Pennsylvania Medicare Supplement Plans (Medigap)
Pennsylvania Medicare Supplement Plans were made to work in conjunction with original Medicare. They were specifically created to provide coverage for the out-of-pocket cost associated with copayments, deductibles and other items not covered by straight Medicare.
Medicare Supplement Plans are another term used for Medigap insurance. We’re going to break it down and compare the different parts and plans here to give you a better understanding.
Pennsylvania Medicare Benefits Explained
Medicare Parts A and Part B: is the standardized Medicare coverage offered by our Government. Medicare Part A is your hospital coverage and Medicare Part B is your medical insurance. Both plans are offered across the Country in every state.
- HMO Plans
- PPO Plans
- Private-Fee-For-Service Plans
- Special needs Plans
- HMO Point-of-Service Plans
- Medical Savings Account Plans
Medicare Part D: work alongside Medicare Part A and/or Part B insurance to help in subsidizing the costs of prescription medications and prescription drug insurance premiums.
Medigap Plans: are supplemental insurance policies to assist in healthcare costs not covered by Medicare Parts A and B. These policies include coverage on copayments, deductibles and coinsurance. They’re sold by most private insurance carriers.
Medicare Coverage in Pennsylvania Includes
To reiterate the traditional Medicare plans, Plan A is your hospital coverage. This plan covers:
- Inpatient hospital care
- Skilled nursing facility admissions
- Hospice Care
Medicare Part B is your medical insurance program that helps to pay for medically necessary services including:
- Doctors’ visits
- Some home health services like occupational and physical therapy
- Some preventative services
- Outpatient care
All of these services in both Plans A and B are covered at 80%. This leaves the 20% leftover, in addition to any out of pocket costs left to the beneficiary to pay. Having a Medigap plan can help the insured cover these remaining costs.
Beneficiaries can apply for Pennsylvania Medicare Supplement Plans as long as they’re currently enrolled in Medicare Part B and over the age of 65. It’s imperative to enroll in Part B upon eligibility to avoid the late penalty fee.
You have 7 months after turning 65 for the initial enrollment. Therefore, after your IEP you can be penalized by having your monthly premium increase up to 10% for each full 12-month period that you went without.
Once enrolled in Part B, you’re eligible for a Medigap plan during the six month Open Enrollment Period (OEP). This time period starts the first day of the month in which you turn 65.
During this time, you’re free to enroll in any policy you like without a premium increase or coverage exclusion.
Pennsylvania Medicare Eligibility for the Disabled, Under 65
If you receive Railroad Retirement Benefits, have End Stage Renal Disease or have had social security benefits for 24 months, you’re automatically eligible for Medicare Part A and Part B. Most states and insurance carriers offer a Medigap plan with Pennsylvania being one of those states. Also, the cost will differ from those who qualify for Medicare and are over the age of 65.
How to Apply for a Pennsylvania Medicare Supplement Plans
As stated above, everyone has Medicare Supplement guaranteed issue rights for a six-month period. You’re given guaranteed issue for coverage if you apply during your Open Enrollment Period.
Your OEP begins the first day of the month after you turn 65 years old and are enrolled in Medicare Part B. Furthermore, with guaranteed issuance, you cannot be denied or charged any more based on your:
- health status
- previous claim history
- any pre-existing medical condition(s)
- if you’re currently undergoing healthcare treatment
Additionally, in Pennsylvania, you also have guaranteed issue rights for two months after termination of employer-sponsored health insurance.
If you purchase a Medigap plan at any other time, you may have a hard time finding insurance coverage or be required to pay more based on the circumstances. Also, insurance companies have the right to deny coverage if you have certain pre existing conditions. Please note, you can still apply for a Medigap plan at any time of the year. You just won’t be granted guaranteed issue and may have to go through medical underwriting.
Medigap Costs in Pennsylvania
Each individual insurance company offering a Medigap plan determines its own monthly premium. Many factors go into this determination including age, sex and location. Insurance premiums quoted in Philadelphia will be different from those quoted in Pittsburgh. Therefore, your premiums will vary based on what pricing method your insurance company chooses to use.
The three methods used:
- Community rated: meaning everyone pays the same amount, regardless of age.
- Issue-Age rated: meaning your premium will be based on the age you were when you first purchased your policy. The older you are, the more you will pay. However, once your premium has been set, it will never increase due to you getting older.
- Attained-Age rated: meaning your premium is based off your current age when you “attained” your policy. It will increase each year as you age.
The Best Medigap Plans in Pennsylvania
The top supplement plans in Pennsylvania are Plans F, G and N. Regardless of which carrier you choose to go with, the plan benefits will be the same. The only difference between the plans is the cost the carrier chooses to charge for their Supplement Plan. What one pays in Hershey, PA will likely differ what another pays in Gettysburg, PA.
One important fact to keep in mind is that Pennsylvania is one of the few states that prohibit doctors from charging excess charges.
Plan F in Pennsylvania
This plan is considered the most popular Medigap plan, as it provides the most benefits with the least amount of out-of-pocket expenses. It covers Medicare Parts A and B deductibles. It also covers any remaining hospital or physician’s costs not covered by Medicare. These costs include any coinsurance or copayments that fall under Part B. It also covers the first 3 pints of blood needed for a medical procedure and includes coverage for any foreign travel emergency up to plan limits. It even has a high deductible version that has a lower premium and gives you the same benefits.
Plan G in Pennsylvania
The only difference between Plan F and Plan G is that Plan G does NOT cover your Medicare Part B deductible, which is $183 as of 2018. Furthermore, Medicare Part B only pays 80% of the total approved charges, leaving the beneficiary responsible for the remaining 20%. Your supplement plan will cover that 20% and most, if not all, your OOP expenses.
Plan N in Pennsylvania
This plan is considered to be “cost-sharing”. The difference between Plan N vs Plan G is that Plan N pays 100% of the Part B coinsurance minus:
- copay of $20 for some physician’s office visits
- copay of $50 for ER visits that don’t result in a hospital admission
No Part B Excess Charges in Pennsylvania
There’s a few states that do not allow excess charges. Excess charges are an extra 15% that healthcare providers are allowed to charge above the Medicare allowables. It’s important to keep this in mind when choosing your Supplemental Plan. Therefore, for those living in Pennsylvania, you may want to go with Supplement Plan F or N, depending on your healthcare needs.
Medicare Advantage Plans in Pennsylvania
Medicare Advantage Plans, also known as “Part C” or “MA Plans,” are offered by private insurance companies that are Medicare approved and come in HMO or PPO form. Whichever insurance carrier you chose will then take over as your primary insurance coverage. Medicare Advantage plans replace your hospital and medical coverage.
Some people choose a Medicare Advantage plan over Pennsylvania Medicare Supplement Plans due to the cheaper premiums. What they don’t realize is that what they save in premiums, they’ll end paying on all the out-of-pocket expenses that add up.
It’s important to do research on both Medicare Advantage Plans and Medicare Supplement Plans when choosing insurance coverage to fit all your financial and healthcare needs. With supplemental Medicare insurance, you may end up spending less money and end up with better coverage. If it’s important to you to keep your current doctor, then you should go with one of the Pennsylvania Medicare Supplement Plans available in your area.
Prescription Drug Plans in Pennsylvania
Prescription Drug Plans, or Medicare Part D, are coverage for your prescription medications. Traditional Medicare as well as Medigap Plans have no prescription benefits. Thus, it’s important to consider a Prescription Drug Plan, in conjunction with your other Medicare policies, as out-of-pocket costs for prescription medications can become expensive.
There’s a late enrollment penalty for going without a Part D Plan, which will be applied to your monthly premium after going 63 consecutive days or more without prescription drug coverage. Therefore, it’s important to sign up for Part D coverage during your Initial Enrollment Period to avoid this extra charge.
A Comparison of Medigap Plans in Pennsylvania
Medigap policies are available through private insurance companies. They cover out-of-pocket Medicare costs like copayments, coinsurance, deductibles and more. Furthermore, plan availability will vary in Pennsylvania. We can help guide you towards the best plan to fit your individual budget and healthcare needs.
Click or call today, our agents are here to help and our services are 100% free. You can also compare rates online here.
Medicare Resources in Pennsylvania
Each state, including Pennsylvania, has a Medicare Savings Program that provides assistance towards Medicare costs. As a result, if you’re on a fixed income, disabled or considered a low income working family, you may be eligible for financial assistance. Therefore, there are a few options for those who qualify. To see the different programs and if you qualify, go to Medicare Savings Program.
As stated before, every state offers extra help with their own individual programs. These programs are provided for free and designed to help those in need of financial help. In addition, there’s a National program called State Health Insurance Assistance program, or SHIP.
New York State FAQs:
- How do I get help paying for Medicare Part B in Pennsylvania? Pennsylvania’s free assistance program is called APPRISE. Here you can talk with and have questions answered by specially trained staff. They will provide you with clear and easy-to-understand information about your Medicare options.
- Do Pennsylvania seniors need Medicare Part D? The short answer is yes, if you want prescriptions drug coverage.
- What doctors take Medicare in Philadelphia? Most doctor takes Medicare insurance. To find a physician in Philadelphia, or see if your doctor participates in Medicare, you may use the Medicare.gov Physician Compare link.