Pennsylvania Medicare Supplement Plans: What You Need to Know
Pennsylvania is home to one of the largest Medicare populations in the country, with over 2.5 million beneficiaries. From the urban centers of Philadelphia and Pittsburgh to the rural communities of central Pennsylvania, having the right Medicare coverage is essential. That's where unbiased, fee-only guidance makes a difference.
Unlike Medicare Advantage plans that vary by county, Medigap plans in Pennsylvania are standardized by letter (A, B, C, D, F, G, K, L, M, N). This means a Plan G from one company covers exactly the same benefits as a Plan G from another company. The only differences are the premium you pay and the company's customer service.
Pennsylvania Medigap Open Enrollment Period
In Pennsylvania, your Medigap Open Enrollment Period begins on the first day of the month you turn 65 and are enrolled in Medicare Part B. This 6-month window is critical because:
- Insurance companies cannot deny you coverage for any reason
- They cannot charge you more due to health conditions
- You have guaranteed issue rights to any Medigap plan sold in Pennsylvania
Pennsylvania Consumer Protection
Pennsylvania law requires insurance companies to offer a 30-day "free look" period for all Medigap policies. During this time, you can review the policy and cancel for a full refund if you're not satisfied, no questions asked.
Most Popular Medigap Plans in Pennsylvania
While 10 standardized Medigap plans are available in Pennsylvania, the most popular choices are:
| Plan | Coverage Level | Best For | PA Monthly Premium* |
|---|---|---|---|
| Plan G | Comprehensive | Most new enrollees (best value) | $120 - $250 |
| Plan N | High with copays | Those wanting lower premiums | $85 - $180 |
| Plan F | Most comprehensive | Those eligible before 2020 | $150 - $300 |
*Premium ranges are estimates and vary by age, location within Pennsylvania, gender, and tobacco use. Contact us for personalized quotes.
Plan G vs Plan N in Pennsylvania
For most Pennsylvania residents new to Medicare, the choice comes down to Plan G or Plan N:
- Plan G covers everything except the Part B deductible ($240 in 2024). No copays, no surprises. Ideal if you want predictable costs and visit doctors frequently.
- Plan N has lower premiums but requires up to $20 copays for office visits and up to $50 for ER visits (waived if admitted). Good choice if you're healthy and want to save on monthly costs.
Pennsylvania Medicare Supplement vs Medicare Advantage
Pennsylvania has a competitive Medicare Advantage market, especially in Philadelphia and Pittsburgh. But these are very different products. Here's how they compare:
| Feature | Medigap (Supplement) | Medicare Advantage |
|---|---|---|
| Monthly Premium | $85 - $300+ | $0 - $50 (some higher) |
| Out-of-Pocket Maximum | Very low (predictable) | Up to $8,850/year |
| Doctor Network | Any doctor accepting Medicare | Network restrictions |
| Referrals Needed | No | Often yes (HMO plans) |
| Prescription Drug Coverage | Separate Part D plan needed | Usually included |
| Extra Benefits | None | May include dental, vision, gym |
Read our complete Medigap vs Medicare Advantage guide to understand which option might be better for your situation.
Pennsylvania-Specific Medicare Considerations
Rural Pennsylvania Coverage
Pennsylvania has extensive rural areas, particularly in the central and northern regions, where Medicare Advantage plan networks can be extremely limited. If you live in or frequently travel to rural Pennsylvania, Medigap offers a significant advantage: any doctor or hospital that accepts Medicare will accept your Medigap plan. This is critical in areas where specialist care may require traveling to Pittsburgh, Philadelphia, or Harrisburg.
Snowbirds and Florida Residents
Many Pennsylvania residents spend winters in Florida or travel frequently out of state. If you're a "snowbird," Medigap provides nationwide coverage that works the same whether you're in Philadelphia, Florida, Arizona, or anywhere else in the United States. Medicare Advantage plans often have network restrictions that can be problematic when traveling or living part-time in another state.
Pennsylvania APPRISE Program
Pennsylvania offers a free counseling program called APPRISE (Pennsylvania's State Health Insurance Assistance Program) through the Department of Aging. APPRISE counselors are available through local Area Agencies on Aging and can provide general Medicare information. However, they cannot recommend specific plans or companies. That's where a fee-only Medicare advisor adds value: we can make specific recommendations based on your individual situation.
Cross-Border Healthcare Considerations
Pennsylvania shares borders with six states: New York, New Jersey, Delaware, Maryland, West Virginia, and Ohio. If you live near a border and receive healthcare in a neighboring state, Medigap plans work seamlessly across state lines with any provider that accepts Medicare. This is particularly valuable for residents of areas like the Lehigh Valley (near New Jersey), Erie (near Ohio), or the Philadelphia suburbs (near Delaware and New Jersey).
Frequently Asked Questions: Pennsylvania Medicare
The best time is during your 6-month Medigap Open Enrollment Period, which starts the month you turn 65 and are enrolled in Part B. During this time, you have guaranteed issue rights and cannot be denied coverage or charged more due to health conditions.
Yes, but you'll need to go through medical underwriting, which means the insurance company can deny you coverage or charge higher premiums based on your health. Some situations trigger "guaranteed issue" rights outside of open enrollment, such as losing employer coverage or moving out of your plan's service area.
Medigap premiums in Pennsylvania typically range from $85-$300+ per month depending on the plan letter, your age, location (Philadelphia and Pittsburgh are often more expensive than rural areas), gender, and tobacco use. Pennsylvania generally has moderate Medigap rates compared to many other states.
Plan F is only available to those who became eligible for Medicare before January 1, 2020. If you turned 65 before that date, you can still enroll in Plan F. However, Plan G offers nearly identical coverage (minus the Part B deductible) and often has lower premiums.
Yes. Medigap plans do not include prescription drug coverage. You'll need to enroll in a standalone Medicare Part D plan separately. Pennsylvania has many Part D options, and we can help you compare them based on your specific medications.
No. Pennsylvania follows federal Medigap rules. Unlike some states that have birthday rules or continuous open enrollment, Pennsylvania only offers guaranteed issue rights during your initial 6-month Medigap Open Enrollment Period when you turn 65 and enroll in Part B. After that, you may need to answer health questions to change plans.