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Pennsylvania Medicare Insurance

Medicare in Pennsylvania

Medicare offers healthcare coverage to Pennsylvania residents age 65 or older, or to those Pennsylvania residents that suffer from certain medical disabilities. In 2015, 2,533,515 people are enrolled in Medicare in Pennsylvania, accounting for 20% of the population in Pennsylvania. In 2009 approximately $10,555 was spent on each Medicare enrollee in Pennsylvania, about 1.83% higher than the national average of $10,365. From 2015 to 2030 the senior population in Pennsylvania is projected to increase by an estimated 34.49% according to calculations based off of the 2000 Census. Therefore the number of eligible Medicare beneficiaries in Pennsylvania is also predicted to grow. Medicare enrollees and their caretakers that reside in Pennsylvania can receive free health insurance counseling from APPRISE, Pennsylvania’s State Health Insurance Assistance Program (SHIP). Assistance from APPRISE is one-on-one, free, objective, and also confidential. Another program called the Pennsylvania Senior Medicare Patrol (PA-SMP) offers residents education and help on how to detect, avoid, and report cases of Medicare fraud, abuse, and/or waste.

Individuals that qualify for Medicare can sign up for Medicare Part A (hospital services) and Part B (medical services) through the Federal government. Part A is generally paid for by paycheck deductions from their working years (or their spouse's) but most Medicare beneficiaries pay for Part B through monthly premiums unless they qualify for financial assistance. If you are eligible for Original Medicare (Parts A & B) or if you are already enrolled in it, you also have the option to enroll in a Medicare Advantage Plan (Medicare Part C) instead of Original Medicare or add a stand alone prescription drug plan (Part D) to your current Original Medicare coverage. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Many Medicare beneficiaries will elect to enroll in a Medicare Advantage plan that includes prescription drug coverage (MAPD) or purchase a stand alone prescription drug plan to go with their Original Medicare coverage. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Additional benefits of Medicare Advantage plans such as dental, vision, or hearing coverage can help reduce out-of-pocket expenses for seniors with certain medical needs. Using CMS data HealthPocket found that:

  • The average total monthly premium for a 2017 Medicare Advantage plan in Pennsylvania is $81.68, 30.73% greater than the national average of $62.48. 24.34% of 2017 Medicare Part C insurance plans in Pennsylvania have a $0 monthly premium.
  • The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $400, but in Pennsylvania the average annual drug deductible for Medicare Part C insurance plans with drug components is $65.33. 79.23% of 2017 Medicare Part C insurance plans with a drug component in Pennsylvania have a $0 annual drug deductible.
  • The average total monthly premium for a 2017 Medicare Advantage plan without a drug component in Pennsylvania is $33.49. 52.56% of 2017 Medicare Part C insurance plans without a drug component in Pennsylvania have a $0 monthly premium.
  • The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Pennsylvania is $5936.06. 11.74% of 2017 Medicare Advantage plans in Pennsylvania had a medical out-of-pocket limit of $3,400 or less.

To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).

  • The average overall CMS star rating assigned to Medicare Part C insurance plans in Pennsylvania was 4.1 stars in 2017.
  • Among Pennsylvania's 2017 Medicare Advantage plans with CMS star ratings:
    • 0.34% earned a score of 5 stars
    • 78.77% earned a score of 4 or 4.5 stars
    • 18.92% earned a score of 3 or 3.5 stars
    • 1.98% of plans are “Not enough data available” or “Too new to be measured”.

Sources:

Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation

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Pennsylvania Medicare Insurance Companies

There are 24 Medicare insurance providers that offer affordable and comprehensive Medicare insurance in Pennsylvania. Of these, the companies that offer the largest variety of plans to choose from are Humana, Coventry Health Care, and Highmark. In Pennsylvania,. The following are all medicare insurance providers in Pennsylvania:

Humana

20 Plans

Highmark

14 Plans

Aetna

11 Plans

WellCare

2 Plans

Vibra Health Plan

2 Plans

Gateway Health Medicare Assured

2 Plans

Sunrise Advantage Plan

1 Plans

Magellan Rx Medicare

1 Plans

MII Life, Inc.

1 Plans

CLOVER HEALTH

1 Plans

Allwell

1 Plans

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2018 Best Medicare Plans in Pennsylvania

There are 123 medicare plans in Pennsylvania. The following are the 10 highest rated medicare plans in Pennsylvania based on their CMS rating for the plan's overall quality.

Monthly CostPlan NameCMS Rating
from $14UnitedHealthcare - AARP MedicareComplete Plan 1 (HMO) - Allegheny County
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from $24UnitedHealthcare - AARP MedicareComplete (HMO) - Bucks County
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from $30UnitedHealthcare - AARP MedicareComplete Plan 3 (HMO) - Allegheny County
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from $33UnitedHealthcare - AARP MedicareComplete Plan 2 (HMO) - Crawford County
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from $36UnitedHealthcare - Erickson Advantage Freedom (HMO-POS) - Bucks County
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from $43UnitedHealthcare - Erickson Advantage Signature with Drugs (HMO-POS) - Bucks County
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from $0Geisinger Gold - Geisinger Gold Essential Rx (HMO) - Columbia County
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from $0Coventry Health Care - Advantra Silver (HMO) - Armstrong County
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from $0Coventry Health Care - Advantra Northern Pennsylvania Gold (HMO) - Blair County
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from $0Independence Blue Cross - Keystone 65 Basic Rx (HMO) - Chester County
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Best Pennsylvania Medicare Plans for Managing High Blood Pressure

The following are the 5 highest rated medicare plans in Pennsylvania based on their CMS rating for the plan's ability for controlling high blood pressure.

Monthly CostPlan NameCMS Rating
from $29Humana - HumanaChoice R0923-002 (Regional PPO)
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from $115Highmark - Security Blue HMO Deluxe (HMO) - Bedford County
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from $115Highmark - Freedom Blue PPO Deluxe (PPO) - Adams County
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from $114Highmark - Community Blue Medicare HMO Prestige (HMO) - Allegheny County
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from $106Highmark - Freedom Blue PPO Classic (PPO) - Allegheny County
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Best Pennsylvania Medicare Plans for Managing Diabetes

The following are the 5 highest rated medicare plans in Pennsylvania based on their CMS rating for the plan's ability for diabetes care including: eye exam, kidney disease monitoring, blood sugar controlled and cholesterol controlled.

Monthly CostPlan NameCMS Rating
from $43UnitedHealthcare - Erickson Advantage Signature with Drugs (HMO-POS) - Bucks County
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from $36UnitedHealthcare - Erickson Advantage Freedom (HMO-POS) - Bucks County
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from $37HealthPartners - Health Partners Medicare Prime (HMO) - Lancaster County
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from $0CLOVER HEALTH - Clover Health PA Green (PPO) - Bucks County
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from $0HealthPartners - Health Partners Medicare Value (HMO) - Philadelphia County
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Best Pennsylvania Medicare Plans for Managing Rheumatoid Arthritis

The following are the 5 highest rated medicare plans in Pennsylvania based on their CMS rating for the plan's ability for rheumatoid arthritis management.

Monthly CostPlan NameCMS Rating
from $37HealthPartners - Health Partners Medicare Prime (HMO) - Lancaster County
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from $0HealthPartners - Health Partners Medicare Value (HMO) - Philadelphia County
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from $41Aetna - Aetna Medicare Premier Plan (HMO) - Bucks County
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from $36Aetna - Aetna Medicare Silver Plan (HMO) - Adams County
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from $33UnitedHealthcare - AARP MedicareComplete Choice (PPO) - Chester County
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Best Pennsylvania Medicare Plans for Managing Osteoporosis

The following are the 5 highest rated medicare plans in Pennsylvania based on their CMS rating for the plan's ability for osteoporosis management.

Monthly CostPlan NameCMS Rating
from $37HealthPartners - Health Partners Medicare Prime (HMO) - Lancaster County
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from $0CLOVER HEALTH - Clover Health PA Green (PPO) - Bucks County
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from $0HealthPartners - Health Partners Medicare Value (HMO) - Philadelphia County
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from $41Aetna - Aetna Medicare Premier Plan (HMO) - Bucks County
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from $36Aetna - Aetna Medicare Silver Plan (HMO) - Adams County
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Most Popular Medicare Doctors in Pennsylvania

The following are the most popular medicare doctors in Pennsylvania based on the provider utilization and payment data published by the U.S. Department of Health & Human Services.

NameSpecialtyLocation
RadiologyKINGSTON, PA
Internal MedicineALTOONA, PA
RadiologyPHILADELPHIA, PA
Orthopaedic SurgeryPHILADELPHIA, PA
RadiologyNEWTOWN SQUARE, PA
OphthalmologyPLYMOUTH MEETING, PA
Internal MedicinePHILADELPHIA, PA
SurgeryBRADFORD, PA
OphthalmologyPLYMOUTH MEETING, PA
Orthopaedic SurgeryMEADVILLE, PA
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Browse Medicare Plans by Cities

  1. Philadelphia, PA
  2. Pittsburgh, PA
  3. Allentown, PA
  4. Erie, PA
  5. Reading, PA
  6. Scranton, PA
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