Pennsylvania Health Insurance

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Senior Pa Medicare Advantage plans (also known as “MA Plans” or “Part C”) are available in all counties as an alternative to original Medicare. Private insurance companies package Part A (hospitalization), Part B (medical insurance), and Part D (prescription drugs) into most plans. Additionally, along with basic Medicare services, many plans include dental, vision, hearing, wellness (gym memberships), over-the-counter drugs, transportation to doctor visits, and adult day-care services.

A fixed payment is paid to each carrier to provide services. A network of doctors, specialists, hospitals, and medical facilities must be selected to take advantage of negotiated lower costs. A referral may be needed to see a specialist, and non-emergency treatment may have different requirements than life-threatening situations.

Monthly rates for Pa Advantage plans are generally much less expensive than Medicare Supplement plans. Often, premiums are $0, although copays and out-of-pocket expenses may be higher for these plans. The four types of available plans are HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), SNP (Special Needs Plans), and PFFS (Private Fee-For-Service Plans).

Medicare Medical Savings Accounts (MSA) do not offer drug coverage so a separate plan must be purchased. Private Fee-For-Service plans may also not offer drug coverage. If you are enrolled in an Advantage PPO or HMO contract and join a separate Part D plan, you will be returned to original Medicare.

 

Pennsylvania Medicare Advantage Plans Without Prescription Drug Coverage

AARP Medicare Advantage Essential – $0 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $5 and $14. Emergency Room and Urgent Care copays are $90 and $30-$40. Occupational, physical, speech, and language therapy visit copays are $20.

Aetna Medicare Advantra Core – $0 per month with $4,900 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $0 and $15. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $25.

Cigna-HealthSpring Advantage – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $0 and $20. Emergency Room and Urgent Care copays are $90 and $55. Occupational, physical, speech, and language therapy visit copays are $40.

Freedom Blue PPO Basic – $77 per month with $5,900 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $35, and lab services and outpatient x-ray copays are $0-$20 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $35.

Geisinger Gold Classic Advantage – $30 per month with $3,400 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $20, and lab services and outpatient x-ray copays are $5 and $25. Emergency Room and Urgent Care copays are $120 and $20. Occupational, physical, speech, and language therapy visit copays are $20.

Humana Honor – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $20 and $50, and lab services and outpatient x-ray copays are $0-$50 and $20-$110. Emergency Room and Urgent Care copays are $90 and $20-$50. Occupational, physical, speech, and language therapy visit copays are $10-$40.

Humana Gold Choice – $38 per month. Primary doctor and specialist in-network office visit copays are $15 and $45, and lab services and outpatient x-ray copays are $0-$40 and $15-$100. Emergency Room and Urgent Care copays are $90 and $15-$45. Occupational, physical, speech, and language therapy visit copays are $20-$40.

Personal Choice 65 Medical Only – $184 per month. Primary doctor and specialist in-network office visit copays are $5 and $40, and lab services and outpatient x-ray copays are $0 and $40. Emergency Room and Urgent Care copays are $90 and $5-$40. Occupational, physical, speech, and language therapy visit copays are $20.

Security Blue HMO-POS Basic – $58.50 per month with $5,900 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $0-$20 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $30.

Security Blue HMO-POS ValueRx – $59.50 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $0-$20 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $30.

UPMC For Life HMO Premier Rx – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $45, and lab services and outpatient x-ray copays are $5 and $30. Emergency Room and Urgent Care copays are $120 and $50. Occupational, physical, speech, and language therapy visit copays are $40.

UPMC For Life HMO No Rx – $0 per month with $3,400 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $45, and lab services and outpatient x-ray copays are $5 and $30. Emergency Room and Urgent Care copays are $120 and $50. Occupational, physical, speech, and language therapy visit copays are $40.

Pennsylvania Medicare Advantage Plans

Pennsylvania Medicare Advantage Plans With Prescription Drug Coverage

Aetna Medicare Advantra Silver – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $35, and lab services and outpatient x-ray copays are $0 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $30. Preferred generic, generic, and preferred brand drug copays are $0, $0, and $47.

Aetna Medicare Advantra Silver Plus – $28 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $35, and lab services and outpatient x-ray copays are $0 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $25. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Aetna Medicare Advantra Gold – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $40, and lab services and outpatient x-ray copays are $0 and $35. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Aetna Medicare Advantra Credit Value – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $35 and $50, and lab services and outpatient x-ray copays are $10 and $60. Emergency Room and Urgent Care copays are $90 and $60. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $3, $7, and $47.

Aetna Medicare Value – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $45, and lab services and outpatient x-ray copays are $5 and $30. Emergency Room and Urgent Care copays are $90 and $10-$50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $2, $5, and $47.

Aetna Medicare PinnacleHealth Prime – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $5 and $15. Emergency Room and Urgent Care copays are $90 and $0-$50. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

Aetna Medicare Elite – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $30 and $50, and lab services and outpatient x-ray copays are $5 and $50. Emergency Room and Urgent Care copays are $90 and $30-$50. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Aetna Medicare Advantra Premier – $27 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $35, and lab services and outpatient x-ray copays are $0 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Aetna Medicare Advantra Premier Plus – $72 per month with $5,900 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $35, and lab services and outpatient x-ray copays are $5 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $25. Preferred generic, generic, and preferred brand drug copays are $0, $0, and $47.

Aetna Medicare Gold Plan – $146 per month with $0 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $35, and lab services and outpatient x-ray copays are $0 and $15. Emergency Room and Urgent Care copays are $90 and $10-$50. Occupational, physical, speech, and language therapy visit copays are $15. Preferred generic, generic, and preferred brand drug copays are $2, $5, and $47.

AARP Medicare Advantage – $15.50 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $5 and $14. Emergency Room and Urgent Care copays are $90 and $30-$40. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $4, $12, and $47.

AARP Medicare Advantage Plan 1 – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $5 and $14. Emergency Room and Urgent Care copays are $90 and $30-$40. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

AARP Medicare Advantage Plan 2 – $0 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $5 and $14. Emergency Room and Urgent Care copays are $90 and $30-$40. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

AARP Medicare Advantage Choice Plan 3 – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $5 and $14. Emergency Room and Urgent Care copays are $90 and $30-$40. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $0, $0, and $47.

Allwell Medicare – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $0-$20 and $0-$40. Emergency Room and Urgent Care copays are $90 and $40. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

 

Pennsylvania MAPD Plans

 

Blue Journey Essential – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $30, and lab services and outpatient x-ray copays are $10 and $50. Emergency Room and Urgent Care copays are $90 and $30-$40. Occupational, physical, speech, and language therapy visit copays are $30. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $40.

Blue Journey Premier – $148 per month with $3,400 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $20, and lab services and outpatient x-ray copays are $10 and $25. Emergency Room and Urgent Care copays are $120 and $30. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $40.

Cigna HealthSpring Alliance – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $0 and $40. Emergency Room and Urgent Care copays are $90 and $55. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $1, $10, and $42.

Cigna HealthSpring True Choice – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $0 and $35. Emergency Room and Urgent Care copays are $90 and $55. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $0, $4, and $40.

Community Blue Medicare HMO Signature – $0 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $20, and lab services and outpatient x-ray copays are $0-$30 and $30. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $20-$40. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Community Blue Medicare PPO Signature – $0 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $20, and lab services and outpatient x-ray copays are $0-$30 and $30. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $20-$40. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Community Blue Medicare PPO Distinct – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $0-$30 and $30. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $5, and $47.

Freedom Blue PPO ValueRx – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $0-$20 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $45.

Freedom Blue PPO Standard – $185.50 per month with $5,000 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $35, and lab services and outpatient x-ray copays are $0-$15 and $20. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $35.

Freedom Blue PPO Deluxe – $288.50 per month with $4,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $30, and lab services and outpatient x-ray copays are $0-$10 and $10. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $30. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $45.

Freedom Blue PPO Select – $132.50 per month with $5,000 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $0-$15 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $30. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $45.

Geisinger Gold Classic 360 Rx – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $0-$15 and $20. Emergency Room and Urgent Care copays are $90 and $35. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $3, $20, and $47.

Geisinger Gold Classic Essential Rx – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $40, and lab services and outpatient x-ray copays are $10 and $35. Emergency Room and Urgent Care copays are $90 and $40. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $3, $20, and $47.

Geisinger Gold Preferred Complete Rx – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $15 and $40, and lab services and outpatient x-ray copays are $30 and $40. Emergency Room and Urgent Care copays are $90 and $40. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $3, $20, and $47.

Geisinger Gold Preferred Enhanced Rx – $45 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $35, and lab services and outpatient x-ray copays are $20 and $35. Emergency Room and Urgent Care copays are $90 and $35. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $3, $20, and $47.

Geisinger Gold Classic Complete Rx – $38 per month with $4,900 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $35, and lab services and outpatient x-ray copays are $5 and $30. Emergency Room and Urgent Care copays are $90 and $35. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $3, $20, and $47.

Health Partners Medicare Simple – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $50, and lab services and outpatient x-ray copays are 20%. Emergency Room and Urgent Care copays are 20%. Occupational, physical, speech, and language therapy visit copays are 20%. Preferred generic, generic, and preferred brand drug copays are $7, $20, and $47

Health Partners Medicare Prime – $35 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $45, and lab services and outpatient x-ray copays are $0 and $30. Emergency Room and Urgent Care copays are $90 and $55. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $7, $20, and $47

 

Pa Humana Plans For Seniors

 

Humana Gold Plus – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $10 and $40, and lab services and outpatient x-ray copays are $10 and $35. Emergency Room and Urgent Care copays are $90 and $40. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $3, $15, and $47.

Humana Value Plus – $22.50 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are 20%, and lab services and outpatient x-ray copays are $0 and 20%. Emergency Room and Urgent Care copays are $90 and 20%. Occupational, physical, speech, and language therapy visit copays are 20%. Preferred generic, generic, and preferred brand drug copays are $2, $20, and $47.

Personal Choice 65 Prime Rx PPO – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5-$20 and $40-$50, and lab services and outpatient x-ray copays are $0 and $45. Emergency Room and Urgent Care copays are $90 and $10-$50. Occupational, physical, speech, and language therapy visit copays are $30. Preferred generic, generic, and preferred brand drug copays are $2, $10, and $47.

Personal Choice 65 Rx PPO – $288 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $40, and lab services and outpatient x-ray copays are $0 and $40. Emergency Room and Urgent Care copays are $90 and $5-$40. Occupational, physical, speech, and language therapy visit copays are $20. Preferred generic, generic, and preferred brand drug copays are $1, $9, and $47.

Security Blue HMO-POS ValueRx – $59.50 per month with $5,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $0-$20 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $45.

Security Blue HMO-POS Standard – $166.50 per month with $5,000 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $30, and lab services and outpatient x-ray copays are $0-$10 and $20. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $45.

Security Blue HMO-POS Deluxe – $226.50 per month with $4,500 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $25, and lab services and outpatient x-ray copays are $0-$10 and $15. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $25. Preferred generic, generic, and preferred brand drug copays are $0, $13, and $42.

UPMC For Life HMO Premier Rx – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $40, and lab services and outpatient x-ray copays are $10. Emergency Room and Urgent Care copays are $90 and $65. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47. Note: UPMC health insurance plans are also very popular for persons under age 65.

UPMC For Life HMO Deductible With Rx – $22 per month with $4,000 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $10. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $0. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

UPMC For Life HMO Rx Choice – $40 per month with $4,250 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $0 and $35, and lab services and outpatient x-ray copays are $10. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $35. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

UPMC For Life PPO Rx Enhanced – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $40, and lab services and outpatient x-ray copays are $5 and $20. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $10, and $47.

Vibra Health Plan Essential – $0 per month with $6,700 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $40, and lab services and outpatient x-ray copays are $15 and $50. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $40. Preferred generic, generic, and preferred brand drug copays are $0, $0, and $40.

Vibra Health Plan Enhanced Complete – $25 per month with $5,800 maximum out-of-pocket expenses. Primary doctor and specialist in-network office visit copays are $5 and $25, and lab services and outpatient x-ray copays are $10 and $25. Emergency Room and Urgent Care copays are $90 and $50. Occupational, physical, speech, and language therapy visit copays are $25. Preferred generic, generic, and preferred brand drug copays are $0, $0, and $40.