Medicare plans just like any other states in Pennsylvania too is designed for seniors and people with disabilities to serve them with high quality healthcare services. Nearly 2.7 million residents of Pennsylvania are enrolled in Medicare through different types of Medicare plans designed to offer benefits to the beneficiaries in Pennsylvania. Right from Original Medicare, to Medicare Advantage, to Prescription Drug benefit, to Medicare Supplement plans, seniors can access the benefits offered by these plans exactly as per their requirements. In Pennsylvania around 2,671,441 beneficiaries have access to Medicare benefits.
Original Medicare (Part A & Part B)
All the individuals qualifying for Medicare plans can sign up for Medicare Part A, which is hospital service and Part B, which is medical service through the Federal government. Beneficiaries do not have to pay any premium for Part A because this amount is paid by paycheck deductions from the beneficiaries or their spouse working years. However, beneficiaries need to pay Part B monthly premiums unless they qualify for financial assistance. beneficiaries of Original Medicare have the flexibility of choosing the healthcare providers and they are nit limited to a network of healthcare providers. In original Medicare, there is no limit on out-of-pocket medical expenses and the insured always need to pay 20% coinsurance for the medical service costs. While signing up for Medicare, people are automatically enrolled in Medicare Part A and Part B. People who are already receiving retirement benefits before they turn 65 get automatically enrolled.
Medicare Part C or Advantage Plan
Medicare beneficiaries of Pennsylvania looking for coverage beyond Original Medicare can enroll in a Medicare Advantage plan offered by a medicare contracted private insurance company. The Medicare Advantage plan offers same level of coverage as Original Medicare with the exception of hospice care along with some additional benefits. The specific Medicare Advantage plan details usually depend upon the county in which one live in. In order to enroll for Medicare Part C in Pennsylvania, beneficiaries must first be enrolled in Original Medicare and they must be living in the service area of a medicare Advantage plan and they must not have end-stage renal disease, or ESRD. Medicare Advantage plan along with Original Medicare coverage also offers additional coverage like vision, dental, hearing and health and wellness programs. Different types of Medicare Advantage plans available in Pennsylvania include:
- Health Maintenance Organization Plans
- Preferred Provider Organization Plans
- Private Fee-for-Service Plans
- Special Needs Plans
- Medicare Savings Account
Medicare Advantage Prescription Drug Plans in Pennsylvania
Prescription drug benefits are not included in the Medicare Advantage plan so Medicare beneficiaries who wish to obtain this benefits can combine medical and prescription drug coverage with a single plan, termed as Medicare Advantage Prescription Drug plan. However, beneficiaries are advised to check the plan’s formulary before enrolling in the plan in order to ensure that the plan chosen by them cover the drugs used be them. Every Medicare Advantage Prescription Drug Plan has its own formulary, which is a list of all the medications covered by the plan so enrolling in this plan must have an idea about all the drugs included in the plan. The plan’s formulary may change at any time, though the notice about it is sent to the members of the plan.
Medicare Part D or Prescription Drug Plan
In Pennsylvania there are 21 Medicare Part-D plans available offered by 12 different health insurance carriers and there are five prescription drug plans also offering additional gap coverage. In most of the conditions Original Medicare doesn’t cover prescription medications so Pennsylvania residents opt for Medicare Part D plan. Medicare Part D is an optional prescription drug coverage offered by private insurance companies that allow prescription drug coverage to help people with their prescription drug costs. Residents of this state can enroll in a stand-alone Medicare Part D plan to work along with the Original Medicare coverage. Every Medicare Part D plan has its own formulary, which is a list of covered prescription medications, and people enrolling in this plan should check the plan’s formulary to see that whether their prescription drugs are included in this list or not.
Medicare Supplement Plans or Medigap Plans in Pennsylvania
Original Medicare does not cover certain health related expenses like copays, coinsurance, deductibles and other out-of-pocket costs, therefore Medicare beneficiaries in Pennsylvania have the option to enroll in a Medicare Supplement plan that help them cover these out-of-pocket expenses. In Pennsylvania there are ten standardized Medigap plans, and each plan is labeled with a letter. Medigap open enrollment period is the best time to enroll in these plans that begins on the first day of the month that a beneficiary is age 65 or older and enrolled in Medicare Part B. During this period, beneficiary can enroll in a Medicare Supplement plan of their choice and have guaranteed issue right, as insurers cannot deny coverage or charge extra during this period. However, insurers can impose a waiting period for any pre-existing conditions. medicare Supplement plans in Pennsylvania do not vary in terms of coverage or benefits between the plans of the same letter, though the costs may vary since every insurance company has their own pricing structure. Beneficiaries can select a Medicare Supplement plan based on its availability in their area and depending upon their health needs and budget.