Read this guide to find out how to find the best Medicare Advantage plans in Pennsylvania. We'll look at the basics as well as some of the specifics for comparison.

By Joseph Arroyo
Updated July 1, 2020

Key Takeaways:

  • In Pennsylvania, Medicare Advantage out-of-pocket maximums in 2020 range from $2,900 to $6,700
  • Premiums in Pennsylvania range from $0 to $301 per month for Medicare Advantage plans
  • Pennsylvania has a large mix of Medicare Advantage plans offering prescription drug coverage
  • Many Medicare Advantage plans offer extra benefits beyond Original Medicare

Have you wondered about Medicare Advantage plans, and whether one could be right for you? If you want to know what Medicare Advantage plans are, what they cover, and how the premiums can be so low, read this quick guide.

Find the Best Medicare Advantage Plan in Pennsylvania

We'll start off by giving a few basics about the Medicare Advantage program. Medicare Advantage plans are also known as Part C plans. These plans are offered by private insurance companies. Medicare Advantage plans are a replacement for Original Medicare. So, when you have a Part C plan, you're no longer in Original Medicare.

Not to worry, though: Medicare Advantage plans are required to cover everything that Part A and B cover. You won't miss out on any benefits by enrolling in Medicare Advantage. In fact, you'll probably have more benefits than under Original Medicare.

People usually choose a Medicare Advantage plan to save money compared to Original Medicare. Part C can save you money by closing some of these gaps in Original Medicare:

  • Deductibles and co-payments or coinsurance
  • No out-of-pocket maximum (OOPM) protection
  • No prescription drug coverage

Lack of out-of-pocket protection and prescription drug coverage are the two biggest gaps in Original Medicare. Without a cap on your out-of-pocket spending, you could be on the hook for tens of thousands of dollars, or more.

Medicare Advantage plans solve both of these problems. They all have an annual cap on spending. And, many of them also offer prescription drug coverage.

Types of Medicare Advantage Plans in Pennsylvania

Medicare Advantage plans come in three main types:

There are a couple of other, more obscure Part C plan types, but they are fairly rare. HMO plans are the most common. These Medicare Advantage plans have a network of doctors and providers. You must use network facilities and providers.

Otherwise, the plan will not cover your services and procedures. An exception to this would be if you need emergency services outside of your plan's service, like visiting another state. In this case, the plan would cover your treatment.

With an HMO plan, you will have a primary care physician. This physician will refer you to specialists as needed.

PPO plans are a little less common. These plans have a network of preferred providers. If you use them, you will pay the lowest amounts of cost sharing (copayments and coinsurance) but you're not required to use the preferred providers. You can go out of network and the plan will still cover your services. However, your cost-sharing will be higher in this case.

Private Fee-For-Service plans are much less common. With PFFS, the plan specifies a set amount it will pay for every service and procedure. Doctors and facilities can choose to accept the plan terms if they want to. It's up to you to make sure that your doctor will accept the plan's terms before you receive treatment.

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Cost of Medicare Advantage Plans in PA

Every Medicare Advantage plan may have the following types of cost:

  • Monthly premium
  • Annual deductible
  • Copayments and coinsurance

In Pennsylvania, there are many Part C plans that don't have a monthly premium, while some change hundreds of dollars. You might wonder how that can be.

The short answer is that when you're in Medicare Advantage, your insurance company pays your medical bills. In return, the federal Medicare program pays your insurance company a certain amount to help with your bills. This is how you can have Medicare Advantage coverage for $0 per month.

Medicare Advantage plans that charge higher premiums may offer some of the following benefits:

  • Lower out-of-pocket maximums
  • Lower copays or coinsurance for each service
  • Expanded provider networks (more choices for doctors and hospitals)
  • Enhanced extra benefits

Regardless of which plan you choose, or how much your premium is, you have the peace of mind that no matter how many services or procedures you need during a year, your expenses will be capped.

Eligibility For Medicare Advantage Plans PA

If you're eligible for Medicare Parts A and B, you're eligible for Medicare Advantage. The only exception is for people with end-stage renal disease (ESRD). Generally, Medicare Advantage plans won't accept patients who have ESRD. However, if you develop ESRD after you're enrolled in a Part C plan, you can keep your coverage, and dialysis treatments are covered by all plans.

Another very important thing to keep in mind is that you must continue to pay your Part B premium. If you stop paying the Part B premium, your Medicare Advantage coverage will end.

Are Medicare Advantage Plans in PA a Good Fit For You?

It's time to help you decide if these benefits are good for you. When you're assessing a specific plan, ask yourself these questions:

  • Can I afford the monthly premium?
  • Is the out-of-pocket maximum low enough that I won't be financially ruined in a high-expense year?
  • Do my doctors accept this plan?
  • Are my medications covered by this plan, at a price I can afford?

If you've found more than one plan that fits these requirements, then you should compare them on the basis of extra benefits. Extra benefits are benefits provided by a Medicare Advantage plan that are not covered by Original Medicare. Extra benefits can include:

You should keep in mind that extra benefits are not guaranteed by the Medicare program, and they sometimes change from year to year. However, if you need vision or hearing care, you should try to find a plan with a good hearing and vision benefit.

Sifting through all of the networks, benefits, and costs of Medicare Advantage plans can be intimidating. The easiest way to find the best Medicare Advantage plans in Pennsylvania is to contact a licensed professional. They can work with you to make sure your doctors will take your plan, that your drugs are covered, and that you're paying the lowest premium possible.

Joseph Arroyo is a licensed Medicare insurance specialist who lives in Hilton Head, South Carolina. Arroyo is certified to sell Medicare products including Medicare Supplement insurance, Medicare Advantage, and prescription drug plans.