Pennsylvania Medigap Plans: Overview and Easy Guide

Pennsylvania Medigap Plans are a type of Medicare supplement insurance that is sold by private insurance companies. These PA plans help to cover some of the healthcare costs that are not covered by Medicare (Pennsylvania doesn’t allow excess charges). There are approximately ten different policies available, each with varying costs and services. These are the same policies found in most states, without any special rules. Let’s review how Medigap plans work in the Keystone state.

Basic Overview of Pennsylvania Medigap Plans

Medicare Supplement Insurance, also known as “Medigap”, is a type of private health insurance that assists with paying certain healthcare costs that Medicare does not cover, such as deductibles, co-payments, and coinsurance. They are four important things to know about Medigap policies:

• To be eligible for a Medigap policy, you must already have Medicare Parts A and B.
• If you have a Medicare Advantage Plan (Part C), you cannot enroll in a Medigap policy.
• Keep in mind that Med Supp policies only cover one person, so if you want coverage for your spouse, you’ll need to purchase separate policies for each of you.
• You have a limited time for open enrollment. After this period, insurance companies may deny you coverage if, for example, you have a pre-existing condition.

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Comparing Pennsylvania Medigap plans

Plans available for those Medicare-eligible after January 1, 2020:

*Medigap Plan G High deductible is also available. Note: Plan F and Plan C are not featured on this chart as they are no longer available to those new to Medicare.

Note: Plans E, H, I, and J are no longer sold, but if you already have one, you may keep it. If you need help finding the right coverage for you, please contact the team here at Senior65.com. There is never a charge for our services.

When should I enroll in a Pennsylvania Medigap plan?

Every person has their own Medigap enrollment period, which begins on the first day of the month when they first enrolled in Medicare Part B. This period is known as Medigap Open Enrollment. It is usually a one-time event that lasts for six months and is sometimes called the initial enrollment period.

During your Medigap open enrollment period, Pennsylvania insurance companies are required to offer every plan they sell without using medical underwriting or considering your medical history. They cannot refuse to sell you a MedSup policy, charge you more for a policy, or make you wait for coverage to start. However, if you have a pre-existing medical condition that existed within the six months before purchasing your Medigap policy, the condition may not be covered during the first six months of your coverage unless you had prior creditable coverage such as group health insurance, individual health insurance, Medicare or Medical Assistance.

Medigap’s open enrollment period requires all PA insurance companies to offer you their policies at the best price available, which is likely to be the lowest price you will find. This is why it is so important that you work with a licensed independent insurance agent to help you select the right plan when you are first eligible. Feel free to call Senior65.com at 800-930-7956.

PA Guaranteed Issue Rights

During specific circumstances, Medigap insurance companies must sell or offer you a Medigap policy without placing conditions on the policy or charging a higher premium due to past or present health problems.
Here are some of the circumstances for guaranteed issue rights in Pennsylvania:

• • If you are in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan’s service area. 

• • If you have Original Medicare and an employer group health plan (including retiree or COBRA coverage), or union coverage that pays after Medicare pays and that plan is ending. If you have COBRA coverage, you can either buy a Medigap policy right away or wait until the COBRA coverage ends.

• • In the same way, if you have Original Medicare and a Medicare SELECT policy, and you move out of the Medicare SELECT policy’s service area.

• • If you joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare.

• • If you dropped a Medigap policy to join a Medicare Advantage Plan (or to switch to a Medicare SELECT policy) for the first time, you have been in the plan less than a year, and you want to switch back.

• • If your Medigap insurance company goes bankrupt, and you lose your coverage, or your Medigap policy coverage otherwise ends through no fault of your own.

• • If you leave a Medicare Advantage Plan or drop a Medigap policy because the company hasn’t followed the rules or misled you. (Source)

Are Medicare Excess Charges Allowed in Pennsilvania?

Excess charges occur when healthcare providers do not accept the Medicare-approved amount as full payment for their services. Instead, they choose to charge up to 15% more than the approved rate.

However, good news for Pennsylvania residents!: Excess charges are not legal within the state. Consequently, If you receive medical care in Pennsylvania, you won’t have to worry about providers tacking on additional fees beyond the Medicare-approved rates. In other words, only healthcare providers who don’t accept “Medicare Assignment” can bill excess charges. Learn more in our article “How To Avoid Medicare Excess Charges“.

Medigap for PA Residents Under 65

Overall, Medigap insurance companies are required to sell you a Medigap policy in Pennsylvania if you are in your open enrollment period. (Source) This is different than in many other states.

Check out our guide to Medigap under 65.

Next Steps for Pennsylvania Medigap

In conclusion, If you found this article informative about Pennsylvania Medigap plans, consider working with one of our licensed agents at 800-930-7956. We know how Medigap works in your state and our agents cannot charge you a fee for our services. No insurance provider or agent can sell you the same Medigap plan for less than we can. Get a quote here or drop a comment/question in the section below.