Medicare Supplement Plans in Pennsylvania

Medicare Supplement plans in Pennsylvania help pay some to all of the out-of-pocket costs left after Original Medicare pays 80% of the approved health care charges. The gaps in the coverage provided by Medicare Part A and Part B can create a phenomenal financial burden for a Medicare beneficiary because Original Medicare places no limit on how much expense the individual might have to pay.

Because Medicare Supplement insurance plans in Pennsylvania help cover the gaps not covered by Original Medicare, they are often called Medigap plans.

Finding the Best Medicare Supplement Plans in Pennsylvania

Medicare Supplement plans in Pennsylvania are not designed to stand alone and may be purchased only by Medicare recipients who choose Original Medicare (Part A and Part B).

Those who opt for a Medicare Advantage plan (Medicare Part C) cannot buy a Medigap plan or their Medicare Advantage will be terminated.

Medigap health plans are popular with people who want to choose any medical provider without being limited by a network and those who travel abroad extensively because Medigap plans offer foreign travel medical emergency coverage generally around $50,000 annually.

Most Medicare Supplement health plans cover 50% to 100% coverage for Skilled Nursing Facility care.

Certain home health care expenses not covered in full by Medicare may be paid by a Medigap plan. This includes help paying for durable medical equipment (DME).

Medigap health care plans do not include prescription drug coverage, so a stand-alone Part D drug coverage plan will need to be purchased separately.

Medicare Advantage plans are a Medicare substitute sold by private insurance companies to serve as an alternate way to receive Medicare benefits. They focus on Medicare preventive care and offer beneficiaries the choice between a Health Maintenance Organization (HMO) or a Preferred Provider Plan (PPO).

Many Advantage plans include prescription drug coverage. Check with a Medicare agent to confirm that drug coverage is part of the plan you are considering. A prescription drug plan cannot be purchased with Medicare Part C.

Dental, vision, and hearing benefits may also be part of your Medicare Advantage plan, as well as Fitness or Wellness extras and more.

Skilled Nursing Facility care is not generally provided by Medicare Part C, so those needing care in a Skilled Nursing Facility will need to go with Part A and Part B coverage and a supplement policy.

Best for Full Coverage – Medicare Supplement Plan F

The long-time favorite Medicare Supplement plan is Medicare Plan F. It provides the ultimate in benefits in a Medigap policy, covering even the deductible for Part B and Medicare excess charges. Unfortunately, this plan is no longer available to Medicare recipients newly eligible for Medicare after January 1, 2020.

Those who became eligible before January 1, 2020, but who have not yet enrolled in Medicare due to having insurance coverage through their (or their spouse’s) continued employment may still be able to enroll in Part F.

All Medicare beneficiaries who were enrolled in Part F prior to January 1, 2020, may continue with this coverage.

Some people will have guaranteed enrollment rights due to employer-based health insurance coverage or certain other circumstances.

Best comprehensive coverage: Medicare Supplement Plan G

Medicare Supplement Plan G is rapidly becoming the most popular Medigap plan available. Medicare Supplement Plan G covers everything that F does except for the Part B deductible.

In 2022, the deductible for Medicare Part B is $233, an increase of $30 from 2021. This expense is offset by the lower premiums and low out-of-pocket costs Part G recipients have to pay. In some cases, the beneficiary actually saves money by paying the deductible up front and enjoying lower premium costs.

Best value: Medicare Supplement Plan N

Medicare Plan N covers almost everything covered under G. The main exception is that Medicare Plan N does not cover excess charges if a provider charges more than the Medicare-approved amount of charges.

Medicare Plan N has cost sharing with some Part B coinsurance including a $20 copay for some doctor visits and a $50 copay for Emergency Room visits that do not lead to a hospital admission.

People who do not generally have frequent doctor visits and who do not suffer from chronic or serious medical conditions may choose Medicare Plan N because the lower monthly premiums can save them money each year. They like the advantage of not paying for more coverage than they need.

How Much Does a Medicare Supplement Plan in Pennsylvania Cost?

The cost of a Medigap plan in Pennsylvania varies according to age, location of residence, gender, and choice of insurance company.

Medigap plans are standardized, meaning each plan by the same letter name will have the same benefits, but each insurance company sets its own price for the health plan.

Women are generally healthier than men, so they may pay lower premiums.

A beneficiary at age 70 and up will be more likely to need more prescription drug coverage and more frequent provider visits, leading to higher premiums. Healthier individuals may enjoy somewhat lower monthly premiums.

The average cost of a Medicare Supplement plan premium in Pennsylvania is in the range of $145 to $220.

A 65-year-old man in the Keystone State will probably pay the following monthly premiums:

• Medicare Plan F – $133
• Medicare Plan G – $118
• Medicare Plan N – $90

When Can I Apply for a Medicare Supplement Plan?

The Medicare Supplement Open Enrollment Period (OEP) takes place at the time of each recipient’s Initial Enrollment Period (IEP). This begins the first day of the month the individual turns 65 years old and is enrolled in Medicare Part B and ends 6 months later.

During this time, you can enroll in the Medicare Supplement plan of your choice without a physical exam (Medical underwriting) and regardless of pre-existing conditions. You cannot be turned down or charged a higher premium than a healthier individual.

After the Medicare Supplement Open Enrollment Period, you may be able to enroll in a Medigap plan, but you may have to undergo Medical Underwriting, pay a higher premium, or be turned down by the insurance company.

Guaranteed issue rights may be granted in the following situations:

• You have Medicare Part C (Advantage plan) and your plan stops providing care in your area, you move out of the area, or the plan is removed from Medicare plans
• You have employer-based coverage (or Cobra/retiree insurance) along with Medicare Part A and B, and your employer-based insurance drops off
• You switched from a Medigap policy to a Medicare SELECT or Advantage plan, and decided to switch back in less than a year

Other situations may give you Guaranteed Issue Rights, so ask an insurance agent if any apply to you. Your agent can provide information about Life Insurance policies if needed. This is a good time to discuss the best prescription drug plan for your specific needs.

Learn more about Pennsylvania Medicare Coverage

https://medicare.com/state/pennsylvania-medicare/