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Best Medicare Advantage Plans in Pennsylvania for 2020

You may have read up on information about Original Medicare (Medicare Part A and Medicare Part B), but you may not have heard about your enhancement options, such as Medicare Advantage plans in Pennsylvania for 2020. You do not have to rely on Original Medicare alone; in fact, most beneficiaries don’t. From Medicare Advantage plans in Pennsylvania to Medicare Supplements, Medicaid for those who are dual-eligible and more, you do have options.

After all, if you stick with Original Medicare alone, you will find that the coinsurance, copayments, and deductibles that aren’t included in your coverage can really add up. This is particularly true if you go to the doctor a lot or otherwise have a lot of healthcare needs.

If you decide that you’re interested in some of the best Medicare Advantage plans in Pennsylvania for 2020, we can help you out. You can learn more about Medicare Advantage plans and what they cover here on our website. Then, if you decide that you want to sign up for a Medicare Advantage plan, you can compare rates and coverage without ever leaving our site. You can even give us a call and talk one-on-one with one of our licensed insurance agents if you want the extra help with finding a policy with top star ratings.

Overview of Medicare Advantage Plans in Pennsylvania for 2020

If you do decide to enroll in a Medicare Advantage plan in Pennsylvania for 2020, you will no longer be considered a recipient of Original Medicare. This is not anything to panic about; you’ll probably like the coverage of your Medicare Advantage plan better anyway, and you can switch back to Medicare Part A and Part B later on if you want to. In the meantime, your policy will be used as a type of replacement policy for Medicare Part A and Part B.

When you start to compare and learn more about these policies, you’ll probably see that they are similar to the type of plan that you might have had through your employer in the past. In fact, HMO and PPO options are both available. These Medicare health plan options are available through private insurance companies and can help you enjoy much more than the basic Medicare benefits and Medicare coverage.

Best Medicare Advantage Plans in Pennsylvania for 2020: When Can You Enroll?

First, you’ll need to be enrolled in Medicare Part A and Part B, even though your Medicare Advantage plan will be considered something of a replacement plan. After you have enrolled in Medicare Part A and Part B, you can sign up for a policy during one of these important periods:

  • Medicare Initial Coverage Election Period ICEP: Each new beneficiary of Medicare Part A and Part B has the opportunity to sign up for a Medicare Advantage plan in the beginning.
  • Medicare Annual Election Period AEP: During a period from October 15 to December 7 of each year, you will be able to enroll, disenroll or change your Medicare Advantage policy.
  • Medicare Advantage Disenrollment Period MADP: For a long time, this period was designated so that you could disenroll from a Medicare Advantage plan and switch back to Original Medicare (Medicare Part A and Part B) coverage, but it has been discontinued.
  • Medicare Advantage Open Enrollment Period MA OEP: The MA OEP is new as of 2019. This Medicare Advantage enrollment period will run from January 1 to March 31st of each year. This is another period when you can change your MA policy.
  • Medicare Special Election Periods SEP: Sometimes people find that their circumstances change outside of any standard Medicare Enrollment Period. Depending on the situation, you might not have to wait to enroll in another policy. An SEP might be triggered so that you can sign up for a Medicare Part C policy in Pennsylvania, such as if you have lost your health insurance coverage.

Best Types of Medicare Advantage Plans in Pennsylvania

If you’re eligible for Medicare and want to know about the different Medicare Advantage plans in Pennsylvania, check out these common and popular Medicare Advantage plans:

PPO Preferred Provider Organization Plans (PPO) in Pennsylvania

  • Provider network service areas do apply.
  • You do have some coverage if you see a doctor or seek care in a hospital outside of your insurance company’s network.
  • You will enjoy preferred, more affordable pricing with in-network doctors, hospitals and other healthcare providers.
  • Referrals are not required with these health plans.

HMO Health Maintenance Organization Plans (HMO) in Pennsylvania

  • If you are looking for the lowest monthly premiums, these Medicare Part C policies in Pennsylvania might be your are best option. You may even be able to find a $0 premium option.
  • Outside of emergency situations, you’ll have to see in-network providers, or your insurance company will not pay.
  • With these Medicare plans, you must have a primary care doctor (PCP) who can give you referrals when you need to see a specialist.

Private Fee-for-Service PFFS in Pennsylvania

  • These are private Medicare Advantage policies; the policy determines how much the insurance company pays and how much you pay
  • There are no network restrictions.

Special Needs Plans SNPs in Pennsylvania

  • Those who have chronic health conditions or institutional conditions, such as end-stage renal disease ESRD, are the beneficiaries who sign up for Special Needs Plans.
  • Medicare Part D prescription drug plans must be included in SNPs.

Medicare Savings Account MSA in Pennsylvania

  • Includes a high deductible policy, such as one of the HMO plans or PPO plans
  • Also includes a special savings account that can be used for paying for medical expenses

Enrollment Figures for Pennsylvania Medicare Advantage Plans

As a beneficiary, you might be curious about Medicare enrollment stats for your state. These are a few:

  • The five largest counties in Pennsylvania are Philadelphia, Allegheny, Montgomery, Bucks and Delaware County.
  • There were 2,725,053 Medicare beneficiaries in Pennsylvania in 2018.
  • 1,099,881 of Medicare beneficiaries in Pennsylvania were enrolled in Medicare Advantage in 2018.

Do Medicare Advantage Plans in Pennsylvania for 2020 Cover Prescription Drugs?

On their own, Medicare Advantage policies do not cover prescription drugs. Instead, they’re designed to help you avoid copays and other medical costs for care in a skilled nursing facility, doctor’s office, nursing home or hospital.

Medicare Advantage prescription drug plans are included in many policies, though. When you compare rates and look for the best option, make sure that you take a look at the formulary that outlines which prescription medicines are covered. Additionally, you can check out the prescription drug tiers for the policy to see what your cost-sharing expenses will be. You will also want to find out if there is a pharmacy network service area restriction with the policy that you’re looking at for drug benefits.

A stand-alone Medicare Part D policy is also an option for prescription drug coverage. If you don’t like the Medicare prescription drug plans that are included with the Advantage policies that are available to you, for example, this is something that you can look into. Many find that signing up for a policy that offers prescription drug coverage is a good way to save money, though.

Network Restrictions for Medicare Advantage Plan in Pennsylvania

Before you can find the best policy, you’ll need to know these things about provider network restrictions and Medicare Advantage:

  • In-Network vs. Out-of-Network Within Coverage Area: HMO Medicare Advantage plans in Pennsylvania and PPO Medicare Advantage plans both cover out-of-network care in emergency situations. An HMO will not pay for out-of-network care in other situations, while a PPO will. If you use an out-of-network provider with a PPO, though, your out-of-pocket expenses will be higher
  • Traveling With Plan: With both health maintenance organization HMO plans or preferred provider organization PPO plans, emergency care is covered throughout the United States when you’re traveling. With a PPO, you can take advantage of out-of-network help even outside of emergency situations, although your costs will be higher.
  • Moving Across State Lines: Medicare Part A and Part B offer the same benefits in all 50 states, but Advantage policies are different. With Medicare Part C in PA, you will need to change plans if you move.

Added Benefits of Medicare Advantage Plan in Pennsylvania for 2020

Consider looking for a policy that offers some or all of these perks to make the most out of Medicare Advantage in 2020:

  • Hearing care, routine vision, and dental care
  • Wellness programs
  • Silver Sneakers or other similar gym membership
  • Recommendations for diet and nutrition
  • Allowance for over-the-counter medication costs
  • Healthy living seminars and classes
  • Transportation to and from medical appointments
  • Payment of some or all of the Medicare Part B premium
  • Starting in 2020, insurance companies that provide Medicare Advantage plans in Pennsylvania will be able to add some supplemental non-health related benefits to certain beneficiaries, such as providing help with making structural changes to the home when needed. This is designed to help those who might need help with widening doorways or installing ramps for their homes.
  • The Centers for Medicare and Medicaid Services approved a 2.53% payment increase to Medicare insurers that offer Medicare Advantage plans in Pennsylvania for 2020.

Pennsylvania Medicare Resources