Medicare Part D is essential for several reasons:
1. Prescription Drug Coverage
Medicare Part D provides coverage for a wide range of prescription medications, helping to reduce out-of-pocket costs for necessary drugs.
This is especially important if you take medications regularly.
2. Financial Protection
Without Medicare Part D, you could face high prescription costs. Medicare Part D plans often have negotiated rates with pharmacies, meaning you may pay less than you would without coverage.
3. Preventive Care
Having coverage encourages you to seek preventive care and necessary treatments, leading to better overall health outcomes. This can help you avoid more serious health issues and expenses down the line.
4. Choice of Plans
There are various Medicare Part D plans available, allowing you to choose one that best fits your medication needs and budget. This flexibility means you can select a plan that covers your specific medications at a cost you can manage.
5. Avoiding Late Enrolment Penalties
If you don’t enroll in a Medicare Part D plan when you first become eligible and go without creditable prescription drug coverage for 63 days or more, you may face a late enrollment penalty if you decide to sign up later.
6. Comprehensive Coverage
Part D can complement other parts of Medicare, providing a more complete healthcare coverage package. It ensures you have access to the medications necessary to manage chronic conditions or acute health issues.
7. Support for Specialty Drugs
If you require specialty medications, many Part D plans offer additional support, including lower co-pays and dedicated pharmacy services to manage these complex treatments.
In summary, enrolling in Medicare Part D helps ensure that you have affordable access to necessary medications, protects your financial well-being, and encourages better health management.
If you’re considering enrolling in a Medicare Advantage plan (otherwise known as Medicare Part C) in Pennsylvania to fulfill your various health insurance needs, you’re not alone.
According to recent Census data estimates, approximately 2.6 million people ages 65 and older live in Pennsylvania, accounting for nearly 20% of the state’s total population[1]. Considering Pennsylvania’s average life expectancy is 77 years, maintaining health insurance coverage after retirement is crucial for both physical and financial well-being[2].
If you’re looking for the best Medicare Advantage plan for your specific needs, Forbes Health has simplified the process with the snapshot below. Using this abbreviated roundup of your state’s market, you can gain a better understanding of how many plan options you have, who the providers tend to be and how much you can expect to pay each month for a plan. You can also download our checklist of easy-to-follow steps for a simplified Medicare Advantage enrollment experience.
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Let us Help You Find the Medicare Plan that May Be Right For You.
- Choose between Medicare Advantage or Medicare Supplement options
- As simple as entering your basic information to compare plans right away
- Easy to distinguish between plan options with straight-forward information
- Plan options from Aetna, Anthem, BCBS, Cigna, Humana, and more
- Licensed, experienced and dedicated Medicare professionals are here to help you navigate your options
- Call 855-644-2121 to speak with a licensed insurance agent. TTY 711, Mon-Sun 8 am – 11 pm EST
Compare plans On MedicareEnrollment.com
Medicare Advantage Plans in Pennsylvania
Since Medicare Advantage plan eligibility is largely dependent on where you live, we gathered data specific to an urban, suburban and rural location in Pennsylvania to show how plan availability, monthly premium rates and in-network maximum out-of-pocket amounts can vary.
Source: Centers for Medicare and Medicaid Services (CMS)
*Data from September 2023
**Data from October 2023
***Plans with less than 10 enrollees are excluded from this data point by CMS
****State averages based on data points for three presented counties
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Medicare Advantage Providers in Pennsylvania
Fifteen private health insurance providers offer Medicare Advantage plans in the state of Pennsylvania, including:
Plan availability varies by ZIP code, so not all providers listed above offer Medicare Advantage plans in every county of Pennsylvania.
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Partner Offers feature brands who paid Forbes Health to appear at the top of our list. While this may influence where their products or services appear on our site, it in no way affects our ratings, which are based on thorough research, solid methodologies and expert advice. Our partners cannot pay us to guarantee favorable reviews of their products or services
Compare Top Medicare Plans From Major Carriers
- Chat with a licensed insurance agent today
- Helps you find the right Medicare coverage from a wide variety of plan options
- Compare plans online
- Plan options from Aetna, Anthem, BCBS, Cigna, Humana, and more
- Call to speak to a licensed insurance agent. TTY 711, Mon-Sun 8 am – 11 pm EST
Compare plans On Medicare Enrollment’s Website
Top-Rated Medicare Advantage Plans in Pennsylvania
Every year CMS rates Medicare Advantage (Part C) and Part D prescription drug plans to reflect the experience of being enrolled in such coverage. The agency uses a scale of one to five stars, with one star representing poor performance and five stars representing excellent performance. The following plans available in the state of Pennsylvania in 2024 earned five-star ratings from CMS.
Highmark Blue Cross Blue Shield
- Community Blue Medicare HMO Prestige (HMO)
- Community Blue Medicare HMO Signature (HMO)
- Security Blue HMO-POS Basic (HMO-POS)
- Security Blue HMO-POS Deluxe (HMO-POS)
- Security Blue HMO-POS Standard (HMO-POS)
- Security Blue HMO-POS ValueRx (HMO-POS)
- Together Blue Medicare HMO Signature (HMO)
UnitedHealthcare
- Erickson Advantage Freedom (HMO-POS)
- Erickson Advantage Liberty (HMO-POS)
- Erickson Advantage Liberty no Rx (HMO-POS)
- Erickson Advantage Signature (HMO-POS)
UPMC for Life
- UPMC for Life HMO Deductible Rx (HMO)
- UPMC for Life HMO No Rx (HMO)
- UPMC for Life HMO Premier Rx (HMO)
- UPMC for Life HMO Rx (HMO)
- UPMC for Life HMO Rx Choice (HMO)
- UPMC for Life HMO Rx Enhanced (HMO)
- UPMC for Life PPO High Deductible Rx (PPO)
- UPMC for Life PPO Premier Rx (PPO)
- UPMC for Life PPO Rx Choice (PPO)
- UPMC for Life PPO Rx Enhanced (PPO)
- UPMC for Life PPO Salute (PPO)
To determine which of these plans might be available in your area, enter your ZIP code in Medicare.gov’s plan finder tool. The tool also displays each plan’s rating from CMS.
Medicare Resources in Pennsylvania
If you live in Pennsylvania and are looking for more information about Medicare plans available and assistance with selecting the best coverage for your health care needs and budget, here are a few resources to help you get started.
- Pennsylvania Medicare Education and Decision Insight (PA MEDI): Provided by the Pennsylvania Department of Aging, this program offers eligible adults free Medicare counseling from specially trained individuals who can answer questions and share objective, easy-to-understand information about Medicare, Medicare Supplement insurance, Medicaid and long-term care insurance.
- Medicare Cost-Savings Programs: Also provided by the Pennsylvania Department of Aging, these three programs can help lower-income older adults pay their Medicare premiums, deductibles, coinsurance, copayments and prescription drug costs.
- Pennsylvania Insurance Department: This state department helps Pennsylvania residents find more information and make informed decisions about their insurance coverage. Help is available to those who already have an insurance policy or are looking to purchase one.
While not exclusive to the state of Pennsylvania, Medicare.gov and CMS’s website are two helpful tools for learning about the various components of Medicare coverage. You can also search for plans available in your ZIP code and compare options via Medicare.gov’s plan finder tool.
How to Pick the Best Medicare Advantage Plan in Pennsylvania
Now that you have a clearer picture of what Medicare Advantage coverage looks like in your state, make sure you understand how to go about finding the best plan for you—especially if you’re approaching the age of 65, navigating another qualifying event or looking to review your plan options ahead of the Medicare Advantage Open Enrollment period (which runs from January 1 to March 31 annually). Use our downloadable checklist below for a step-by-step guide through the process to simplify and improve your enrollment experience.
Forbes Advisor
Your Medicare Advantage Plan Shopping Checklist1. Visit Medicare.gov
Read the expert explainers on the parts of Medicare, how it works and what it costs.
2. Use Medicare.gov’s Plan Comparison Tool
See how many plans are available to you based on your location.
3. Search by Hospital
Enter your preferred hospital network information to further narrow your list of plan options.
4. Search by Physician(s)
Enter your preferred physician information to refine your list of plan options again.
5. Search by Prescription Drug(s)
Enter the prescription drug(s)—and doses—you currently take to see which drug formularies will give you the most cost-effective coverage of your medications.
6. Consider Your Expected Utilization
Think you’ll use your benefits often? Prioritize plans with lower out-of-pocket maximums and higher monthly premiums. Otherwise, focus on plans with high out-of-pocket maximums, low copays and high deductibles.
7. Browse Additional Coverage
Compare your final plan options based on other included health care benefits, such as dental, vision, hearing, over-the-counter or transportation coverage, to identify the best plan for you.
Medicare Advantage Plans By State
HealthCompare Insurance Services does not offer every plan available in your area. Currently it represents 18 organizations, which offers 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
HealthCompare Insurance Services represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Frequently Asked Questions (FAQs)
What is every Medicare Advantage plan required to include?
Every Medicare Advantage plan must include the benefits provided by Original Medicare (Part A and Part B). Part A covers 80% of hospital stays, skilled nursing, home health care and hospice care. Part B covers 80% of doctor’s visits, preventative care, mental health services, physical therapy, occupational therapy, lab services and other outpatient services.
How is Medicare Advantage different from Original Medicare?
Medicare Advantage covers everything included in Original Medicare (Part A and Part B), but most Medicare Advantage plans also include prescription drug coverage (Part D), and some plans provide dental and vision coverage and hearing aids and fitness benefits as well. These extra coverages and benefits vary depending on the plan you choose. While there are several distinctions between Original Medicare and Medicare Advantage, one noteworthy difference is people enrolled in a Medicare Advantage plan must pay both the monthly premium associated with Part B ($174.70 for most people in 2024) and the monthly premium associated with their Medicare Advantage (Part C) plan, which is described in the data above.
Who can benefit most from Medicare Advantage coverage?
Any qualifying U.S. adult interested in convenient coverage options that are largely covered by a single insurer can benefit from a Medicare Advantage plan. People with chronic health conditions and specific coverage needs might also find bundled coverage under a Medicare Advantage plan to be more affordable than taking a piecemeal approach with Original Medicare (Part A and Part B) and Medigap plans.
Sources
Footnotes
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Information provided on Forbes Health is for educational purposes only. Your health and wellness is unique to you, and the products and services we review may not be right for your circumstances. We do not offer individual medical advice, diagnosis or treatment plans. For personal advice, please consult with a medical professional.
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Credit To Author: Robby Brumberg – Editor
Robby has spent his career in a variety of writing, editing and storytelling roles. He now resides near Birmingham, Alabama, with his wife and three kids. He enjoys woodworking, playing rec league soccer and supporting chaotic, downtrodden sports franchises like the Miami Dolphins and Tottenham Hotspur.
Valerie Williams – Editor
Valerie is a seasoned writer and editor who has spent her career creating content in the parenting and women’s wellness spaces. Before joining Forbes Health, Valerie was the trending news editor at Scary Mommy. When she’s not helping women and families live their best and healthiest lives, she’s spending time with her family, walking her dogs, reading or exercising.