Original Medicare (Part A and Part B) is only one way to get Medicare coverage. You also have the option of getting one of the Medicare Advantage plans in Pennsylvania. While the federal government manages Original Medicare, private insurance companies offer Medicare Advantage plans, also referred to as Medicare Part C. To offer a plan, the insurer must be approved by Medicare. Medicare Advantage plans are required to have at least the same coverage provided by Original Medicare, although many of these plans offer additional benefits. Learn more about your options to determine if a Medicare Advantage plan is right for you.
Before you purchase one of the Medicare Advantage plans in Pennsylvania, it’s important to get a better understanding of Original Medicare (Part A and Part B). Medicare Part A is hospital insurance and pays for inpatient hospital care, a stay at a skilled nursing facility or hospice, surgery, lab tests, and home healthcare.
Medicare Part B is your medical insurance. You will use this policy for doctor visits and other forms of outpatient care. It also covers home healthcare and medical equipment, along with some preventative services.
Original Medicare does not cover prescription drugs. You have to add Medicare Part D to get this coverage, and it works as a standalone policy.
Medicare Advantage plans have to provide the same coverage offered by Original Medicare, but many offer additional benefits. Benefits change depending on the plan, but you can find a policy that covers wellness programs, dental care, and hearing and vision services. Also, many Medicare Advantage plans also include prescription drug coverage. All of the benefits are in one policy, so you do not need to use one plan for one service and another for a different service.
Because Medicare Advantage plans typically offer more benefits, the out-of-pocket costs are usually lower than with Original Medicare.
When comparing Medicare Advantage Plans in Pennsylvania, you will notice you have options. Plan availability depends on where you live, but it’s still a good idea to learn about the possibilities.
HMOs have a large network of providers that you can access. You’re only covered if you see a provider inside the network, with the exception of emergency care. You will need a primary care doctor when you use an HMO. Your doctor can refer you to specialists as needed.
If you want more flexibility, consider a PPO Medicare Advantage plan. While PPOs also have a network, you’ll be covered both in and out of the network. However, you can expect to pay more out of your own pocket if you see providers outside of the network.
If you have a chronic health condition, are living in a nursing home, or have Medicaid and Medicare, you might qualify for a Special Needs Plan. These plans were created to meet the special medical needs of a select group of people. If you are not sure if you qualify for a Special Needs Plan, a licensed insurance agent can help.
MSA plans are similar to HSA health insurance plans. These plans have a high deductible, and Medicare puts money into a savings account for you to use to pay for healthcare. The money deposited is generally less than the deductible, and these plans do not include prescription drug coverage.
PFFS plans are the closest to Original Medicare. The plan pays healthcare providers and hospitals a previously determined amount, and it also determines how much you will pay.
Some Medicare Advantage plans do not include prescription drug benefits. If you want prescription benefits, you need to purchase a Medicare Advantage Prescription Drug plan. This option covers healthcare and prescription drugs in a single plan.
Each plan has a formulary you can access to see which prescription drugs are covered. Look at the formulary before purchasing a prescription drug plan to ensure it covers the drugs you currently take or might take in the near future.
There are lots of options for Medicare Advantage plans in Pennsylvania. Some plans don’t have monthly premiums, while others have low out-of-pocket costs and lots of benefits. This can seem overwhelming, but help is available. Call 844-903-4406 to speak to a licensed insurance agent today.