October 6, 2016
Did you know that there’s a specific type of health insurance plan in Pennsylvania designed to help pay for Medicare’s out-of-pocket costs? That’s where Medicare Supplement (or Medigap) insurance comes in. In Pennsylvania, as in other states, you may be able to enroll in a Medigap plan to supplement your Original Medicare, Part A and Part B, coverage.
Medicare Supplement policies are available through private insurance companies and may cover out-of-pocket Medicare costs like copayments, coinsurance, deductibles, and more. Plan availability may vary throughout Pennsylvania.
In 47 states, including Pennsylvania, there are 10 standardized Medicare Supplement (Medigap) plans for Medicare beneficiaries. Each Medigap plan is labeled with one of 10 letters (A, B, C, D, F, G, K, L, M, and N), and plans of the same letter cover the same standardized benefits. Three states (Massachusetts, Minnesota, and Wisconsin) have different standardized Medigap plans from the rest of the country. Also, please note that some companies may offer additional innovative benefits.
If you’re interested in enrolling in a Medigap plan in Pennsylvania, you must first be enrolled in Original Medicare, Part A and Part B. You can join a Medigap plan during your Medigap Open Enrollment Period, which automatically starts the first day you are both age 65 or older and enrolled in Medicare Part B. During this six-month period, you have guaranteed-issue rights, meaning that you can enroll in any Medigap plan available in your area, and insurers can’t turn you down for coverage because of pre-existing conditions (although waiting periods may apply). Insurers also aren’t allowed to require medical underwriting during this period.
If you apply for a Medigap plan after your Medigap Open Enrollment Period ends or decide to switch plans, you may have trouble finding an insurance company that will sell you a policy. Outside of this period, insurers can review your health history and decide to reject your enrollment application or charge you a higher premium if you have health issues. However, there are some limited situations when you do have a guaranteed-issue right to enroll in a Medigap plan, such as losing your current Medigap plan coverage through no fault of your own.
Since Medigap insurance in Pennsylvania is meant to supplement rather than replace Original Medicare, you must remain enrolled in Original Medicare and continue paying your Medicare Part B premium to keep your health coverage. Also, keep in mind that Medigap plans in Pennsylvania don’t work with Medicare Part C and can’t be used to pay for Medicare Advantage costs. Medigap plans sold today also don’t come with prescription drug coverage. If you need help with prescription drug costs, you may want to sign up for Medicare prescription drug coverage.
In Pennsylvania, there are 10 types of standardized Medicare Supplement plans available to Medicare beneficiaries, although not every plan may be universally available throughout the state. Here’s a look at the benefits available under each type of Medigap plan. In this table, a blank cell means no coverage for a Medicare service or item, while an X means it is covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C||D||F*||G||K||L||M||N|
|Medicare Part A coinsurance and hospital costs up to an additional|
365 days after Medicare benefits are exhausted
|Medicare Part B copayment or coinsurance||X||X||X||X||X||X||50%||75%||X||X***|
|First three pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Medicare Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled nursing facility (SNF) care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B ‘excess charges’||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Medicare Part B preventive care coinsurance||X||X||X||X||X||X||X||X||X||X|
|Out-of-pocket limits apply**|
Medicare beneficiaries who want broader coverage may find that Medicare Supplement Plan F fits their needs. Plan F pays for almost all the Medicare-associated out-of-pocket costs listed above, but may have a higher premium than other Medigap plans.
Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance, but under this plan, you still need to pay the copayment of up to $20 for some doctor office visits, and up to $50 for emergency room visits.
Keep in mind that Medicare Supplement Plan K and Plan L have out-of-pocket limits that are subject to change each year.
Although Medicare Supplement plans with the same letter designation provide the same coverage and benefits, the plans may have different monthly premiums. For example, you may find that a Medigap Plan F in Pittsburgh has a different premium than the same plan sold by a different insurance company in Allentown. It may be a good idea to compare the Medicare Supplement plans in Pennsylvania available in your vicinity.
You may also want to learn about Medicare Advantage plans in Pennsylvania.
With all the Medigap plans that may be available to you in Pennsylvania, you may want help sorting through all of your choices. You can take a look at Medigap plans on your own; just type your zip code in the form on this page. Or, feel free to call an eHealth licensed insurance agent at the number shown below.
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.