Table of Contents

Medicare Plans by State

STATE -Select-
  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Page Reviewed / Updated – December 20, 2023
Reviewed by Dr. Brindusa Vanta, MD

Medicare is a federal health care program for adults aged 65 and older and younger people with qualifying disabilities. By 2022, 65 million citizens had enrolled in the program, with seniors making up 57.3 million of beneficiaries. Forward to 2023, Pennsylvanians comprise 2.8 million of the cohort, which, according to the latest financial data, costs the Commonwealth of Pennsylvania $15.8 billion annually. However, a growing number of Pennsylvanians are switching to Medicare Advantage. In 2022, 49% had signed up for a plan, rising to 51% the following year. The country’s average is 48%, suggesting Pennsylvanians are slightly keener to move away from Original Medicare.

Medicare’s foundation is Original Medicare, also called Part A and Part B. The former covers essential services, such as hospital stays, blood transfusions, skilled nursing care and limited home health care. The latter covers outpatient services, including primary care physicians, medical transportation, medical equipment and supplies. Most beneficiaries of Part A don’t pay a premium, but, as of 2023, Part B’s recipients must pay $164.90 per month. Medicare Part D provides coverage for prescription drugs. Premiums vary between beneficiaries because several factors influence costs, particularly the individual’s drug prescription and the tier their drugs have been assigned. 

Medicare Advantage, known as Part C, consolidates the coverage provided by Parts A and B into one plan, minus hospice care. As of 2023, Pennsylvanians can choose from 262 plans, 22 more than the previous year. While the Centers for Medicare and Medicaid Services (CMS) administer Original Medicare, approved private insurance companies are responsible for Part C plans. Premiums start at 0%, but they rise as beneficiaries add more coverage, such as hearing, vision and dental care. As a consequence, Pennsylvania’s median monthly premium is $30.05, an 11% reduction on 2022’s average. Seniors concerned about the expenses Medicare doesn’t cover, such as deductibles, co-pays and coinsurance, can enroll in a Medicare Supplement Insurance plan, commonly known as Medigap. 

This guide considers Medicare options in Pennsylvania, including how to tailor plans to suit specific needs. It also lists several resources that can help seniors get the most from Medicare.

Options for Medicare Coverage in Pennsylvania

Original Medicare can be a great choice for many seniors, but it isn’t right for everyone. Pennsylvania seniors have several other options for structuring their benefits in ways that better suit their particular needs. In addition to the basic Medicare program, seniors may be eligible to participate in Medicare Advantage, Medigap and private health insurance designed for seniors.

Original Medicare (Parts A & B)

Original Medicare enables access to the same care services nationwide, including when beneficiaries are vacationing or relocating to another state. However, Medicare rarely pays medical costs outside the United States. Consequently, it’s recommended that Americans traveling to other countries purchase appropriate health insurance before they leave.

Original Medicare beneficiaries must pay an annual deductible, which, as of 2023, is $1,600 for Part A and $226 for Part B. Furthermore, they must pay their medical costs when they receive the service. However, Original Medicare subsequently covers 80% of the fee for eligible services, with the beneficiary covering the remaining 20%. 

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

  • Travel frequently within the United States
  • Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
  • Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Original Medicare’s coverage is uniform nationwide, but Medicare Advantage’s flexibility enables personalized coverage. There are five types of plans, each of which can be adapted by approved private insurance companies to ensure their clients get the care services they want at their preferred price point. For example, PFFS plans give beneficiaries wider networks of providers, allowing more choice over who delivers medical care. Conversely, HMO plans have restricted networks, but premiums are often lower. Every plan the insurance company develops must conform to CMS rules and regulations, which are intended to protect consumers and ensure standards are maintained.

Who Should Consider Medicare Advantage 

Medicare Advantage may be a good option for those who: 

  • Want to limit out-of-pocket costs 
  • Need extra benefits such as vision and dental care 
  • Are generally healthy and may benefit from low premiums 
  • Are comfortable with managed care 

The Top 10 Medicare Advantage Plans in Pennsylvania 

Pennsylvania seniors live in a state with several highly rated Medicare Advantage plans open to them. The table below lists the top Part C providers according to their enrollment figures. The list gives prices for each provider, which are current as of August 2023. Visit the Medicare Advantage Plans in Pennsylvania page for the most up-to-date information about these plans.

Enrollment Medicare Star Rating Monthly Cost Range Plan Types
Aetna Medicare 399,055 3.5 $0 – $197 PPO, HMO
Highmark Inc. 225,381 5 $0 – $285 PPO, HMO
UPMC for Life 166,491 5 $0 – $295 PPO, HMO
Independence Blue Cross 107,968 4 $0 – $277 PPO, HMO
Humana 104,373 4 $0 – $123 PPO, HMO, PFFS
Geisinger Gold 99,881 4.5 $0 – $155 PPO, HMO
UnitedHealthcare 65,405 3 $0 – $44 PPO, HMO
Cigna 44,656 3 $0 – $118 PPO, HMO
Capital Blue Cross 34,006 4 $0 – $174 PPO, HMO
Wellcare by Allwell 11,989 2.5 $0 – $14 HMO

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

  • Currently take prescription medication or expect to in the future
  • Want to avoid late enrollment penalties
  • Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

  • Have ongoing health issues and expenses
  • Travel overseas often
  • Want to access an expanded network of health care providers
  • Expect to need health services not covered by Original Medicare

Medicare Resources in Pennsylvania

Pennsylvania seniors have a lot of options for how to structure their Medicare, Medigap and other health insurance plans. Finding the right programs and successfully applying for coverage can be challenging, especially for seniors navigating the system for the first time. Fortunately, Pennsylvania has several state and private nonprofit resources available to help out. These agencies have trained counselors who can answer questions about health insurance, Medicare in particular, and assist seniors with filing for and structuring their benefits.

Pennsylvania Medicare Education and Decision Insight (PA MEDI)

PA MEDI is the recently adopted name for Pennsylvania’s previous Health Insurance Counseling and Assistance Program (HICAP). Trained HICAP counselors help seniors find and apply for Medicare coverage fitted to their needs, as well as screenings for benefits eligibility and financial assistance. Program counselors help seniors and their loved ones navigate Medicare and related health insurance options in Pennsylvania, and they offer limited assistance with appealing a denial of benefits if necessary.

Contact Info

Seniors can reach PA MEDI by phone at 800-783-7067 or online at the program’s website. Callers can speak to a live operator from 8 a.m. to 5 p.m. Monday through Friday.

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Pennsylvania Association of Area Agencies on Aging

Pennsylvania’s 52 Area Agencies on Aging (AAA) work together to provide excellent regional coverage to help seniors in every part of the state. Local agencies have trained HICAP counselors available to explain Medicare benefits and requirements for seniors or help organize applications and appeals. Benefits counselors can also offer advice and education on a variety of other senior-related topics, including nutrition support and civil legal aid.

Contact Info

Seniors can get help directly from their local AAA. A list of agencies is available online on the Pennsylvania Association of Area Agencies on Aging’s website. For help finding an AAA, seniors can call 717-541-4214.

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Department of Insurance

Pennsylvania’s Department of Insurance is responsible for issues relating to consumer rights, information and counseling in all insurance matters. Seniors can visit the department online to read about current insurance alerts and fraud warnings, look over fact sheets that explain the various insurance options available in the state and contact the department to ask a question or report problems. The department can answer basic questions about how Medicare and Medicaid operate in Pennsylvania, and department staff can provide referrals to outside agencies for seniors who need more personal assistance.

Contact Info

Pennsylvania seniors can visit the Department of Insurance online or reach a department staff member by calling 877-881-6388. The statewide hotline operates during normal business hours.

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PA Health Advocates

Pennsylvania’s nonprofit PA Health Advocates provides Keystone State seniors with reliable, unbiased advice about their Medicare and other benefits. Trained HICAP counselors at PA Health Advocates offer one-on-one counseling and education sessions to help seniors apply for and structure their health choices to get the best coverage for their unique needs. Information is available for Medicare, Medicare Advantage, Medigap, Medicaid and private health insurance for Pennsylvania seniors. 

Contact Info

Seniors can find PA Health Advocates online or reach the statewide hotline by calling 717-400-1244 from anywhere in the state.

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Senior Medicare Patrol

The Senior Medicare Patrol (SMP) is a helpful volunteer-based nonprofit resource that helps seniors understand their Medicare benefits and protect themselves from waste, fraud, and other system abuse. Trained counselors at SMP can help beneficiaries identify unusual or unauthorized charges on their invoices, spot fraudulent use of their identity and report suspected benefits misuse cases that might interfere with their own coverage. The SMP also keeps up-to-date warnings on its website about likely signs of fraud and various known Medicare benefits scams.

Contact Info

Seniors can reach Pennsylvania’s SMP by phone at 800-356-3606 or online on the agency’s website. The SMP maintains up-to-the-minute information, updates and alerts on its Facebook and Twitter pages.

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Social Security Administration

The federal Social Security Administration (SSA) provides helpful information on its website about the Medicare program and related coverage types, including Medicare Advantage and Medigap. Seniors can use the SSA’s online portal to check their eligibility for benefits, including Medicare Savings Plan participation, sign up for benefits or request a replacement card. The SSA also offers fact sheets to help seniors better understand how each program works.

Contact Info

Pennsylvania seniors can visit the SSA online on the administration’s online benefits hub. They can also reach the SSA by phone at 800-772-1213.

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