Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Residents of the United States who are 65 or older, or have certain disabilities, are eligible to apply for health care coverage under Medicare and related programs, including Medicare Advantage.
Medicare Advantage, also called Medicare Part C or MA, is privately offered health insurance that provides the same benefits that come with government-run Original Medicare’s Part A and Part B, and may offer more benefits as well. Every Medicare Advantage Plan must cover at least as many benefits as Original Medicare, except for hospice care under Medicare Part A. However, many Medicare Advantage plans include additional benefits not covered with Original Medicare, including vision, dental and hearing services; wellness programs; and transportation to medical appointments. Almost all Medicare Advantage Plans carry prescription drug benefits beyond Original Medicare, eliminating the need to pay for supplementary prescription coverage under Medicare Part D.
The Centers for Medicare & Medicaid Services regulate Medicare Advantage Plans, but MA providers are allowed to determine their own out-of-pocket cost limits and establish guidelines about using referrals and in-network and out-of-network health care services. In Pennsylvania, 2,818067 residents were enrolled in Medicare in December 2021, and 47% were enrolled in Medicare Advantage. This is slightly above than the national average of 42%.
This guide discusses MA Plans in Pennsylvania, explaining coverage details and eligibility criteria. It also offers seniors help in finding and enrolling in a Medicare Advantage Plan.
The Top 10 Medicare Advantage Plans in Pennsylvania
Medicare-eligible residents in Pennsylvania can find several private insurance companies offering a variety of Medicare Advantage Plans throughout the state. The following table lists Pennsylvania’s top 10 Medicare Advantage providers according to their enrollment figures. Most insurers carry multiple Medicare Advantage plans, so we’ve displayed cost information as a range rather than an average price. Also, we added the enrollment estimates for each provider’s MA plan together to arrive at a provider’s total enrollment statewide. This plan information was accurate as of April 2022. Check with Medicare.gov for up-to-date details on the plans available in your area.
UPMC for Life
Independence Blue Cross
HMO, PPO, PFFS
Capital Blue Cross
How Medicare Advantage Plans Work in Pennsylvania
It’s important to be clear on how Medicare Advantage works in Pennsylvania compared to Original Medicare before enrolling in the program. Insurance companies offer multiple plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Each type of plan lays out different stipulations regarding in-network versus out-of-network coverage, choosing a primary care provider, referrals and prescription drug coverage. Here, we describe the four most common plans in Pennsylvania:
What Medicare Advantage Plans Cover in Pennsylvania
Medicare Advantage Plans must offer the same services, rights and protections available under Medicare Part A and Part B. These services include preventive screenings, X-rays, lab tests, care provided during a hospital stay and emergency and urgent care. The exception is hospice care, which is covered by Medicare Part A. MA plans may also include provisions for some things not covered by Original Medicare, such as vision, dental and hearing services or fitness program memberships and discounts.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Durable Medical Equipment
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Pennsylvania
To qualify for Medicare Advantage, an applicant must already be enrolled in Original Medicare Parts A and B, live in the plan’s service area and satisfy all other Medicare eligibility criteria. They must also be at least 65 years of age or have a disability that qualifies them for Medicare at a younger age. Applicants must also be able to prove U.S. citizenship or lawful immigrant status. As with other types of health insurance, Medicare Advantage is open for enrollment at certain times during the year, so seniors should be sure to find out when to enroll in Medicare or change plans. The list below lets you know more about enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
Medicare Advantage Open Enrollment Period
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Pennsylvania
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Pennsylvania’s APPRISE program is a free Medicare, Medicaid and long-term care insurance counseling program. The program is operated by the Department of Aging, and administered through the statewide Area Agency on Aging network. APPRISE counselors can help seniors understand Medicare eligibility and enrollment criteria, Medicare Part A and B benefits, Medicare Part D prescription drug and Medicare Advantage plans. Seniors can book a one-on-one counseling session with a local APPRISE counselor, or schedule a phone consultation to discuss their specific situation. APPRISE counselors are also available to make presentations to seniors groups and community organizations.
The Center for Advocacy for the Rights and Interests of the Elderly, CARIE, launched the Pennsylvania Senior Medicare Patrol (PA-SMP) in 1997 to combat Medicare abuse, errors and fraud. The PA-SMP works to educate seniors and caregivers about Medicare Advantage scams, overbilling and other issues that can decrease care quality and increase health care costs. The SMP also operates ScamWire, an alert service that notifies seniors, caregivers and support agencies about emerging scams targeting older adults. PA-SMP services are delivered through a network of trained volunteers who give informational presentations to community, faith and seniors groups throughout Pennsylvania. Volunteers also staff information booths at health fairs and public events.
Low-income and isolated seniors aged 60 and older who need legal assistance can contact the Older Pennsylvanians Legal Assistance Program, or OPLAP. This program provides elders with access to free legal services including one-on-one legal advice and representation with civil matters. Seniors who have concerns about Medicare Advantage, Social Security, guardianship, age discrimination or elder abuse can use this program.
Seniors can contact the OPLAP by calling the Pennsylvania Department of Aging at 717-783-1550.
Pennsylvania Health Law Project
The Pennsylvania Health Law Project, or PHLP, is a nonprofit organization that works to improve access to health care for the elderly, people with disabilities and low-income adults. The PHLP operates a free helpline that seniors can call to connect with a legal advocate who will review the caller’s concerns and provide legal advice. The organization also provides free legal representation to clients who are struggling to pay health care costs, need support obtaining health care services or who have been denied coverage.
Seniors can contact the Pennsylvania Health Law Project by calling the PHLP helpline at 1-800-274-3258.
Pennsylvania Assistive Technology Foundation
The Pennsylvania Assistive Technology Foundation (PATF) is a nonprofit organization that works to connect older adults and people with disabilities with affordable assistive technology devices and services. Seniors who need mobility devices and other items that are not fully covered by their Medicare Advantage plan can contact the PATF to learn about low-cost loans for medical equipment, grants and other resources that can be used to supplement their MA plan benefits.
To contact the PATF, call 484-674-0506 or toll free at 1-888-774-1938.
Local Medicare Advantage Resources
Vintage Center for Active Adults
The Vintage Center for Active Adults provides services to Pittsburgh seniors to help elders avoid institutionalization, maintain community connections and stay active. The Center offers a variety of free and low-cost programs that seniors who are considering enrolling in a Medicare Advantage plan can utilize, including preventative screening services, one-on-one health behavior counseling and chronic condition management clinics that can help seniors assess their current and future health insurance needs. The Center also holds regular information sessions to keep seniors up to date on Medicare Advantage plans, regulations and related issues.