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PA Medicare: The Ultimate Guide

Medicare can be overwhelming with the abundance of available options. Every person’s health and financial needs are different, and with more than 1.6 million Medicare-enrollees in Pennsylvania, not everyone will fit into the same plan. At Medicare Plan Finder, we are committed to helping you find the best PA Medicare plan for your specific needs and budget.

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What Does PA Medicare Cover?

Original Medicare (Part A and Part B) is the same no matter which state you live in and is the first step in Medicare enrollment. Part A is hospital coverage, and Part B is medical coverage. Once you have enrolled in Original Medicare, you can add a Part D (prescription drug) plan.

If you are enrolled in Parts A and B, you are eligible to enroll in a Medicare Advantage (Part C) or Medicare Supplement (Medigap) plan. Medicare Advantage plans are a great way to get additional benefits like vision, hearing, and dental coverage on top of Original Medicare coverage. Medigap plans work alongside Original Medicare to help pay for coinsurance, copayments, and deductibles. You cannot be enrolled in Medicare Advantage and Medicare Supplements at the same time.

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What is the Cost of PA Medicare?

Have you been employed and paid Medicare taxes for at least 39 quarters? If so, you can enroll in Part A without a monthly premium. If you have only paid Medicare taxes for 39-30 quarters, you'll have to pay $240 per month in 2019. If you have paid Medicare taxes for less than 30 quarters, you will have to pay $437* per month in 2019.

The premium for Part B will vary based on your income but is $135.50/month* for most Medicare-enrollees in 2019. Monthly premiums for Part D, Medicare Advantage, or Medicare Supplement plans will vary based on plan and carrier.

*These prices are true for 2019 but are subject to change each year.

PA Medicare Eligibility

If you are over 65, you automatically qualify for Medicare. Unlike private insurance plans, pre-existing health conditions do not impact your eligibility status. You can enroll during your initial enrollment period (three months before and after your 65th birthday). It’s crucial you enroll during your IEP to avoid paying a late-enrollment penalty fee.

If you are under 65, you can still qualify for Medicare if you are diagnosed with ESRD (End-State Renal Disease) or ALS (Lou Gehrig’s Disease). You will also be automatically enrolled in Medicare if you have been receiving SSDI (Social Security Disability income) for over 24 months.

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How do I Sign up for PA Medicare?

If you are ready to enroll in PA Medicare, you need to go through Social Security. You can visit their website at www.SocialSecurity.gov, call them at 1-800-772-1213 (TTY 1-800-325-0778) Monday through Friday from 7 AM to 7 PM, or apply in person at your local office.

Once you have PA Medicare (Parts A and B), you’ll need to consider prescription drug coverage through Part D or Medicare Advantage. We can help you with that.

Can I Have Medicare and Medicaid in Pennsylvania?

Medicare and Medicaid are often confused, but they are two very different programs. They are both operated by the Centers for Medicare and Medicaid Services (CMS), but Medicare is for seniors and people with certain disabilities whereas Medicaid is for low-income individuals and families. You can, in fact, be eligible for both programs, but they are by no means the same thing.

If you do qualify for both Medicare and Medicaid, you will be considered a dual-eligible and qualify for extra benefits. You may be eligible for a Dual Eligible Special Needs Plan  (DSNP). You will also have a Special Enrollment Period which gives you the flexibility to enroll in the best plan based on your needs and budget regardless of the time of year. Plus, you may even qualify for Extra Help which is a Medicare prescription drugs program, or other Medicare Savings Programs.

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Types of Medicare Plans in PA

Medicare Advantage plans are a one-stop-shop that includes Part A, B, and sometimes D. Plus, they generally offer additional benefits like hearing, vision, or dental coverage, non-emergency transportation, monthly OTC drug allowance, and even group fitness classes. There are likely several MA plans available in your area. Costs will vary based on provider, location, and benefits. This is because MA plans are offered through private insurance companies, rather than the government.

Some Medicare Supplement plans offer prescription drug coverage, but it is rare. These plans are intended to add financial benefits instead of health benefits. They can help cover Part A and B deductibles, copayments, and coinsurance.

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Senior Programs in PA

The Department of Aging in Pennsylvania offers programs that provide places where seniors, family members, caregivers, and healthcare professionals can find Pennsylvania resources for the elderly and disabled. These programs include:

Caregiver Support: The Pennsylvania Caregiver Support Program provides caregivers a break from respite care and can even help with reimbursement of caregiving-related supplies, education, and training. This program is administered through your local Area Agency on Aging.

Employment: The Senior Community Service Employment Program helps older, low-income adults find employment and training services. To find a service program in your area, contact your local Area Agency on Aging.

Health & Wellness: Pennsylvania's Department of Aging Health & Wellness Program promotes healthy lifestyles to improve quality of life and cut back on health care expenses. They help teach seniors how to self-manage chronic conditions, exercise, nutrition, mental health, medications, and substance abuse.

Help at Home: The Pennsylvania Department of Aging wants to keep older adults in their home and comfortable as long as possible. The Help at Home Program includes adult day care, transportation, meal delivery, care services, home modifications, care management, and much more!

Housing: The Property Tax/Rent Rebate Program helps pay for taxes and rent for those over 65, widows over 50, and people with disabilities.

Legal Assistance: The Legal Assistance Program helps older adults with legal issues including age discrimination, utilities, abuse, guardianship defense, social security, Medicaid, and Medicare.

Meals: The Department of Aging wants to make sure meals are available to seniors who need it. There are more than 600 community centers throughout Pennsylvania that provide nutritious meals. They also offer home-delivered meals, a SNAP program, and a Senior Farmers Market Nutrition Program.

Ombudsman: Pennsylvania's Long-Term Care Ombudsman Program helps resolve issues from those who are living in long-term settings like nursing homes or assisted living facilities. This program helps educate residents on their rights and advocate for those who may not be able to.

Protective Services: The Older Adults Protective Act helps protect seniors against physical, emotional, and financial abuse. If you think you or a loved one is being abused, called the statewide abuse hotline 1-800-490-8505.

Medicare Supplements in PA

Medicare Supplements help cover copayments, deductibles, and coinsurance. Medicare Supplements in Pennsylvania are organized by letter (A, B, C, D, F, G, K, L, M, N). Each letter represents a different plan type with a different price range and coverage level. Most Medigap plans are going to have the same basic coverage regardless of which carrier you choose. However, the prices will vary based on carrier, zip code, age, gender, and tobacco use. Your best bet is to speak with a licensed agent. To schedule an appointment, fill out this form or call us at 833-438-3676.

Medicare Advantage in PA

If Medicare Supplements are not right for you, you may want to consider enrolling in a Medicare Advantage plan. MA plans are required to cover, at a minimum, the same benefits as Original Medicare. However, they offer additional benefits like hearing, vision, and dental coverage, and even group fitness classes like SilverSneakers. Enrollment has increased every year and more than 20.4 million beneficiaries are taking advantage of these amazing benefits. If you want to learn more or meet with a licensed agent, fill out this form or call us at 833-438-3676.

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