Original Medicare is a valuable resource for improving your health and helping you stay on top of your medical bills. However, it falls short of fully covering the costs of even routine preventative care. So, if like many Medicare recipients, you find the 20% coinsurance for Medicare Part B and other out-of-pocket expenses cost-prohibitive, you should look into a Pennsylvania Medicare Supplement Plan.
These plans are provided by private insurance companies, but all the plans that they sell must adhere to government regulations and provide the same level of basic coverage. In fact, the Centers for Medicare & Medicaid Services (CMS) requires that all Medicare Supplement Plans with the same letter name provide the same coverage to enrollees.
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Because premiums for Medicare Supplement Plans are set by the private insurance companies that sell them, prices can vary greatly. That means it’s best to shop around before deciding on a plan and an insurance provider. Our Pennsylvania Medicare Supplement Plans Buyer’s Guide will help you choose the best plan for your needs. And an EZ agent can help you get the best rates and will sign you up without any hassle.
Pennsylvania Medicare Supplement Plans
If you require more coverage than what Original Medicare provides, you should consider purchasing a Medicare Supplement Plan.
There are ten to choose from (Plans A,B,C,D,F,G,K,L,M,N). Regardless of whether all insurance companies in Pennsylvania offer all of these plans or not, the state requires that everyone have access to at least Plan A. Medicare Plans C and F are closed to new enrollees who became eligible for Medicare after January 1, 2020.
We’ve compiled a list of all ten plans available to Pennsylvania residents. Along with information about what each one covers, and the monthly premiums associated with them.
Plan A
The most basic Medicare Supplement Plan is Plan A. It’s fairly bare bones, but it covers the 20% of Medicare Part B outpatient care costs that you are required to pay. Among some other basic, but major, expenses as outlined below.
Insurance providers in Pennsylvania are required to offer Medicare Supplement Plan A to all beneficiaries over the age of 65, but they are not required to cover Medicare beneficiaries under the age of 65.
In Pennsylvania, Plan A costs between $68 and $369 a month.
Plan B
Medicare Supplement Plan B covers all the basics that Plan A does, including:
- Medicare Part A coinsurance and hospital costs – Medicare Part A only fully covers your first 60 days of inpatient hospital stays in a benefit period; after that, you are required to pay coinsurance for each day after your initial 60 days. Days 61-90 have a coinsurance of $400 a day, days 91-150 (after you use your Lifetime Reserve days) have a coinsurance of $800 a day. Plan B covers 100% of these costs.
- Medicare Part B coinsurance or copay – You’ll typically have to pay Medicare Part B coinsurance for doctor visits and other outpatient care. That means Medicare Part B pays 80% of the Medicare-approved amount for covered services, leaving you to pay the remaining 20%. Plan B covers 100% of this.
- First 3 pints of blood – Original Medicare only pays for the fourth and subsequent pints of blood if you need blood during treatment. Plan B will pay for the first three pints.
- Part A hospice care and coinsurance – Hospice care is for patients who are nearing the end of their lives. These services are covered by Medicare, but copayments are required. These copayments include $5 for each symptom and pain relief medication prescription, as well as 5% of the Medicare-approved amount for inpatient assisted living. Plan B covers all expenses related to hospice care.
But what makes Plan B less bare bones than Plan A is that it covers Medicare Part A deductibles, which Plan A does not. Because the Medicare Part A deductible ($1,600 in 2023) is calculated on a 60-day basis rather than on an annual basis, you may have to pay it more than once a year, so having coverage for this could end up being invaluable.
Pennsylvania residents can expect to pay between $113 and $393 per month for Plan B insurance premiums.
Plan C
Part C is one of the most comprehensive Medicare Supplement Plans sold, but it is not available to everyone. It covers all copayments and deductibles; the only thing it doesn’t cover are Medicare Part B excess charges.
Coverage includes the following:
- Part A hospital deductible and coinsurance
- Hospital costs up to an additional 365 days after Medicare benefits are exhausted
- Part A hospice care coinsurance or copayment
- Blood (the first 3 pints)
- Other Medicare-approved expenses associated with Part A hospitalization
- Medicare Part B coinsurance and copayments
- Part B deductible
- Other Medicare-approved expenses associated with Part B coverage
Medicare beneficiaries who became eligible after January 1, 2020 are no longer able to purchase Plan C. If you had Plan C prior to that date, you can keep it, and if you were eligible for Medicare but didn’t enroll at that time, you may still be able to purchase it.
In Pennsylvania, Plan C premiums range from $142 to $528 per month.
Plan D
Plan D covers the majority of out-of-pocket expenses associated with Original Medicare, including:
- Part A hospital coinsurance and hospital costs up to an extra 365 days after Original Medicare benefits are exhausted
- Part A hospice care coinsurance or copayment
- Part B coinsurance
- First 3 pints of blood
- Skilled nursing facility (SNF) care coinsurance – After the 20th day of your stay as an inpatient in a skilled nursing facility, Medicare Part A requires you to pay coinsurance. Part A coinsurance for skilled nursing facility care is $200 per day in 2023. Part D covers this coinsurance.
- Part A deductible
- 80% of foreign travel emergency costs (up to plan limits)
Medicare Part B copayments and deductibles are not covered by Plan D, and neither are Part B excess charges. If your doctor refuses to accept Medicare assignment and bills you for more than Medicare will cover, the difference is known as Part B excess charges. And while some plans cover these charges, if you have Plan D, you will be responsible for paying this difference.
Medicare Supplement Plan D prices in Pennsylvania range from $120 to $277 per month.
Plan F
Plan F has always been the most popular plan because of its comprehensive coverage, but like Plan C, it is not available to all beneficiaries. The monthly premium for Plan F is all you’ll have to pay out-of-pocket for this coverage. That means Plan F covers all of the following:
- Part A hospital deductible and coinsurance
- Hospital costs up to an additional 365 days after Medicare benefits are exhausted
- Part A hospice care coinsurance or copayment
- Blood (the first 3 pints)
- Other Medicare-approved expenses associated with Part A hospitalization
- Medicare Part B 20% coinsurance and copayments
- Medicare-approved doctor’s office fees
- Part B deductible
- Medicare Part B excess charges
- Other Medicare-approved expenses associated with Part B coverage
If you became eligible for Medicare after January 1, 2020, you cannot purchase one of these plans. But those who currently have Plan F can keep their plans indefinitely, and if you became eligible for Medicare prior to 2020, but did not enroll then, you might still be able to buy one of these plans.
Plan F premiums in Pennsylvania range from $133 to $530 monthly.
Plan G
If you like the sound of Plan F, but are not eligible to purchase one of these plans, look into Plan G. This plan covers almost everything that Plan F does, including:
- Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
- Part A deductible
- Part A hospice care coinsurance or copayment
- Part B coinsurance or copayment
- Part B excess charges (if a provider is permitted to charge more than Medicare’s approved amount and does so)
- Blood transfusion (first 3 pints)
Plan G’s coverage only excludes the Medicare Part B deductible, making it a very comprehensive plan that is a better deal than many other plans. In fact, Plan G premiums are typically between $118 and $509 per month, making it less expensive than Plan F.
Plan K
Medicare Supplement Plan K reduces your out-of-pocket expenses, but it does not completely fill the gaps in Original Medicare. Plan K only covers half of the following costs:
- Medicare Part B coinsurance – Plan K covers half of these costs, so you will be responsible for 50% of your 20% coinsurance. For example, if your doctor charges $100 for a service, Medicare Part B will cover $80, Plan K will cover $10, and you will pay the remaining $10.
- First 3 pints of blood
- Part A hospice care coinsurance or copayment – Plan K will pay for half of these costs.
- Skilled nursing facility care coinsurance – Plan K pays half of the coinsurance for medical care in skilled nursing care facilities.
- Medicare Part A deductible – Medicare Supplement Plan K will pay half of these deductibles, or $800. Plan K requires you to pay the Medicare Part B deductible, which is $226 in 2023.
Plan K has some higher out-of-pocket expenses. But one reason that many people choose this plan is that it has an annual out-of-pocket maximum, which most plans do not. Plan K’s out-of-pocket maximum is $6,620 (as of 2023). And once you have spent this much on healthcare in a year, your Medicare Supplement Plan K coverage will begin to pay the entirety of your costs. Your annual limit will be reset at the start of each calendar year.
And, although Plan K only covers half of many of your out-of-pocket expenses, it does cover Medicare Part A coinsurance in full. This means an unexpected hospital stay that lasts longer than 60 days will not result in massive medical bills.
Plan K premiums in Pennsylvania range from $48 to $162. Which is lower than those of most other plans, because of Plan K’s higher out-of-pocket costs.
Plan L
Medicare Supplement Plan L helps cover some but not all of your out-of-pocket expenses. Although it covers them at a higher percentage than Plan K does. Plus, Plan L’s annual out-of-pocket maximum, which you’ll have to pay before your insurance company takes over, is lower than Plan K’s ($3,310 in 2023). These are the only two plans that have this out-of-pocket maximum. So, if this is important to you, Plan L might be a good choice.
Plan L also very helpfully covers Part A deductibles and copayments. It also covers a percentage of:
- Medicare Part B coinsurance – Plan L covers 75% of your Part B coinsurance.
- Blood – If you require blood while in the hospital, Plan L will cover 75% of the cost of the first three pints.
- Part A hospice care copayments – Plan L pays 75% of your Part A copays for hospice care.
- Skilled nursing facility care coinsurance – Plan L pays 75% of the $200 per day (after the 20th day of your stay) coinsurance for medical care in skilled nursing care facilities.
- Part A deductible – Medicare Supplement Plan L will cover 75% of your Part A deductibles for each 60-day benefit period. You must still meet your Medicare Part B deductible, which is $226 per year in 2023, if you choose Plan L.
Medicare Supplement Plan L premiums cost between $77 and $304 a month in Pennsylvania.
Plan M
Plan M covers the majority of your Original Medicare out-of-pocket expenses, but not all, although it fully covers more things than either Plan K or Plan L does. It covers:
- Medicare Part B coinsurance – Plan M pays your Part B coinsurance and/or copayments in full.
- Blood – If you require blood while in the hospital, Medicare Supplement Plan M will cover the first three pints of blood in full.
- Part A hospice care coinsurance or copayment – Plan M will cover all of your hospice care coinsurance and copays in full.
- Skilled nursing facility care coinsurance – Plan M covers the entire cost of Part A skilled nursing facility coinsurance.
- Part A hospital expenses and coinsurance
- Part A deductible – While Medicare Supplement Plan M covers most Part A costs, it will only cover half of your Medicare Part A deductible. If you have Plan M, you will have to pay half of the $1,600 (or $800) deductible rather than the full $1,600.
The cost of Plan M premiums in Pennsylvania is between $86 and $345 per month.
Plan N
Plan N is a great, comprehensive plan that covers almost everything. Although it has copayments for some Medicare Part B services, which most other plans do not. The only other coverage exceptions with Plan N are the Medicare Part B deductible ($226 in 2023) and Medicare Part B excess charges (portions of medical bills that exceed the Medicare-approved amount).
The majority of the costs associated with the following are covered by Medicare Supplement Plan N:
- Medicare Part B coinsurance – Plan N will cover your Part B coinsurance costs in full, with the exception of a copayment of up to $20 for some office visits. For emergency room visits that do not result in an inpatient admission, a second copayment of up to $50 may be required.
- Blood – If you require blood while in the hospital, Medicare Supplement Plan N will cover the first three pints.
- Part A hospice care coinsurance or copayment – Plan N pays your hospice care coinsurance and copayments in full.
- Skilled nursing facility care coinsurance – Your skilled nursing facility coinsurance will be fully covered by Medicare Supplement Plan N.
- Part A deductible – Medicare Supplement Plan N pays your $1,600 deductible in full for each 60-day benefit period.
- Foreign travel emergency care – Original Medicare typically does not cover medical care received outside of the United States. If you need emergency care while traveling outside of the United States, Medicare Supplement Plan N will cover 80% of the costs of qualified emergency medical care.
The price for Plan N ranges from $90 to $435 a month in Pennsylvania.
When to Enroll
Federal regulations have established a six-month guaranteed-issue window for Medicare Supplement Plans. Which begins when you turn 65 and enroll in Medicare Part B. This means that, if you enroll during this time, you cannot be denied or charged more for coverage based on your health.
With that being said, there is no federally guaranteed access to Medicare Supplement Plans for people under 65 who are eligible for Medicare due to a disability. However, Pennsylvania is among the majority of states that have rules ensuring at least some access to Medicare Supplement Plans for enrollees under 65. In Pennsylvania, the six-month Open Enrollment Period for Medicare Supplement Plans begins when you enroll in Part B. Regardless of age.
How To Choose
When it comes to Medicare coverage, don’t be afraid to ask questions. Speak to an EZ agent who can explain everything to you and tell you everything you need to know. EZ can assist you in enrolling in Medicare, looking for a Medicare Supplement Plan, or simply weighing your options. Our agents work with the best insurance companies in the country. So, they can provide you with a free comparison of all available plans in your area. We will go over your medical and financial needs with you and help you find a plan that works for you. To get started, simply enter your zip code in the bar below or give one of our licensed agents a call at 877-670-3602.
