Medicare Advantage in Pennsylvania

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Pennsylvania state

Information about Medicare Advantage Plans in Pennsylvania

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There are 184 different Pennsylvania Medicare Advantage (Medicare Part C) plans in 2022.1 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.

Average costs of Medicare Advantage in Pennsylvania

Although the average premium for a Medicare Advantage plan in Pennsylvania is $68.56 per month in 2022.

  • Average in-network out-of-pocket spending limit: $5,533.33
  • Average drug deductible (weighted): $243.442

Premiums and other costs for individual Medicare Advantage plans can vary based on where you live and the plan you have. A licensed insurance agent can help you compare Medicare Advantage plan costs in your area.

Compare Pennsylvania Medicare Advantage plan costs

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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 $0 premium Pennsylvania Medicare Advantage plans

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Top-rated Medicare Advantage Plans in Pennsylvania 2022

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).3

60.6% of Medicare Advantage plans in Pennsylvania are rated four stars or higher in 2022.2

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 2022

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

Find $0 premium Pennsylvania Medicare Advantage plans

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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.

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 2022 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 Freed M. et al. (Nov. 2, 2021). Medicare Advantage 2022 Spotlight: First Look. Kaiser Family Foundation. Retrieved from www.kff.org/issue-brief/medicare-advantage-2022-spotlight-first-look.

2 MedicareAdvantage.com's The Best States for Medicare report.

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