Medicare is a national health insurance program that provides health insurance to millions of seniors and some younger people with disabilities across the country. Medicare provides health coverage for more than 49 million people in the United States, and that number is expected to grow to 64 million by 2020.
Coverage
Medicare offers four different types of coverage: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage). After you turn 65, you should have some combination of these four parts to give you the health insurance coverage you need to stay healthy and independent. Most people will enroll in Original Medicare (Part A and Part B), but Pennsylvania also offers 252 Medicare Advantage plans across the state. Use Medicare’s Plan Finder to find a plan that’s right for you.
Eligibility
Most people will automatically be enrolled in Part A by aging into the system at age 65. You may also automatically be enrolled in Part B at this time if you are already receiving Social Security benefits. Everyone else will need to manually enroll in Part B coverage through Social Security during one of Medicare’s enrollment periods. If you have a long-term disability, you may qualify for Medicare, even if you are younger than 65. Check with your local Social Security office to see if you qualify for Medicare coverage.
Medicare Advantage
Medicare Part C (also known as Medicare Advantage) is sold through private insurance companies and provides Part A and Part B coverage. Some plans offer additional benefits like vision, dental, and hearing care, and prescription drug coverage. In 2017, one in three Medicare beneficiaries had a Medicare Advantage plan. According to the Kaiser Family Foundation, 41 percent of people in Pennsylvania were enrolled in Medicare Advantage plans in 2017. Medicare Advantage plans vary based on where you live, so your plan in Pennsylvania might be different from your friend’s in Florida. Prices also vary based on your county. Research Medicare Advantage plans with Medicare’s Plan Finder.
Medigap
If you have a chronic illness, you might consider purchasing a Medigap policy. Medigap fills in the “gaps” in your Medicare coverage. Some policies cover things like copays, premiums, and deductibles. If you anticipate frequent doctor visits or just need help covering out-of-pocket Medicare costs, Medigap may be right for you. Like Medicare Advantage, Medigap policies are sold by private insurance companies approved by Medicare. Medigap policies are standard across the country (with the exception of Massachusetts, Minnesota, and Wisconsin), though premiums vary based on where you live.
The three most popular Medigap plans in Pennsylvania are Plan F, Plan G, and Plan N. The only difference between Plan F and Plan G is that Plan F covers the Medicare Part B deductible, which is $185 in 2019. However, the yearly premium for Plan F might be more expensive than the Plan B deductible, so weigh your options when choosing a plan. Medigap Plan F and Plan C are being phased out in 2020. If you already have these plans, though, you can keep them indefinitely.
Local resources for Medicare in Pennsylvania
For more help or a free Medicare consultation, contact your local SHIP, or State Health Insurance Assistance Program. SHIPs offer free and unbiased counseling to help guide you through the Medicare system. SHIP counseling is available for Medicare beneficiaries, caregivers, and family members. Visit Pennsylvania’s APPRISE website.
The Department of Health and Human Services (HHS) also offers free, unbiased counseling to help guide you through Medicare. Representatives at HHS can help you enroll in Medicare, find necessary information, and counsel you about your options. Visit your local HHS website.
If you have low income and assets, Pennsylvania has Medicare Savings Programs available to qualified beneficiaries. These programs offer discounts for some out-of-pocket Medicare expenses, like the Part A and Part B premium, deductible, coinsurance, and copayments. See if you qualify for any of the Medicare Savings Programs in Pennsylvania.
To contact Medicare directly, call 1-800-MEDICARE (TTY users call 1-877-486-2048) 24 hours a day, 7 days a week.
