Medicare Advantage Plans in Pennsylvania

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.

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.

*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.

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.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources