Medicare Advantage in Pennsylvania

Looking for Pennsylvania Medicare Advantage Plans? Enter your ZIP below to compare affordable or $0 premium plans in your area.

Pennsylvania state

Information about Medicare Advantage Plans in Pennsylvania

Quick links:

There are 126 different Pennsylvania Medicare Advantage Prescription Drug (MAPD) plans in 2021.1 Plan availability can vary by location, though, so it's important to find out which plans are offered where you live.

A licensed insurance agent can help you compare Pennsylvania Medicare Advantage plans that are available near you.

You can also learn more about other types of Medicare plans:

Average costs of Medicare Advantage in Pennsylvania

The average premium for a Medicare Advantage plan with prescription drug coverage in Pennsylvania is $53 per month in 2021.

  • Average monthly premium cost in 2021 (weighted): $53
  • Average in-network out-of-pocket spending limit: $6,012
  • Average drug deductible in 2021 (weighted): $341

Premiums and other costs for individual Medicare Advantage plans can vary based on where you live and the plan you have.

You can view the 2021 average Pennsylvania Medicare Advantage plan monthly premiums by county listed below in this guide.

A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Compare Pennsylvania Medicare Advantage plan costs

Compare Plans

Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Medicare Eligibility & Enrollment

You may not sign up for a Medicare Advantage plan in Pennsylvania without first enrolling in Medicare Part A and Part B, otherwise known as Original Medicare.

To be eligible for Original Medicare at age 65, you must meet the following requirements:

  • You must be a U.S. citizen or permanent legal resident who has lived in the U.S. for five continuous years.

  • You or your spouse must have worked long enough to be eligible for Social Security or Railroad Retirement benefits.

  • You or your spouse must be government employees or retirees who have not paid into Social Security but have paid Medicare payroll taxes.

You may potentially qualify for Medicare benefits under 65 if:

  • You have been receiving Social Security disability benefits or certain Railroad Retirement Board disability benefits for at least 24 months.

  • You have ALS (amyotrophic lateral sclerosis, or Lou Gehrig's disease).

  • You have End-Stage Renal Disease (ESRD), and you or your spouse have paid Social Security taxes for a certain length of time.

If you have ESRD, you may be able to enroll in a Medicare Advantage plan or a Pennsylvania Medicare Special Needs Plan (SNP) that is specifically designed to help meet your health care needs.

How to sign up for a Medicare Advantage Plan in Pennsylvania

For most Medicare beneficiaries, the first time you may be able to enroll in a Pennsylvania Medicare Part C plan is during your Medicare Initial Enrollment Period (IEP).

Medicare Initial Enrollment Period graphic

Your Medicare IEP is a seven-month period that begins three months before you turn 65, includes the month of your birthday and continues for three more months after your birthday.

Once your IEP ends, you may be able to sign up for Medicare Advantage during one of the following periods:

Medicare Advantage Open Enrollment Period graphic

Medicare Advantage Open Enrollment Period: January 1 – March 31

During this enrollment period, you may switch Medicare Advantage plans or drop your Medicare Advantage plan and return to Original Medicare.

If you return to Original Medicare during this period, you'll be able to join a Medicare standalone prescription drug plan (Medicare Part D).

Medicare AEP graphic

Medicare Annual Enrollment Period (AEP): October 15 – December 7

During AEP, you may enroll in a Medicare Advantage plan or switch from one Medicare Advantage plan to another.

You may also drop your existing Medicare Advantage plan and return to Original Medicare. You may also join, switch or drop a Medicare Part D plan. 

Medicare Special Enrollment Periods (SEP)

You could potentially qualify for a Medicare Special Enrollment Period (SEP) at any time throughout the year, though you must meet specific requirements.

A licensed insurance agent can help you find out if you qualify for a Medicare Special Enrollment Period.

Find a Pennsylvania Medicare Advantage plan

Compare Plans

Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Top-rated Medicare Advantage Plans in Pennsylvania 2021

In order for a Medicare Advantage plan to be considered a top-rated plan, it must have four or more stars out of five stars based on the Star Ratings that are awarded by the Centers for Medicare & Medicaid Services (CMS).2

There are 87 top-rated 2021 Medicare Advantage Prescription Drug plans in Pennsylvania that are rated four stars or higher. That equals 73 percent of all MAPD plans offered in the state in 2021.

Medicare Star Ratings
Star Ratings

★★★★★

Excellent

★★★★

Above Average

★★★

Average

★★

Below Average

Poor

The CMS uses these five categories to rate Medicare Advantage plans:

  • Preventive care and health maintenance (screenings, tests, vaccines, etc.)
  • Management of chronic conditions
  • Member experiences and ratings of the plan
  • Member complaints, problems receiving services and member retention
  • Customer service

The information for the star ratings is gathered from information that is submitted to Medicare, Medicare’s regular monitoring activities and member surveys.

List of Medicare Advantage Plans Available in Pennsylvania in 2021

To view a list of PA Medicare Advantage plans available near you, use our plan comparison tool.

Find a Pennsylvania Medicare Advantage plan

Compare Plans

Or call TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

Private insurance companies offer Medicare Advantage plans in Pennsylvania

One or more insurance carriers may offer Medicare Advantage plans where you live in Pennsylvania, though availability can vary.

Private insurance companies offer Medicare Advantage plans that may be unique to the plan area they serve.

Call to speak with a licensed insurance agent who can help you compare the Medicare Advantage plans that are sold by insurance companies in your area.

You can also use these sources of information as you learn more about your Medicare Advantage plan options:

  • The Medicare Star Ratings can give you an idea of a plan’s overall quality.

  • Agencies like A.M. Best, Moody’s and Standard & Poor’s can provide information about an insurance company’s credit rating and financial standing.

  • Websites such as the Better Business Bureau and Consumer Reports can teach you about a company’s reputation among its customers.

  • You can read through Medicare Advantage plan reviews and testimonials from customers.

Pennsylvania Medicare Advantage plans by county

Learn more about Medicare Advantage plans in some of Pennsylvania's most populous counties.

The chart below provides some more information about 2021 Pennsylvania Medicare Advantage Prescription Drug plans by county.1

  • Lackawanna County, Dauphin County and Cumberland County are home to the lowest average monthly premiums for 2021 Medicare Advantage Prescription Drug plans in Pennsylvania.

  • Dauphin County, Lancaster County and Lebanon County each have the highest number of MAPD plans in Pennsylvania in 2021.
2021 PA Medicare Advantage by County
County Total Enrollees in County Average Premium % of Plans Rated 4 Stars or Higher Avg. Annual Drug Deductible # Plans Available
Adams 8303 $51.58 77% $25.75 50
Allegheny 169253 $62.01 88% $31.86 45
Armstrong 11745 $63.99 87% $34.84 42
Beaver 28003 $60.17 88% $30.97 46
Bedford 6927 $52.07 80% $33.18 43
Berks 32956 $44.11 74% $28.60 62
Blair 17107 $53.49 80% $28.08 50
Bradford 4874 $55.80 72% $40.83 40
Bucks 49733 $49.44 56% $53.94 60
Butler 27099 $60.17 88% $30.97 46
Cambria 24706 $68.20 78% $30.42 45
Cameron 579 $57.69 76% $35.44 45
Carbon 4531 $48.23 73% $25.12 51
Centre 12871 $49.95 76% $33.52 54
Chester 25587 $44.75 52% $46.51 55
Clarion 4065 $60.02 84% $31.30 36
Clearfield 9064 $57.34 80% $31.29 45
Clinton 4308 $51.05 74% $30.29 44
Columbia 6265 $54.24 77% $20.94 39
Crawford 8903 $52.37 83% $35.00 46
Cumberland 23359 $42.84 74% $28.04 63
Dauphin 29931 $42.07 73% $26.98 65
Delaware 33299 $48.55 53% $57.63 48
Elk 2368 $59.96 84% $31.30 36
Erie 31692 $51.14 84% $39.73 48
Fayette 20453 $63.02 87% $34.22 42
Forest 790 $54.07 86% $27.26 41
Franklin 11115 $46.93 73% $29.43 44
Fulton 1101 $50.97 77% $27.38 50
Greene 5174 $60.02 87% $32.21 44
Huntingdon 4929 $51.97 74% $34.30 55
Indiana 12548 $76.12 83% $40.56 34
Jefferson 5248 $53.16 79% $37.31 51
Juniata 2684 $47.32 76% $34.30 54
Lackawanna 16369 $38.48 73% $31.97 43
Lancaster 48820 $43.66 74% $26.98 65
Lawrence 14181 $61.42 88% $19.31 46
Lebanon 14509 $44.09 75% $30.19 65
Lehigh 28548 $47.64 77% $10.94 58
Luzerne 23538 $45.57 74% $12.86 37
Lycoming 10531 $46.80 73% $38.82 49
McKean 3240 $58.41 86% $35.97 40
Mercer 16107 $53.62 88% $12.71 45
Mifflin 5322 $47.63 74% $36.38 51
Monroe 10122 $45.29 80% $21.61 39
Montgomery 50613 $47.06 53% $48.24 44
Montour 2330 $57.19 76% $26.41 49
Northampton 23908 $47.77 77% $16.15 58
Northumberland 9765 $56.85 71% $22.41 35
Perry 5142 $47.45 72% $23.98 55
Philadelphia 123988 $48.18 53% $50.92 49
Pike 2925 $67.37 65% N/A 21
Potter 1701 $57.54 78% $38.82 49
Schuylkill 11964 $50.28 79% $18.61 44
Snyder 3938 $51.14 76% $33.52 55
Somerset 11745 $55.12 80% $29.59 48
Sullivan 634 $47.80 73% $38.82 49
Susquehanna 3006 $45.84 73% $38.82 49
Tioga 3978 $57.22 73% $39.52 41
Union 3435 $52.68 78% $27.38 50
Venango 7698 $52.72 87% $26.41 42
Warren 3938 $54.51 88% $32.79 44
Washington 32352 $60.17 88% $30.97 46
Wayne 3400 $46.83 73% $39.86 48
Westmoreland 61826 $60.17 88% $30.97 46
Wyoming 2391 $44.73 73% $28.51 48
York 39136 $45.35 79% $28.67 60

PA Medicare Advantage plans by plan type

The major types of Medicare Advantage plans include:

  • A Medicare Health Maintenance Organization (HMO) usually requires that you select a primary care physician (PCP) who can write referrals for you if you need to see a specialist.

    An HMO plan will typically require you to only visit providers in your plan network, except for in cases of an emergency.

  • Medicare Advantage beneficiaries in a Preferred Provider Organization (PPO) are typically free to visit providers in or out of their plan network. Out-of-pocket costs are often lower when visiting an in-network provider.

    PPO plans typically do not require patients to get a referral before visiting with a specialist.

  • PFFS
    A Private Fee-For-Service (PFFS) plan will determine how much you are required to pay for services at the point that you receive them.

    You can typically visit any provider who accepts Medicare and your plan terms.

  • SNP
    A Special Needs Plan (SNP) is a type of Medicare Advantage plan limited to people with certain chronic conditions and other specific characteristics.

    SNPs typically require you to visit providers in the SNP network, and all Medicare SNPs provide prescription drug coverage.

Not all of these types of plans may be available in your area. A licensed insurance agent can help you compare the types of 2021 Pennsylvania Medicare Advantage plans that are available where you live.

Local health insurance resources in Pennsylvania

  • Pennsylvania’s Apprise Health Insurance Counseling Program offers free help for the state’s Medicare beneficiaries. The objective and confidential counseling is provided by trained volunteers with the goal of helping Pennsylvania’s seniors make the best use of their Medicare insurance.

    The program may be reached at 800-783-7067.

  • You can also explore more information about the insurance industry in Pennsylvania by visiting the state’s Department of Insurance website.

  • Pennsylvania Prescription Drug Assistance Programs
    The state of Pennsylvania has a number of programs designed to help with the cost of prescription drugs. There are programs for both Medicare beneficiaries and non-Medicare beneficiaries alike that can cover the cost of premiums and cost-sharing or even lower the cost of the drugs themselves.

 

1 MedicareAdvantage.com's The Best States for Medicare in 2021 report. (Oct. 27, 2020).

2 Medicare evaluates plans based on a 5- star rating system.