Medicare Advantage Plans in Pennsylvania

Private insurance companies contract with the Centers for Medicare and Medicaid Services to offer Medicare Advantage plans in Pennsylvania. These plans are designed to work in the place of Original Medicare, enhancing the coverage options offered by Medicare Part A and Medicare Part B.
Each insurance company has the option to provide additional coverage to make their plans more competitive. Each plan must also include all benefits offered by Medicare Part A and Part B, so most plans allow beneficiaries to combine wellness, medical, and prescription benefits in one plan.

Popular Medicare Advantage plan types in Pennsylvania

Medicare Advantage PPO in Pennsylvania

Provider networks go hand in hand with Advantage plans, but PPO plans are less restrictive than HMO plans. Beneficiaries aren’t required to secure a referral before seeing a specialist. Most plans have larger networks, which means more options when selecting providers. Many plans also allow out-of-network providers at higher cost to the beneficiary.
There are some $0 premium PPOs available, but monthly premiums can go up to $100.

Medicare Advantage HMO Plan in Pennsylvania

An HMO plan will require beneficiaries to choose from a narrower field of network healthcare providers, but the plans are often the most affordable options. Beneficiaries give up some of their provider options in exchange for lower monthly premiums.

Out-of-network service providers aren’t permitted in most HMO plans. Beneficiaries must select a primary care physician and seek a referral before seeing a specialist.

Most Pennsylvania beneficiaries have access to $0 premium HMO Advantage plans.

Medicare Advantage D-SNIP in Pennsylvania

Special needs plans are limited to beneficiaries with chronic health conditions or income limitations. Plans are arranged as HMOs or PPOs, and each one is dedicated to a specific health care or income need. This type of Medicare Advantage plan in Pennsylvania typically offers additional Medicare coverage that correlates to the covered medical condition.

How much does Medicare Advantage cost in Pennsylvania?

The average monthly premium for a Pennsylvania Medicare Advantage plan was $76.33 in 2022. Most plans were PPOs, and many $0 premium options were available. Some counties may also offer HMO plans with no premium in future years.

The full cost of Advantage health plans goes beyond the monthly premium. Beneficiaries will also pay out of pocket costs like deductibles, copays, excess charges, and coinsurance. Some plans will cover all or part of the Part B premium.

Many Medicare Advantage Prescription Drug plans (MAPD) are available in Pennsylvania, so many enrollees do not need to pay separately for Part D prescription drug insurance plans.

When can I enroll in a Medicare Advantage plan in Pennsylvania?

Initial Enrollment Period

Each beneficiary has a unique initial enrollment period. It serves as the first opportunity to enroll in an Advantage plan. It lasts for seven months, including the month a beneficiary turns 65 plus the three months before and the three months after that birthday month.

Eligibility for an Advantage plan begins when a beneficiary is at least 65 years old and enrolled in Medicare Part A and Part B. The initial enrollment period is a one-time event for each beneficiary.

Open Enrollment Period – AKA Annual Election Period

The Medicare Open Enrollment Period runs from October 15 to December 7 every year. Beneficiaries can join an Advantage plan during this period. They can also add a Part D plan if they select an Advantage plan that doesn’t include prescription drug coverage.

Medicare Advantage Open Enrollment Period

From January 1 to March 31 each year, Medicare Advantage holds its own open enrollment period. It’s reserved only for beneficiaries already enrolled in Medicare Part C. The options are to switch to a new Part C plan or move back to Original Medicare with or without a Part D plan.

Special Enrollment Periods – Special Circumstances

A special enrollment period entitles individual beneficiaries to make Medicare Advantage plan changes outside of the initial and open enrollment periods. Beneficiaries must have a qualifying reason to make the changes. For example, some beneficiaries may have a special enrollment period after moving out of their current plan’s service area.

5-star Special Enrollment Period

This special enrollment period gives every beneficiary the opportunity to make a one-time switch to a Pennsylvania Medicare Advantage plan that has a 5-star rating. Beneficiaries can initiate that change between November 30 and December 8.

Special Enrollment Periods if you get “Extra Help”

Beneficiaries who qualify for Medicare’s Extra Help program and Medicaid have the opportunity to join a Part C plan, switch to a new plan, or move back to Original Medicare one time during each of the following annual periods:

  • January – March
  • April – June
  • July – September

Beneficiaries who receive Extra Help only for prescription drug coverage can make changes to their Part D prescription drug plans one time during each of those annual periods.

When can I make changes to my Medicare Advantage plan?

Once enrolled in a Pennsylvania Medicare Advantage plan, beneficiaries can make plan changes during Medicare’s annual open enrollment period. It runs from October 15 to December 7 and allows beneficiaries to do the following:

  • Join a new Advantage plan
  • Switch back to Original Medicare
  • Join a Part D plan

Medicare Advantage also has an annual open enrollment period from January 1 to March 31. Only beneficiaries already enrolled in a Part C plan are eligible, and the following actions are permitted:

  • Switch Advantage plans
  • Switch back to Original Medicare with or without a Part D plan


Can I have a Medicare Advantage plan with a Medigap Plan?

Beneficiaries cannot enroll in a Medicare Supplement and Medicare Advantage plan at the same time. It’s important to compare prices and plan benefits online prior to selecting between these plan types. Consulting with an insurance agent experienced in Medicare policies can help as well.

Do Medicare Advantage plans use the Silver Sneakers program?

Some Medicare Advantage plans include SilverSneakers memberships. Some include free or discounted gym memberships through other programs and fitness centers.