Medicare in Pennsylvania
Key Takeaways
- Applying for Medicare in Pennsylvania when you approach age 65 is easy, but it’s important that you understand the coverage and costs involved.
- Supplemental insurance can help with out-of-pocket costs associated with both Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
- Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans can help you get additional coverage like dental and vision plans.
Pennsylvania is a treasure trove of American symbols. The Liberty Bell. Independence Hall. The cheesesteak. Deciding between historic sites is as easy as crossing the street. It’s the same with deciding between Pat’s or Geno’s for lunch.
But deciding between healthcare insurance plans? That’s decidedly more difficult. That’s where GoHealth comes in.
How Do I Get Medicare in PA?
You are eligible to get Medicare in Pennsylvania if you’re a U.S. citizen or permanent resident age 65 or older. You can be eligible for Medicare before 65 if:
- You have received Social Security Disability Insurance payments or Railroad benefits payments for 24 months, regardless of your age.
- You have end-stage renal disease or Lou Gehrig’s disease (ALS).
How to Enroll in Medicare in Pennsylvania
- You can enroll online with the Social Security Administration.
- You can enroll via phone by calling 1-800-772-1213 (TTY: 1-800-325-0778).
- You can enroll by visiting a local Social Security office.
Start your Medicare PlanFit CheckUp today.
What Does Medicare Cover in PA?
Medicare is a health insurance program that provides hospital and medical coverage for Americans ages 65 and over, and those under 65 with qualifying disabilities.
Medicare Part A and Part B
Part A of Original Medicare covers a portion of your hospital-related expenses, and Part B covers a portion of your other medical expenses.
Part D
Part D can be added to Original Medicare to cover a portion of your prescription expenses.
Part C
Medicare Advantage, also known as Part C, is available from private insurance companies and bundles those coverages while offering additional ones like dental and vision coverage.
How Much Does Medicare Cost in PA?
Premiums for Medicare in PA can vary. For most people who enroll in Medicare, Part A and Part B have standard costs that depend on your income and whether or not you’ve paid enough tax into Medicare and Social Security. Here’s a breakdown:
- For most Americans who contribute to Medicare and Social Security for at least 10 years through payroll, you won’t pay a monthly premium for your Part A plan.
- The standard Part B premium for 2025 is $185. Still, this monthly premium can increase based on individual or joint incomes.
- Medicare Advantage (Part C), Part D, and Medicare Supplement plans can vary in cost and benefits from state to state.
My Medicare coverage doesn’t address all of my needs.
What Is the Best Medicare Supplement Plan in Pennsylvania?
Private insurance companies offer Medigap, supplemental plans that help fill cost gaps for Original Medicare. Whether a plan is right for you depends on what you need covered in terms deductibles, copays, and coinsurance.
Within the first six months of enrolling in a supplement plan, a carrier cannot deny coverage based on pre-existing conditions. Beyond the six-month window, coverage and costs are not standardized.
What Are the Parts of Medicare?
Medicare Advantage plans bundle services, and this is a fundamental difference between Medicare plans in Pennsylvania.
- Medicare Advantage can substitute for Original Medicare. You get Part A and B benefits through a private insurance carrier. You also get drug coverage with most Medicare Advantage plans.
- Medicare Advantage plans offer additional coverage options not offered by Original Medicare like dental and vision and a monthly stipend for purchasing over-the-counter supplies.
- While Original Medicare can be used nationwide, Medicare Advantage is usually limited to a network of providers in your area. That distinction allows Medicare Advantage in Pennsylvania to often offer more affordable options.
What Is the Best Medicare Advantage Plan in Pennsylvania?
While there is a standard Original Medicare plan, Medicare Advantage in Pennsylvania offers multiple plan options to meet your needs. A GoHealth licensed insurance agent specializes in guiding you through the strengths of various plans, helping you make an educated decision.
Ready for a new Medicare Advantage plan?
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 2,616,214 people are enrolled in Medicare Part A and B in Pennsylvania. The total number of beneficiaries enrolled in Medicare Advantage increased from 1,219,894 to 1,293,353 year over year. Medicare Advantage participation in Pennsylvania went from 47.46% to 49.44% year over year. If you’d like to dive deeper into how Medicare in Pennsylvania breaks down across the state, we provide a glance at who is using Medicare and how.
2,616,214 Beneficiaries with Part A & Part B
1,293,353 Medicare Advantage Beneficiaries
49.44% Medicare Advantage Participation Rate
55.03% Female
44.97% Male
87.15% Non-Hispanic White
6.36% African American
2.28% Hispanic
4.20% Other/Unknown
16.24% Eligible for Medicaid
1 Average HCC Score
$10,405.70 Actual Per Capita Costs
18.09% Hospital Readmission Rate
26.49% % of Beneficiaries with an Emergency Department Visit
1,219,894 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
47.46% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
APPRISE - Medicare Counseling
Phone lines up M-F, 9 a.m. to 4 p.m.
https://www.aging.pa.gov/aging-services/medicare-counseling/Pages/default.aspx
What should I know about APPRISE?
Counselors on behalf of the Pennsylvania Department of Aging offer older Pennsylvanians free guidance to navigate Medicare.
COMPASS
Phone lines open M-F, 8:30 a.m. to 4:45 p.m.
https://www.compass.state.pa.us/compass.web/Public/CMPHome
What should I know about COMPASS?
The go-to source for Pennsylvanians looking to apply for Medicaid or other cost-saving services for those in need.
Pennie
Phone lines open M-F, 8 a.m. to 6 p.m.
https://pennie.com/
What should I know about Pennie?
Acts as the official Healthcare Marketplace for Pennsylvania residents.
Department of Military and Veterans Affairs
https://www.dmva.pa.gov/Veterans/Pages/default.aspx
What should I know about the Department of Military and Veterans Affairs?
Dedicated to meeting the needs of Pennsylvania veterans and their families.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Pennsylvania about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
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
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.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.