Pennsylvania residents have a number of Medicare Advantage plan options to choose from. See which plans are the top options in the state, and learn how you can quickly and easily compare plans online.
Original Medicare ( Medicare Part A and Part B ) offers hospital and medical insurance to beneficiaries, which may be sufficient healthcare coverage for some. However, if you’re looking for more coverage, you may be considering a Medicare Advantage plan ( Medicare Part C ).
MA insurance plans bundle Original Healthcare with additional coverage such as Medicare Part D drug coverage. These plans often include other benefits like vision, dental, hearing, and skilled nursing facility care as well. However, these plans can be a bit difficult to compare since they’re provided by private insurers that set plan costs and benefits.
Want to compare your Pennsylvania Medicare Advantage options? See all the plans in your service area in one place with the Insurify Medicare comparison tool.
The MA plans available to you will vary depending on your county of residence. However, knowing the top eight plans in the state can help you determine if you’re getting a good deal with the plans you’re interested in.
1.Complete Blue PPO Distinct (PPO) - Score: 76.76
2. Community Blue Medicare PPO Signature (PPO) - Score: 76.76
3. Community Blue Medicare PPO Distinct (PPO) - Score: 76.76
4. Community Blue Medicare Plus PPO Signature (PPO) - Score: 76.76
5. Community Blue Medicare Plus PPO Distinct (PPO) - Score: 76.76
6. Aetna Medicare PennHighlands Prime (HMO) - Score: 74.68
7. Aetna Medicare Beaver Valley Prime (HMO) - Score: 74.68
8. Aetna Medicare Advantra Washington Prime (HMO) - Score: 74.68
The plans below were selected based on a few factors, including their Medicare star ratings, monthly premium and deductible costs, and out-of-pocket maximums. Plan benefits were also considered in the rankings. To learn more about each plan, visit the provider’s website, where you’ll find a list of benefits and possible requirements, such as seeking care from the plan’s network of providers.
Premium: $35
Deductible: $0
Out-of-pocket maximum: $6,500
This plan offers $0 copays for Tier 1 generic prescriptions. And you’ll get $0 office visits for preventive and primary care, whether you go in-network or out-of-network. There’s also generous coverage for in-network hearing, preventive dental, comprehensive dental, and routine vision care.
Add to that low copays for specialist visits, foot care, and emergency care —p lus covered wellness programs and high customer service marks. And you can see why this plan made the top of the list.
Premium: $0
Deductible: $0
Out-of-pocket maximum: $7,550
Here’s another plan with $0-$15 copays for Tier 1 and Tier 2 drugs. And you’ll find a lot of low-cost care for office visits out of network. Plus $0 visits for preventive and primary care and low cost diagnostics and lab services.
You’ll get hearing coverage for $35 copays, preventive dental at $15 per office visit, and $0 copays for vision care. Plus low-cost mental health, foot care, and covered wellness programs.
Premium: $35
Deductible: $0
Out-of-pocket maximum: $6,500
This plan has $0–$15 co-pays for Tier 1 and Tier 2 drugs. For in-network doctor visits, expect to pay $0 for primary care and preventive care. It’s just $25 for specialist care. And doctor visit rates are the same whether you work in or out-of-network.
Your hearing exams will cost just a $25 copay. Preventive dental and routine vision have $0 copays. And you’ll get low copays for diagnostic services, mental health, and foot care.
Premium: $0
Deductible: $0
Out-of-pocket maximum: $7,550
It shouldn’t come as a surprise that another Blue Cross plan is going to offer you low costs on most common care. Plus low cost on office visits even when they’re out of network. This plan is no different.
You’ll get low copays for prescriptions, doctor visits, emergency care, and diagnostic services. The same goes for hearing, preventive dental, and routine vision. Plus covered wellness programs like your gym membership and a nursing hotline.
Premium: $35
Deductible: $0
Out-of-pocket maximum: $6,550
Here’s the final Blue Cross plan to make it to the list. This plan offers similar bells and whistles as the previous plans. That includes low-cost prescriptions, low-cost doctor visits in and out of network, and low-cost diagnostic services.
Plus hearing, preventive dental, and routine vision all at reasonable rates. You also get $40 copays for mental health and rehabilitation services. Plus a covered wellness program.
Premium: $0
Deductible: $0
Out-of-pocket maximum: $7,550
Unlike the Blue Cross plans, Aetna plans don’t offer out-of-network coverage. But, that may be the reason Aetna plans are able to offer so much low-cost care. For example $0 copays for Tier 1 and Tier 2 drugs when you use a preferred provider. A $0 health plan deductible. And $0 for primary and preventive care doctor visits, lab services, and diagnostic services (except diagnostic radiology).
Hearing exams are $35, but fittings and hearing aids have a $0 copay. And you’ll get $0 copays for preventive dental and routine vision care.
Premium: $0
Deductible: $0
Out-of-pocket maximum: $7,550
Tier 1 and Tier 2 drugs in this plan require $0 co-pays when you use a preferred retailer. D octor visits require $5 co-pays for primary care and $40 for specialist care. But preventive care doctor visits are $0.
A hearing exam co-pay is $40. Most routine vision and preventive dental benefit co-pays are $0. For most comprehensive dental benefits, expect to pay 20–50 percent coinsurance.
Premium: $0
Deductible: $0
Out-of-pocket maximum: $7,550
With as low a monthly premium as you could get, this plan offers a ton of other low-cost benefits. That includes $0 copays for both Tier 1 and Tier 2 prescriptions so long as you use a preferred retailer. There are $0 copays for preventive and primary care doctor visits. And just $30 to see a specialist.
You’ll also get low or no-cost copays for hearing, preventive dental, and routine vision. Low cost rehabilitation services and foot care. Plus a covered wellness program.
Ready to compare the plan options available in your ZIP code? See which plan benefits you best by using the Insurify Medicare comparison tool.
If you’re looking for a Medicare Advantage plan in Pennsylvania, be prepared to possibly pay more than the national average for your plan premium. However, you could also find a plan with a $0 premium or even a $0 deductible, such as a few of the options above.
Keep in mind that each insurance company determines plan costs and benefits, so it’s important to compare them thoroughly to determine which one has the best mix of benefits for you. You can also check each plan’s formulary to see which prescription drugs are covered and how much you will pay for medications.
A Medicare Advantage health plan bundles Medicare Parts A and B coverage with additional health benefits. These can include traditional benefits, like vision, dental, and hearing, and additional benefits, like drug coverage, wellness benefits, and nursing home care.
Eligibility for a plan usually begins when you enroll in Original Medicare. However, beginning January 1, 2021, those with end-stage renal disease (ESRD) can enroll in an MA plan without first enrolling in Original Medicare coverage. Enrollment in a plan also depends on where you live, since certain plans are only available in specific areas.
You can join an MA plan either when you’re first eligible or during Medicare’s Open Enrollment Period each year (October 15 to December 7). During the Medicare Advantage Open Enrollment Period (January 1 to March 31 each year), you can change your MA health insurance plan or go back to Original Medicare coverage.
There are four main types of MA plans, all of which you can find in Pennsylvania. The four most common types are health maintenance organization ( HMO ) plans, preferred provider organization (PPO) plans, private fee-for-service ( PFFS ) plans, and special needs plans ( SNPs ).
HMO plans generally:
Require you to see an in- network provider
Provide prescription drug coverage
Require you to pick a primary care doctor
Require referrals for specialist care
PPO plans typically:
Have lower costs for in-network care
Usually cover prescription drug costs
Don’t require you to choose a primary care doctor
Don’t require referrals for specialist care
PFFS plans:
May or may not have a provider network
May allow you to see any doctor (in or out of the network) who agrees to treat your plan’s members
May or may not provide prescription drug coverage
Usually don’t require you to pick a primary care doctor
Usually don’t require specialist referrals
SNPs:
Only offer membership to individuals with certain diseases or characteristics
Usually require you to see an in- network provider
Must offer drug coverage
Usually require you to have a primary care doctor or care coordinator
Usually require referrals for specialist care
See More: What Is Medicare Advantage and Is It Right for You?
Prescription drug plans and MA plans can be purchased together if the MA plan doesn’t include drug coverage. If you purchase an MA plan with drug coverage and then purchase a separate drug plan, you’ll be disenrolled from the MA plan and returned to Original Medicare coverage.
Medigap plans help pay Medicare co-payments, coinsurance, and deductibles while offering additional health benefits to “fill in the gaps” of Original Medicare. While MA plans are more varied from plan to plan, there are 10 standardized Medigap plan options that you can purchase to use along with your Medicare coverage. Plus, you can’t have an MA plan and a Medigap plan at the same time.
Medicare beneficiaries who meet requirements for Medicaid benefits may be eligible for dual enrollment. You can learn more about dual enrollment on the Centers for Medicare & Medicaid Services website, cms.gov.
There are a number of Medicare Advantage coverage options in Pennsylvania, and each plan offers a unique mix of benefits. Costs vary from plan to plan, too, which can make it difficult to pick the right option.
To make sure you’re picking the right plan, consider comparing all your options in one place.
Start comparing your options quickly and easily today with the Insurify Medicare comparison tool.
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