanently pay a higher cost. This could result in thousands of dollars of out-of-pocket expenses.
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. Rates are subject to change each year. Prices can increase or decrease.
Unless you have a Supplement plan, potential out-of-pocket costs are unlimited. During Open Enrollment, no medical requirements are needed. Not all plans are offered by each carrier. For example, in your county, Aetna and Humana may offer Plan F, while AARP-UnitedHealthcare and Cigna don’t. And vice versa.
Unlike conventional healthcare policies, a family cannot be covered under one contract. Each applicant must purchase their own policy, which results in two separate applications. You can cancel at any time, and there is no extra cost for not combining policies. Terminating your own policy will not impact the status of you spouse’s policy. It’s also possible for one spouse to be covered under an Advantage contract while the other spouse is covered under original Medicare.
If you have a Medical Savings Account (MSA), you cannot 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. However, often these types of plans have large application fees that are not refundable.
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. Also, it is possible to receive Group benefits at work after you reach age 65. It is also possible that one spouse may be covered under a Marketplace or employer-provided plan, while the other spouse utilizes Senior coverage.
State Health Insurance Assistance Program
Additional help is provided by SHIP (State Health Insurance Assistance Program) and the Medicare Plan Finder, which is located online. SHIP provides local assistance and counseling to caregivers and persons that are eligible for Medicare. In-person help is offered to review plan or prescription drug options. Other topics that can be discussed include out-of-pocket expenses, eligibility guidelines, coverage details, and impact of supplemental contracts and the determination of which company pays specific expenses.
APPRISE is the Keystone State’s SHIP program and is responsible for aging services and programs. Elderly rights and interests are protected through legislation and counsel. The Governor and General Assembly receive updates of member opinions regarding delivery and quality of services. A Long-Term Care Council communicates with several Agencies and overseas operations are supported by the Bureau of Finance.
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, 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. Any current medications you take will not impact your premium.
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. Filling in the gaps will have different costs, depending where you reside.
For example, Highmark, UPMC, Capital Blue Cross, Geisinger, and Independence Blue Cross cover specific areas of the state, while Aetna and UnitedHealthcare have larger Pa service areas. Although Cigna does not currently offer private under age-65 products, they do offer various Senior plans. Humana offers Senior and Group products, but not individual private medical plans to applicants under age 65. It’s always possible that Humana and other carriers could return to the under-65 Pa Marketplace.
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 don’t qualify for a “Special Enrollment Period,” you can also enroll between January 1 and March 31. However, the effective date will be delayed until July 1, and you might have to pay an increased premium.
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, Americo, and Medico 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, (Advantage coverage) 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. Copays for office visits and prescriptions will likely be different when comparing multiple plans. Inpatient and outpatient hospital service copays and duration of expenses will also be different.
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 �rescriptions less expensively with limited restrictions. Any changes to the carrier formulary drug list must also be considered when choosing plans.
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. Each carrier generally provides a “formulary drug list” that helps consumers with determining out-of-pocket costs. Whenever possible, your physician should prescribe a generic drug, if available. Multiple pharmacies will be available in your area.
Can You Apply For Medicare Benefits Online?
Yes, and you don’t have to be retired yet. The process generally takes about 10-15 minutes, and there are no required signatures or forms to complete. The Medicare card will be sent to you via US mail. Information needed will include date of birth, place of birth, and current health insurance (beginning and end dates for Group coverage). You will be able to manage benefits online and view information and provided services.
To apply online, you must have reached the age of 64 years and 9 months, and not currently covered for Medicare. Also, you should not currently be receiving Social Security benefits. Parts A and B can be applied for online. You won’t have to visit a Social Security office, and corrections can be made to your application before submission. A receipt is provided, and the status can be easily checked.
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 2020 plans, Open Enrollment ran from November 1 to December 15. Most applications are processed online, since it is the quickest option, and most efficient. 2021 enrollment also began in November.
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 provided an SEP exception. However, if you voluntarily terminate COBRA outside of the OE period, a qualifying event does not occur. Coverage may still be available from many companies, but benefits may be limited in several areas, and pre-existing conditions are not likely to be covered. If you become eligible for Medicare, guaranteed benefits will be available.
Can You Switch From One Plan To Another?
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 and suitability should always be considered. Star ratings can also be used.
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. Carriers will occasionally change their “service area,” so specific counties may be added or deleted effective January 1. Part D and Advantage plans may become available in specific areas, and no longer be offered in specific areas.
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 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. New ID cards will no longer show your social security number. This improved security should reduce the risk of identity theft.
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. If you have already enrolled in Part A (but not Part B), Form CMS 40-B must be completed. 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. Depending on your household income, financial assistance may be available to help pay for some prescription costs.
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 custodial care 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.
Activities of daily living are typically some of the main benefits of LTC plans. Examples include going to the bathroom, bathing, dressing, and cooking. Most contracts will provide reimbursement (up to policy limits) for care provided in your home, an assisted living facility, a Senior day care center, or a nursing home.
Several of the larger carriers that offer this type of plan (also called custodial care) 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. Independent and assisted living coverage can generally cost between $2,000 and $5,000 per month, depending upon the area and facility. Many facilities offer both independent and assisted options within the same facility.
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. Rates are lower for younger applicants, although prices can increase due to increasing medical costs and inflation.
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. Long-term, rates tend to be less than similar Issue Age plans.
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, foot care, 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. Experimental and non-approved surgeries and procedures are not covered.
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. Copays and deductibles will vary, depending on the carrier. Hearing aids are often covered with annual or 24-month caps.
What If You Are Retired And Have Group And Medicare Coverage?
Typically, Medicare is the primary carrier, and the Group plan is the secondary carrier. Thus, covered expenses are first paid by Medicare. It’s also possible you are covered under your spouse’s Group plan. Although the employer is not required to continue benefits after you reach age 65, larger employers often provide some benefits. If your prior employer files for bankruptcy or is no longer in business, COBRA benefits might be available with other companies within the corporation.
You may be required to sign up for Medicare to receive employer-provided benefits. The plan benefit booklet can provide details regarding how and when primary and spouse benefits are provided. You may not need a Supplement policy if your Group plan provides similar benefits. Often, the employer will pay a portion of the cost of coverage.
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 one of the least expensive options, although it may not be the most cost-effective solution in many situations. UnitedHealthcare underwrites all AARP plans. “Advantage” plans offered and underwritten by UnitedHealthcare include AARP Medicare Advantage, AARP Medicare Essential, AARP Medicare Advantage Plan 1, AARP Medicare Advantage Plan 2, AARP Medicare Advantage Plan 3, AARP Medicare Advantage Choice Plan 1, AARP Medicare Advantage Choice Plan 2, and AARP Medicare Advantage Choice Plan 3. The UHC nationwide network of physicians, hospitals, and other medical facilities is used. Plan F (HD) is typically the least-expensive option when all carriers are compared.
What Are Some Of The Companies That Offer Medigap Plans In Pennsylvania?
There many participating companies, and 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. This page provides help with other products, including life insurance, annuities, travel plans, long term coverage, and the ratings and safety of other carriers. Medigap plans are discussed, including Part A and Part B deductibles, and Part B excess charges.
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 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. The first three pints of blood are also covered.
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 all Supplement prices in Pennsylvania. Insurers frequently change prices, and updated options should always be reviewed.
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. Advantage contracts must include comparable Part A and B benefits, and typically drug coverage is also included. Part D plans (PDP) with the largest formulary drug list are listed below:
Blue Rx PDP Plus
Blue Rx PDP Complete
SecureRx Option 1
Aetna Medicare Rx Select
Aetna Medicare Rx Value Plus
Aetna Medicare Rx Saver
AARP MedicareRx Preferred
WellCare Value Script
Cigna-HealthSpring Rx Secure-Extra
What Is A Part C Plan?
These are “Medicare Advantage” (MA) plans and are operated by private insurance companies. Many of the 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 cannot have a supplement AND an Advantage plan. We have listed several of the highest-rated (US News And World Report 4.5 Stars) options below:
Aetna – Advanta Butler Prime, Advantra Cares, Advantra Credit Value, Advantra Excela Prime, Advantra Gold, Advantra Premier, Advantra Premier Plus, Advantra Silver, Advantra Silver Plus, and Advantra Value.
Community Blue – Medicare Plus PPO Distinct, Medicare Plus PPO Signature, Medicare PPO Distinct, and Medicare PPO Signature.
Erickson – Advantage Champion, Advantage Freedom, Advantage Guardian, Advantage Liberty With Drugs, and Advantage Signature With Drugs.
Freedom Blue – PPO Classic, PPO Deluxe, PPO Select, PPO Standard, and PPO ValueRx.
UnitedHealthcare – Nursing Home Plan 2.
UPMC – HMO Deductible With Rx, HMO Premier Rx, HMO Rx Choice, HMO Rx Enhanced, HMO Rx, PPO High Deductible With Rx, and PPO Rx Enhanced.
What Are Pennsylvania Public School Employees Retirement System (PSERS) Options?
PSERS is a defined benefit plan under Section 401 (a) of the IRS code. Assets have grown to more than $50 billion, which provides public school employees a safe retirement option. Headquartered in Harrisburg, reporting units include 500 school districts, 64 technology schools, 163 charter schools, and 18 universities and community colleges.
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.
What Services Are Offered By The Pa Department Of Aging?
Many free programs are offered to Keystone State residents. Several popular services include caregiver support, help at home, housing, prescriptions, transportation, meals, protective services, employment, legal assistance, and ombudsman. A free healthcare counseling program is also offered. APPRISE provides counselors and other resources that can assist with your Medigap questions. The Department Of Aging also provides assistance to the elderly, and any person with dementia-related disease or other brain syndromes.
The caregiver and care receiver (if not related) must be Pa residents and receive a needs assessment. the caregiver must also be age 18 or older and the care receiver must be age 60 or older (18-59 allowed if suffering from chronic dementia or Alzheimer’s). If related, the caregiver must be age 55 or older and the care receiver (dependent) under age 18. Financial eligibility is not required. However, the amount of reimbursement is determined by household size and income.
APPRISE workers can also make presentations to organizations and groups, and assist Seniors with the Medicare appeal process, eligibility and enrollment, how to apply for financial assistance, and understanding long term care plans and benefits. Volunteers are also needed to explain benefits to members of the program. An online event link provides dates and locations for local residents.
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 Silver Sneakers 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 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 effective dates, several of the available Advantage policies in Pennsylvania that feature a $0 premium include:
Advantra Basic Medical
Advantra Choice Plan
Advantra Beaver Valley Prime
Advantra Basic Medical
Advantra Northern Pennsylvania Gold
Community Blue Medicare HMO Signature
Humana Gold Plus H6622-035
Humana Gold Plus H6622-043
UPMC For Life
UPMC For Life HMO Premier Rx
Geisinger Gold Essential Rx
Geisinger Gold Preferred Complete Rx
Vibra Health Plan Essential Coverage