How to find the best Medicare Advantage plan in Pennsylvania
2.8 million people in Pennsylvania are enrolled in Medicare, and 49% of them have Medicare Advantage plans. With 50 different plans to choose from in most counties, you have plenty of choices for Medicare Advantage plans in Pennsylvania.
In this post, we’ll explore highly-rated options, insurance providers that offer Medicare Advantage plans, and how to find the best Medicare Advantage plan in Pennsylvania.
Key takeaways:
The best PA Medicare Advantage plans for you will depend on your unique health and financial situation. Understanding your healthcare priorities and budget is the first step in finding the best plan for you.
Top-rated Medicare Advantage plans in Pennsylvania come from: Highmark Blue Cross Blue Shield, UnitedHealthcare, and UPMC for Life.
Facts about Medicare Advantage plans in Pennsylvania
In 2024, the average monthly premium for Pennsylvania Medicare Advantage plans is $27.94.
You can choose from 281 Medicare Advantage plans in Pennsylvania.
There are 14 insurance providers that offer Medicare Advantage plans in Pennsylvania, including Aetna Medicare, Cigna, Humana, UnitedHealthcare, and Wellcare.
What’s included in a Medicare Advantage plan?
When Medicare was first introduced, you could only enroll in Original Medicare. Two parts make up Original Medicare: Part A, or your hospital insurance, and Part B, or your outpatient medical insurance. Notably, Original Medicare doesn’t cover prescription drugs or routine dental, vision, and hearing services. It also doesn’t have a limit to your out-of-pocket healthcare costs. Some positive aspects, however, are that it doesn’t have restrictive provider networks and doesn’t require prior authorization. You can also significantly reduce your out-of-pocket costs by enrolling in a Medicare Supplement plan.
Medicare Advantage plans cover the same things asPart A and Part B. You can also find Medicare Advantage plans that include Part D (prescription drug coverage). These plans often include additional benefits like:
Coverage for routine dental, vision, and hearing services
Transportation benefits
Fitness and wellness memberships
Unlike Original Medicare, Medicare Advantage plans have out-of-pocket maximums and networks of providers.
Best Medicare Advantage plans in Pennsylvania
The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage plans for their quality every year with a star-rating system. They award 5 stars for the highest-quality plans and 1 star for the lowest quality plans. Below we list insurance providers that carry plans with five stars. The five-star rating indicates that they provide some of the top Medicare Advantage plans in Pennsylvania for 2024:
Plans with 5-stars come from the following carriers:
Highmark Blue Cross Blue Shield
UnitedHealthcare
UPMC for Life
Plans with 4.5 stars come from the following carriers:
Aetna Medicare
Highmark Blue Cross Blue Shield
Humana
Independence Blue Cross
While these carriers offer highly-rated plans, the highly rated plans may not be the best for you. To find the best Medicare Advantage plan for you, you should take a close look at your healthcare needs and financial situation to determine the plan that covers your needs while remaining in budget.
Searching for the best Medicare Advantage plan in Pennsylvania
There are a few factors to keep in mind when choosing the best Medicare Advantage plan in Pennsylvania.
Costs
Consider the portion of the bill your insurance will cover and what you’ll have to pay for your medical services. Medicare Advantage plans have different price structures, so your share of costs will be different from one plan to another. You may have to pay more for services if you go with an out-of-network provider. If you need a lot of healthcare services, it’s a good idea to find a plan that covers a higher portion of costs and has a lower out-of-pocket maximum.
Keep in mind that you’ll have to pay Part B premiums in addition to any premium that the Medicare Advantage plan charges. There are zero-dollar premium plans available in Pennsylvania, but they aren’t always the best option because your out-of-pocket costs may be higher with these plans.
Access to care
There are three ways that Medicare Advantage plans could limit your access to care. First, these plans have provider networks. If you see a doctor who’s out of network, you will pay much more for the healthcare you receive. As a result, you should make sure your preferred providers are included in a plan’s network before choosing or switching your plan.
Second, Medicare Advantage plans are notorious for requiring prior authorization, especially for more expensive services. Prior authorization requirements can delay or even limit your access to care—because, if denied, you would be responsible for 100% of the cost of service. While most carriers require prior authorization, some do less than others. You can learn more about prior authorization behaviors among insurance companies here.
Finally, Medicare Advantage plans can require referrals to see a specialist, which can delay your access to care.
Prescriptions and priorities
We recommend you make a list of all the services and medications you need. This makes it easier to pick a plan that provides coverage for what you need. Make sure that the drug coverage you choose (whether it’s included with your Medicare Advantage plan or through a standalone drug plan), covers all the medications you take.
Enrolling in the best Medicare Advantage plan in Pennsylvania
Enrolling in the right Medicare plan can feel like a lot of pressure, and choosing the wrong plan can cost you. That said, you can switch between Medicare Advantage plans or switch between Medicare Advantage and Original Medicare during the Open Enrollment Period (OEP) that occurs each year.
Whether you’re just getting started with Medicare enrollment or considering switching plans, we can help take the pressure off! Talk to a licensed Chapter Medicare Advisor for personalized advice on what the best Medicare plan is for you. We can review your needs and your options with you and help you choose and enroll in the best Medicare Advantage plan for you. Call us at 855-900-2427 or schedule a time to talk today.