Medicare Supplement (Medigap) Plans in Pennsylvania
Key Takeaways
- Medicare Supplement Plans are optional insurance plans you can add to Original Medicare.
- These plans can help reduce your out-of-pocket costs and are sold through private insurance companies.
- Medicare Supplement Plans, also called Medigap, can be used to pay for things like deductibles and copayments you would normally pay with Original Medicare.
- Medigap plans cannot be added on to Medicare Advantage plans.
What are Medicare Supplement Plans?
Medicare Supplement Plans are private insurance plans that you can add on to your Original Medicare. These optional plans can be used to help pay for your share of the cost for Medicare-covered services.
There are several types of these plans, also known as Medigap plans. Each plan offers different coverage, rates and availability. Because Medigap plans are private plans, you might not find the same plans or rates everywhere. You will have to check with insurance companies in your region to see what specific plans are available and how much they will cost.
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Pennsylvania Medicare Supplement Plan Coverage
There are several types of Medigap plans, and some have high-deductible versions. The federal government sets rules for what each plan must cover, but some insurance companies may not offer all of these plans. Plans can’t offer less coverage than the federal government requires, but they can include additional coverage.
All Pennsylvania Medigap plans will cover:
- Medicare Part A coinsurance for hospital and hospice care
- Medicare Part B coinsurance and copayments
- Blood needed for medical procedures (first 3 pints in a year)
- Part A coinsurance for skilled nursing care facility
- Part A deductible
- Part B excess charges
- Up to 80% of foreign travel emergency healthcare
Pennsylvania Medigap Plan Costs
Medigap rates can vary based on the insurance company offering the plan. Some plans also determine costs based on age and medical condition, while others price premiums based on market conditions rather than age.
Monthly premiums for Medigap plans in Pennsylvania range from $46 to $983 for a standard plan in 2022 and $32 to $252 for a high-deductible plan. For most of these plans, the Part B deductible is $233, and copayments are nothing or minimal once this deductible is met. Your exact cost will depend on where you live, the insurance company you choose, and your overall health.
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Medicare Supplement Plan Eligibility & Enrollment in Pennsylvania
If you are eligible for Original Medicare, you can purchase a Medigap plan. If you don’t buy a Medigap plan when you are first eligible for Medicare, though, there’s no guarantee that you will be able to buy a plan later on. If you can still buy a plan, you could end up paying more for it.
You will get the best prices and the most choices if you purchase a Medigap plan during the initial six-month open enrollment period when you first become eligible. This period begins the first month you have Medicare Part B coverage. After this initial period, you may not be able to buy a plan at all — especially if you have pre-existing health conditions.
If you decide to add a Medigap plan to your Original Medicare, you should start by reviewing the different types of plans. Next, compare which insurance companies offer the plans that best fit your needs and budget. You can use Medicare’s online plan finder tool to help you locate plans and providers in your zip code. Or you can call GoHealth to speak to one of our licensed insurance agents who can help you compare plans.
Are There Pennsylvania Medicare Supplement Plans with Prescription Drug Coverage?
At one point, Medigap plans were allowed to include prescription drug coverage. That changed in 2006. If you bought a Medigap plan before January 1, 2006, you can keep your coverage, but if you ever remove your drug coverage you won’t be able to add it back on later.
While you can’t include drug coverage in your Medigap plan anymore, you can still get stand-alone prescription plans through Medicare. To get prescription drug coverage, you will need to purchase a Medicare Part D plan.
If you do have drug coverage from a Medigap plan purchased before 2006, you cannot be enrolled in a Part D plan at the same time.
Medigap vs. Medicare Advantage in Pennsylvania
Medigap plans can only be purchased with Original Medicare, so if you enroll in a Medicare Advantage plan, you will have to cancel your Medigap policy.
Medicare Advantage plans already combine all of the elements of Original Medicare plus optional services like prescription coverage, hearing and vision coverage, and more. If you switch from Original Medicare with a Medigap plan to a Medicare Advantage plan and you’re not happy with your choice, you will have a one-time, 12-month grace period where you can switch back to your old plan or select a new Medigap plan.
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Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- When can I buy Medigap? Medicare.gov.
- Find a Medigap policy that works for you. Medicare.gov.
- What’s Medicare Supplement Insurance (Medigap)? Medicare.gov.
- How to compare Medigap policies. Medicare.gov.
- Supplement Insurance (Medigap) plans in Pennsylvania. Medicare.gov.
- Buying your Medigap policy. Medicare.gov.
- Medigap & Medicare drug coverage (Part D). Medicare.gov.
- Medigap & Medicare Advantage plans. Medicare.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.