Medicare in Pennsylvania

Tamera Jackson by Tamera Jackson | Licensed since 2007
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This article was updated on: 09/16/2018

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Are you browsing Medicare options in Pennsylvania? As a Medicare beneficiary, you may have many ways you can get your coverage. You can stay with Original Medicare, or consider Medicare plan options like Medigap, Medicare Advantage, or Medicare Prescription Drug Plans. It’s a good idea to familiarize yourself with all the potential coverage options available in your area so that you can make a confident and informed decision.

About Medicare in Pennsylvania

One of your choices as a Pennsylvania resident (as in any state) is Original Medicare, Part A and Part B, the federally-run health care program. Medicare Part A provides beneficiaries with inpatient hospital care while Medicare Part B includes physician services, some preventive care, and some durable medical equipment coverage.

Medicare beneficiaries in Pennsylvania may enroll in Original Medicare, Part A and Part B, and then supplement that coverage with a stand-alone Medicare Part D Prescription Drug Plan and/or a Medigap policy.

Another option is to receive all of your Medicare benefits through a single Medicare Advantage Prescription Drug plan, which is an alternative to Original Medicare, described below.

Types of Medicare plans in Pennsylvania

Many types of Medicare plans are only available through private Medicare-approved insurance companies. As a Pennsylvania beneficiary, here are some of your Medicare plan options:

Medicare prescription drug coverage (Medicare Part D):

Original Medicare beneficiaries can add on this coverage with a stand-alone Medicare Part D Prescription Drug Plan.  You can also get Medicare Part D coverage through a Medicare Advantage Prescription Drug plan.

Medicare Advantage (Medicare Part C):

These are Medicare health plans offered by private insurance companies with Medicare’s approval. Medicare Advantage plans must cover at least what Original Medicare does (excluding hospice care), but can include additional benefits such as routine hearing services, or prescription drug coverage. If you enrolled in a Medicare Advantage Prescription Drug plan, you wouldn’t need to enroll in a separate Medicare Part D Prescription Drug Plan. People who enroll in a Medicare Advantage plan are still responsible for paying the Medicare Part B premium.

Medicare Supplement (Medigap) plans:

These plans cover “gaps” in Original Medicare coverage, such as deductibles, copayments, coinsurance, and possibly some foreign travel emergency health care coverage. Most states, Pennsylvania included, can offer up to 10 standardized Medigap policy options, each one labeled with a letter. Different Medigap plans include different coverage details, but all plans of the same letter are guaranteed to offer the same benefits, regardless of insurance company. For example, Plan G coverage details are identical no matter which insurance company the policy is purchased from, or in what state; however, costs may vary. These plans work with Original Medicare; you can’t use Medigap benefits to pay for Medicare Advantage costs.

Local Medicare resources in Pennsylvania

Medicare Savings Programs in Pennsylvania: Each state offers programs that help beneficiaries with limited income. These programs pay for some out-of-pocket Original Medicare costs like premiums, copayments, and deductibles. Contact your local Medicaid agency for more information and to apply.

Pennsylvania State Health Insurance Counseling and Assistance Program (SHIP): The APPRISE health insurance counseling program offers free health insurance counseling to Pennsylvanians with Medicare. Specially trained volunteers answer questions about all sorts of Medicare topics.

How to apply for Medicare in Pennsylvania

To qualify for Medicare, you must be either a United States citizen or a legal permanent resident of at least five continuous years.

In Pennsylvania, like the rest of the country, you’re typically enrolled in Medicare Part A and Part B automatically at age 65 if you receive benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). You are eligible for the program before reaching age 65 if you have certain qualifying disabilities or conditions; you’re automatically enrolled in Medicare after receiving disability benefits for 24 consecutive months. You’re also automatically enrolled in Medicare in the first month of disability benefits, if you have amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease). If you have End-Stage Renal Disease (kidney failure), you may be eligible for Medicare, but you need to apply as explained below; you’re not automatically enrolled.

If you have to enroll manually, you may do so through Social Security or the Railroad Retirement Board (if you worked at a railroad):

  • Visit the Social Security website.
  • Call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778), Monday through Friday, 7AM to 7PM.
  • Apply in person at a Social Security office near you.
  • Apply through the Railroad Retirement Board if you worked at a railroad, by calling 1-877-772-5772 (TTY users call 312-751-4701), Monday through Friday, 9AM to 3:30PM.

When looking to join a Medicare Advantage, Medicare Supplement, or Medicare Prescription Drug Plan, you may apply by contacting the plan directly, or by calling
1-800-MEDICARE (TTY users call 1-877-486-2048), 24 hours a day, seven days a week. Companies such as eHealth also offer licensed insurance agents who are able to assist you with plan enrollment.

As you can tell, you may have many options when it comes to how to get your Medicare benefits. Keep in mind that Medicare insurance costs and benefits vary widely by plan, so it’s always a good idea to shop around and compare. If you are curious what Medicare plans are available near you, I can help you learn more. Take a look at my profile below to get a better sense of my background. Then, if you like, I can talk to you about some of your options over the phone or through email; use the links below to set that up. If you’d like to find plans now, you can use the “Compare Plans” button on this page.

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