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Medicare Plan Options in Pennsylvania

As people grow older, they naturally become more susceptible to various medical conditions and illnesses that may require expensive treatments and medications. It’s even worse when unforeseen medical emergencies lead to hospitalization or the need for nursing care facilities.

Statistics reveal that even if Americans work all their lives and meticulously plan their expenses so they can retire comfortably, sometimes, even a single medical emergency is enough to lead people to bankruptcy. People with disabilities are even more likely to go through medical debt and financial troubles due to extensive hospital stays and medical equipment.

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In today’s day and age, affordable healthcare is out of reach for far too many people. So the US government initiated the Medicare health insurance plan, which finally gave Americans the chance to alleviate any financial stress they were facing due to medical treatments. Numerous senior citizens in the US place their trust in these government-backed programs to streamline ample support whenever they come face to face with medical emergencies.

Residents of Pennsylvania aged 65 or above can sign up for Medicare Plans, Medigap, and Medicare Advantage as per their needs. Those with disabilities can also join this program at any time if they meet the eligibility criteria. This broad health insurance coverage covers a wide range of medical expenses for eligible and legal US citizens, enabling them to enjoy a comfortable retirement without the perils of going bankrupt due to health-related issues.

Since there are numerous healthcare options to choose from, people of Pennsylvania often feel overwhelmed with the lengthy process of signing up for an insurance plan. Finding a sturdy healthcare plan that provides coverage for all of your specific needs and requirements is not simple and requires extensive research.  

Reliable Medicare insurance agents at Integrity Now Insurance Brokers can help make sure you secure the most relevant healthcare policies at the most competitive rates. Our Medicare insurance brokers are annually accredited by the AHIP and have years of experience in the insurance industry. They remain updated with the latest laws, best practices, and compliance requirements, ensuring nothing comes in your way when accessing quality healthcare in Pennsylvania.

Our network includes top-rated Medicare health insurance agencies, so rest assured that you’re in safe hands. We only partner with insurance carriers that have a proven track record and provide comprehensive policies without denying claims unjustly.

Give us a call to talk to our insurance agents! They will go above and beyond to help you find the best health coverage plan that adequately covers all the bases.


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What You Need to Know About Medicare Insurance Plans in Pennsylvania

Medicare coverage is automatically activated once any US citizen reaches the age of 65. In addition to that, any person becomes eligible for Medicare if they have been receiving disability benefits from the Railroad Retirement Board or social security for at least 24 months. Those who are on regular dialysis, have had renal failure, or have been diagnosed with Lou Gehrig’s disease will start receiving Medicare benefits in the first month of getting disability benefits.

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Original Medicare

Original Medicare or traditional Medicare includes two comprehensive coverage plans: Part A and Part B.

Part A plans provide coverage for hospital services like hospital inpatient treatments, hospice care, and other at-home healthcare options. It also covers lab tests and skilled nursing home care that isn’t custodial or long-term.

When you sign up for Part B, you’re legible for a copay for outpatient care, blood purchase, doctor visits, medical equipment, and more. While it might be one of the most advantageous solutions, it won’t be as helpful for anyone that receives creditable coverage from their employer or their spouse’s employer that also covers them.

This option covers many major cost-sinking healthcare services, such as the necessary medical services required to diagnose or treat the medical condition. And preventive services like healthcare to prevent illnesses and detection of illness at an early stage.

Outpatient care, doctor appointments, mental health, in-home care, partial hospitalization, and certain medical equipment are also covered. It also includes certain preventive care, such as vaccines and screenings, to maintain your health and prevent illnesses from worsening.

However, Original Medicare doesn’t cover prescription drugs, plus there are virtually no limits on the annual out-of-pocket expenses.

Medicare Part C (Medicare Advantage)

The Medicare Advantage or Part C plan provides comprehensive coverage and is funded by private insurance companies. These private insurers are under a contract with Medicare and offer lower copays with in-network healthcare providers.

Medicare Advantage is usually preferred by the people of Pennsylvania since it is an all-in-one solution for all of their medical requirements. This plan provides complete coverage that consists of all Part A, Part B, and Part D (prescription drug coverage) benefits, including additional benefits like dental, vision, hearing, over-the-counter drugs, gym membership, and other fitness and wellness programs.

There are four types of Medicare Advantage plans available in Pennsylvania.

Health Maintenance Organization (HMO)

The HMOs mandate their subscribers to opt for in-network providers to receive their healthcare benefits.

This network of medical insurance providers offers coverage for medical treatments by physicians and hospitals that work on their terms and conditions. To become eligible for the HMO, you require a PCP (primary care provider), a specialty referral, and get approval for certain treatments and medications.

Preferred Provider Organization (PPO)

Medicare PPO plans have a recommended network of healthcare providers that subscribers can choose from. If you prefer to opt for an out-of-network provider, you will have to pay higher premiums and charges.

To qualify, you do not require a PCP or a specialist’s referral. You will get ample coverage for prescription medication, but you also have the option to purchase a drug plan separately.


Private Fee-for-Service (PFFS)

Offered by State-licensed organizations that agree to the terms and conditions of the Center for Medicare & Medicaid Services, the PFFS healthcare plan also gives its subscribers a network of providers to choose from.

To qualify, no specialty referral or PCP is required. Drug coverage is included, and you will have to pay higher premiums if you choose an out-of-network provider.

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Special Needs Plan (SNP)

This plan only allows individuals who are diagnosed with certain medical conditions to get their membership. This healthcare plan includes special treatments and medical services that are specifically designed to meet the needs of people with chronic conditions.

For this health insurance plan, you will require a PCP and a specialist’s referral. You will get adequate coverage for prescription medication, and you can join this plan at any time if you meet the eligibility criteria.

Medicare Part D

A significant drawback of many of the original Medicare plans is that you don’t get any coverage for the drugs that you need. If your prescription drug requirements are fairly high, you will need a dedicated plan for it.

Part D is the solution in such a case. In various chronic and acute conditions, prescription drug requirements and consumption can be fairly expensive, which can take a toll on your financial health in the long run. This plan allows you to acquire a copay to take care of a large roster of generic and brand-name drug purchases.

Part D plans usually charge a monthly premium, copay or coinsurance, and an annual deductible. These costs vary and depend on the plan you opt for. Do note that the budget isn’t unlimited; you only get coverage for the allocated budget. Beneficiaries will be expected to pay 25% of the cost-sharing, and 75% will be covered by the plan.

Some categories of medicine are not included in the package, with various aesthetic-related prescription drugs being the prime example. If you’re a regular consumer of a particular medicine, make sure that you talk to a Medicare insurance company in Pennsylvania to confirm that it’s covered before you get the wrong idea.

When signing up for a health insurance plan, many people will find the process intimidating and can get overwhelmed with the number of options available. But our Medicare insurance agents are committed to simplifying things as much as they can and can help you choose well-rounded insurance plans that will provide ample coverage at competitive rates.

To learn more about the different Medicare options available in Pennsylvania, make sure to check out our blog and learn the step-by-step process of signing up for Medicare.


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Medicare Supplement (Medigap) Plans in Pennsylvania

Medigap plan is Medicare supplement insurance offered by private insurance carriers for covering cost-sharing requirements for the Original Medicare Part A and Part B. Although Medicare pays for a significant chunk of the healthcare expenses, you’re still responsible for some costs, typically in the form of copays, deductibles, and coinsurance. Medigap plans not only help pay for these costs but also offer opportunities to add coverage for excess charges or health emergencies during foreign travel.

Although Plan G and Plan F were the most popular plan types, given their comprehensive coverages, Plan F is no longer available for those who qualify for Medicare as per the changes in laws applicable from January 2020. Differently-abled Medicare beneficiaries under the age of 65 can still get Medigap in Pennsylvania, but the plans come with much higher premiums.

How Do Medigap Insurers Set Their Premiums?

Medigap insurers have three ways of pricing their premiums:

  • Community Rating: Premiums remain the same regardless of the enrollee’s age.
  • Issue Age Rating: In this method, premiums are less costly for younger people in comparison to people older than 65. These premiums might increase due to inflation and other reasons, but never due to the enrollee’s age.
  • Attained Age Rating: This method of calculating premiums is based on the enrollee’s age. As you age, your premiums get higher.

Other factors that affect these rates can be location, marital status, gender, inflation, and lifestyle.

When applying for a health insurance plan, you must make sure you’re getting comprehensive coverage policies that also include additional benefits that are well-suited to your situation. But finding a well-rounded health insurance plan is not as simple as it seems. It requires proper research and an insurance specialist’s insight to find sturdy healthcare policies that are within your budget. Feel free to call our Medicare insurance agents at any time to get suitable healthcare policies at the most reasonable rates.

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Comparing Medicare Plans in Pennsylvania: Factors to Consider

Amount of Coverage Required

It’s best to maintain a list of all the goals and requirements that you expect your insurance plan to meet when you set out to shop for health insurance in Pennsylvania. A list of all your specific needs will help you keep your goals in mind and choose a plan that fulfills them all. You can reach one of our Medigap Agents to compare the pricing on different plans in Pennsylvania.

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Provider Network

Many Medicare plans require the beneficiaries to only choose in-network healthcare facilities. You will be asked to pay a higher premium for an out-of-network provider. This is why you should research and find in-network healthcare providers to save money on medical expenses.

Plan Ratings

The Center for Medicare & Medicaid Services (CMS) releases Part C and Part D performance data annually that you can go through to compare ratings.

Monthly Premium

The Medicare Advantage and Medigap plans add a premium to your medical budget, and you will have to pay the Part B deductible whether or not you exercise your benefits. Sign for at least one non-premium plan with sufficient coverage to save yourself from the financial strain.

Drug Coverage

Prescription drugs are costly, which is why it’s best to ensure your plan has adequate drug coverage before you sign up for it. You can consult with the policy’s formulary to check whether the drugs you’re prescribed are listed on it. If not, you can ask your doctor for an alternate or generic version of the drug.

Coinsurance & Co-pays

Often referred to as cost-sharing, you’re responsible for these costs when you use your benefits. Find out how much your insurance covers for doctor’s appointments, treatments, services, and prescriptions.


This is the amount you must pay before the insurance plan starts to help cover costs. Medicare Advantage Plans have set deductibles that typically change every year.

Extra Benefits

Most Medicare Advantage Plans cover prescription medications, but some also include additional benefits that the Original Medicare doesn’t cover.

You might require hearing or vision benefits, dental services, transportation to doctor’s visits, discounted gym memberships, and other targeted services.

Medicare Advantage Plans offer benefits that can be tailored to meet the particular needs of chronically ill beneficiaries. Think about the additional benefits that are crucial to your situation. Many first-time Medicare enrollees in Pennsylvania find the enrolment process difficult.

You can rely on Medicare Hope to provide you with all the details you need about sturdy health insurance policies that meet your requirements and are within your budget.


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Medicare Enrollment in Pennsylvania

Enrollment in Medicare, Pennsylvania, is open during the following time frames:

Initial Enrollment

The initial registration period begins three months before and ends three months after your 65th birthday. This is the time to enroll if you have never had Medicare before. You can also change or update your current Medicare plan if you began receiving it at a younger age.

General Enrollment

For those who missed the initial enrollment time, you get another window from January 1 to March 31. During this period, you can enroll in Original Medicare (Parts A and B), Medicare Advantage (Part C), Medigap, and Part D plans.

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Open Enrollment

You get a 3-month window from October 15 to December 7 each year, during which you can make changes to your Part C plan.

Special Enrollment

If you lose your insurance coverage or your eligibility changes due to unforeseen circumstances, you may be eligible for a special enrollment period.


Why Trust Medicare Hope Insurance Agents at Integrity Now Insurance Agents?

Our team of Medicare insurance agents is a certified team of experienced insurance agents who are well-versed in complex jargon and industry dynamics. We make sure we’re going the extra mile for all of our clients and helping them land comprehensive health insurance plans that fulfill all their needs and requirements and are within their budget.

With our assistance, countless of our clients in Pennsylvania have received well-rounded healthcare plans from top-tier Medicare insurance providers across the US. We assure you that your health is our priority. With our AHIP-certified agents, you never have to worry about any lacking in your retirement plans again.

Let’s schedule a call today and get free-of-charge assistance from our reliable Medicare insurance agents. We will help you compare quotes and walk through the intimidating process of signing up for Medicare.

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