The Keystone State has one of the largest number of Medicare Supplement enrollees in the country. More than half a million residents have a policy that helps them manage their Medicare out-of-pocket costs.1 And there are multiple Medicare Supplement plans in Pennsylvania to choose from.
What Are Medicare Supplement Plans in Pennsylvania?
Medicare Supplement in Pennsylvania is a private insurance plan that helps fill the coverage gaps in Original Medicare, or Part A (hospital services) and Part B (doctor and preventive care). These gaps are mainly out-of-pocket costs, such as copayments, coinsurance, and deductibles. You’re responsible for paying these expenses when you use your benefits, and there’s no cap on total expenses. That’s where Medicare Supplement, also called Medigap, comes in. It helps cover some or all of these leftover costs.
There are 10 standard types of Medigap policies available to Pennsylvanians 65 and older as well as those under 65. Each plan is represented by a letter: A, B, C, D, F, G, K, L, M, N. But if you were first eligible for Medicare on or after January 1, 2020, you can’t enroll in Plans C or F. Benefits are the same among all companies that sell Medigap policies, but prices vary.2
How Do You Choose a Medigap Policy in Pennsylvania?
Medigap may be right for you if you want coverage for your out-of-pocket costs under Original Medicare. Your medical needs, budget, and lifestyle are also important factors to consider.
Here are some questions that can help you decide:
- Do you visit doctors and specialists often? A plan that covers the majority of your coinsurance or copayment may be right for you.
- Do you expect to need an extended stay in a hospital or skilled nursing facility? Consider a plan that pays your Part A coinsurance and deductible.
- Do you travel overseas often? Consider a plan that includes foreign travel benefits. Most Pennsylvania Medigap policies cover qualifying emergency care while overseas.
What You Need to Know
You pay a premium each month and your policy covers up to 100% of your approved out-of-pocket expenses after Medicare pays its portion.
You can choose from among 10 standard plans to fit your needs and budget as long as you’re enrolled in Original Medicare.
Your Medigap policy is accepted at any Medicare provider nationwide, and is guaranteed renewable as long as you pay premiums on time.
When Can You Enroll in Medigap?
More than 700,000 Pennsylvanians are enrolled in Medigap as of 2018. This number represents nearly 42% of Original Medicare beneficiaries in the state.3
You can enroll in a Medicare Supplement plan any time of the year. But the best time to sign up is during your Medigap Open Enrollment Period (OEP). In Pennsylvania, your Medigap OEP starts the month you enroll in Medicare Part B, whether or not you’re age 65 yet. Some states allow insurers to charge higher premiums to people under 65. But Pennsylvanians under 65 who sign up for Medigap during their OEP are protected from paying more based on age.4
During your six-month OEP, you can enroll in any Medigap policy at the best price available. Insurers can’t ask questions about your health, known as medical underwriting, to issue you a policy. Outside of your Medigap OEP, insurers are allowed to use medical underwriting. This means you can be denied coverage or charged more based on any health issues or preexisting conditions.
There are exceptions when you can get guaranteed issue Medigap coverage even if you’re outside of your OEP. These exceptions usually apply when you have another type of health insurance that changes or ends in some way.5
A Word of Advice
You can get the best plan at the best price during your Medigap Open Enrollment Period.
What If You Want to Change Your Medicare Supplement Plan?
All Pennsylvania Medigap policies have a 30-day “free-look period” in which you can cancel your policy and enroll in a different one. Insurers usually require that you keep your first policy active until the new one takes effect, which may require paying for two policies for one month.
You may have to go through medical underwriting if you change policies, which means you could pay a higher premium or be denied coverage. But that won’t apply if you’re still within your OEP or you have another guaranteed issue period.6
What Are the Most Popular Medigap Policies in Pennsylvania?
|Plan Type||Total Enrolled (Rounded)||Percent of Total Enrolled|
Medigap Policies F, G, or N are the most popular plans in Pennsylvania. They provide coverage for most of your Medicare out-of-pocket costs. Here’s an overview of each plan:
- Plan F is the most comprehensive. It covers all of your out-of-pocket costs, and is one of only two plans that covers the Part B deductible ($233 in 2021).7 There’s also a high-deductible version of Plan F that offers the same benefits.
- Plan G is the second most comprehensive and also has a high-deductible option. Plan G covers everything Plan F does, except the Part B deductible.
- Plan N is a close third, covering all expenses except the Part B deductible and the Part B excess charge.
Did You Know?
Plan benefits are the same, but prices vary by insurer.
What Is the Cost of Pennsylvania Medigap Policies F, G, and N?
Although all insurers that sell Medigap policies offer the same benefits, prices vary by company. Your age and tobacco usage can also determine how much you pay.
Below are Medigap premiums in Pennsylvania based on a non-tobacco-smoking, 65-year-old female and male:8
65-Year-Old Woman, No Tobacco Use
|Plan Type||Premium Range|
65-Year-Old Man, No Tobacco Use
|Plan Type||Premium Range|
Who Sells Medicare Supplement Plans in Pennsylvania?
There are more than 60 Medicare Supplement insurance companies in Pennsylvania as of November 2020. Some of the most popular companies include:9
What Are Alternatives to Medigap?
Medicare Advantage, also called Medicare Part C, is another type of plan that helps fill the gaps in Original Medicare. Part C plans work much like HMO and PPO plans in that they provide comprehensive coverage and typically require using provider networks. Unlike Medigap, which helps pay for out-of-pocket costs, Medicare Advantage plans include Medicare Part A and B, and many offer extra benefits like dental, vision, and prescription drug coverage. If you choose Medicare Advantage, you can’t have a Medigap policy at the same time.
What Are Medicare Supplement Resources in Pennsylvania?
Medicare beneficiaries in Pennsylvania have a number of resources to learn about Medicare Supplement plans and get financial assistance. Here are some options:
- Pennsylvania State Health Insurance Assistance Programs (SHIP) provides Medicare counseling to seniors through the Department of Aging.10
- Pennsylvania’s Insurance Department is the official government source to learn about Medicare Supplement in Pennsylvania, search for an insurance company, or file a complaint.11
- Medicare Savings Programs in Pennsylvania are available to low-income beneficiaries through the state’s Department of Aging. You typically need to be eligible for both Medicare and Medicaid to get financial assistance with premiums, deductibles, and copayments. However, you might not need Medigap if you’re eligible for full Medicaid benefits.12
- The Medicare Part D Low-Income Subsidy (LIS) program, also called Extra Help, is available through the Department of Social Security. If you qualify, you can get help to pay your prescription drug plan premiums, deductibles, and coinsurance.13
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If you’re ready to explore your options for a Medigap policy, you can choose from among several insurance companies in the state or use this free tool to find a Pennsylvania Medicare Supplement plan today.
1. AHIP. “State of Medigap: Trends in Enrollment and Demographics.” ahip.org (accessed November 22, 2020).
2. U.S. Government Website for Medicare. “Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare.” medicare.gov (accessed November 22, 2020).
4. Commonwealth of Pennsylvania. “Subchapter K. Medicare Supplement Insurance Minimum Standards.” pacodeandbulletin.gov (accessed November 30, 2020).
7. U.S. Government Site for Medicare. “Part B Costs.” medicare.gov (accessed November 27, 2020).
8. U.S. Government Website for Medicare. “Supplemental Insurance (Medigap) Plans in Pennsylvania.” medicare.gov (accessed November 27, 2020).
9. Pennsylvania Insurance Department. “Pennsylvania Medicare Supplement Available Plans.” insurance.pa.gov (accessed November 30, 2020).
10. Pennsylvania SHIP. “Pennsylvania Department of Aging.” aging.pa.gov (accessed November 30, 2020).
11. Pennsylvania Insurance Department. “Medicare Supplement Coverage.” insurance.pa.gov (accessed November 30, 2020).
12. Pennsylvania Insurance Department. “Medicare Cost-Savings Programs.” insurance.pa.gov (accessed November 30, 2020).
13. U.S. Social Security Administration. “Extra Help With Medicare Prescription Drug Plan Costs.” ssa.gov (accessed November 30, 2020).