Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage Plans replace Original Medicare coverage (Parts A and B). The Centers for Medicare & Medicaid Services regulate Medicare Advantage, or Part C, and require that policies offer benefits similar to traditional Medicare’s Parts A and B combined. However, most plans provide more extensive coverage, including additional benefits such as prescription drug coverage (Part D), dental care and vision services. People eligible for Original Medicare qualify for Medicare Advantage policies. However, unlike with Original Medicare, enrollees must purchase coverage via a Medicare-approved health insurance company.
The cost of a Medicare Advantage policy is influenced by factors such as the insurer, covered benefits and out-of-pocket expenses, which can vary significantly between providers and may be more or less affordable than Original Medicare. Notably, Medicare Advantage Plans impose limits on annual out-of-pocket costs, whereas Original Medicare lacks such caps. Additionally, coverage restrictions differ between these options. Original Medicare covers services from any provider nationwide, whereas Medicare Advantage Plans usually operate with approved provider networks. Although some plans allow out-of-network care, the enrollee generally covers the cost difference. Exceptions are often made for emergencies within Medicare Advantage Plans.
Between 2022 and 2023, Medicare Advantage enrollment in Pennsylvania grew by 7.15%. As the national average increase in enrollment was 9.75%, a smaller proportion of Pennsylvania seniors opted for Medicare Advantage enrollment than the nationwide uptake. These figures reflect the growth in eligibility for Medicare Advantage Plans — the number of Medicare Advantage-eligible people in Pennsylvania rose by 2.16%, while eligibility increased by 2.66% across the U.S. The growth of Medicare Advantage enrollment among eligible individuals was also lower compared to nationwide eligibility increases. The number of qualified people purchasing Medicare Advantage coverage in the state increased by 4.89%, compared to 6.9% nationally.
This guide is all about Medicare Advantage (MA) Plans in Pennsylvania. It explains what they cover and who can qualify. It even shows seniors how to find and sign up for a Medicare Advantage Plan.
The Top 10 Medicare Advantage Plans in Pennsylvania
Medicare-eligible seniors in Pennsylvania can choose between multiple Medicare Advantage providers, and each insurance company typically provides several policies. Therefore, enrollees have many options for Medicare Advantage coverage. The following table lists Pennsylvania’s top 13 Medicare Advantage providers by the number of enrollees. Enrollment figures represent the total number of enrollees across every Medicare Advantage Plan sold by each carrier. Prices are presented as a range to reflect the policy options available as of July 2023. Visit Medicare.gov to find updated enrollment information and details of Medicare Advantage Plans available in Pennsylvania.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
Aetna Medicare
399055
3.5
$0 – $197
PPO, HMO
Highmark Inc.
225381
5
$0 – $285
PPO, HMO
UPMC for Life
166491
5
$0 – $295
PPO, HMO
Independence Blue Cross
107968
4
$0 – $277
PPO, HMO
Humana
104373
4
$0 – $123
PPO, HMO, PFFS
Geisinger Gold
99881
4.5
$0 – $155
PPO, HMO
UnitedHealthcare
65405
3
$0 – $44
PPO, HMO
Cigna
44656
3
$0 – $118
PPO, HMO
Capital Blue Cross
34006
4
$0 – $174
PPO, HMO
Wellcare by Allwell
11989
2.5
$0 – $14
HMO
How Medicare Advantage Plans Work in Pennsylvania
It’s important to be clear on how Medicare Advantage works in Pennsylvania compared to Original Medicare before enrolling in the program. Insurance companies offer multiple plans such as health maintenance organizations (HMOs) and preferred provider organizations (PPOs). Each type of plan lays out different stipulations regarding in-network versus out-of-network coverage, choosing a primary care provider, referrals and prescription drug coverage. Here, we describe the four most common plans in Pennsylvania:
What Medicare Advantage Plans Cover in Pennsylvania
Medicare Advantage Plans must offer the same services, rights and protections available under Medicare Part A and Part B. These services include preventive screenings, X-rays, lab tests, care provided during a hospital stay and emergency and urgent care. The exception is hospice care, which is covered by Medicare Part A. MA plans may also include provisions for some things not covered by Original Medicare, such as vision, dental and hearing services or fitness program memberships and discounts.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Pennsylvania
To qualify for Medicare Advantage, an applicant must already be enrolled in Original Medicare Parts A and B, live in the plan’s service area and satisfy all other Medicare eligibility criteria. They must also be at least 65 years of age or have a disability that qualifies them for Medicare at a younger age. Applicants must also be able to prove U.S. citizenship or lawful immigrant status. As with other types of health insurance, Medicare Advantage is open for enrollment at certain times during the year, so seniors should be sure to find out when to enroll in Medicare or change plans. The list below lets you know more about enrollment timing.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Pennsylvania
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Pennsylvania’s APPRISE program is a free Medicare, Medicaid and long-term care insurance counseling program. The program is operated by the Department of Aging, and administered through the statewide Area Agency on Aging network. APPRISE counselors can help seniors understand Medicare eligibility and enrollment criteria, Medicare Part A and B benefits, Medicare Part D prescription drug and Medicare Advantage plans. Seniors can book a one-on-one counseling session with a local APPRISE counselor, or schedule a phone consultation to discuss their specific situation. APPRISE counselors are also available to make presentations to seniors groups and community organizations.
The Center for Advocacy for the Rights and Interests of the Elderly, CARIE, launched the Pennsylvania Senior Medicare Patrol (PA-SMP) in 1997 to combat Medicare abuse, errors and fraud. The PA-SMP works to educate seniors and caregivers about Medicare Advantage scams, overbilling and other issues that can decrease care quality and increase health care costs. The SMP also operates ScamWire, an alert service that notifies seniors, caregivers and support agencies about emerging scams targeting older adults. PA-SMP services are delivered through a network of trained volunteers who give informational presentations to community, faith and seniors groups throughout Pennsylvania. Volunteers also staff information booths at health fairs and public events.
Seniors who have questions or concerns about Medicare Advantage fraud, overbilling or Medicare-related identity theft can call the PA-SMP at 1-800-356-3606 or complete an online report form.
Low-income and isolated seniors aged 60 and older who need legal assistance can contact the Older Pennsylvanians Legal Assistance Program, or OPLAP. This program provides elders with access to free legal services including one-on-one legal advice and representation with civil matters. Seniors who have concerns about Medicare Advantage, Social Security, guardianship, age discrimination or elder abuse can use this program.
Seniors can contact the OPLAP by calling the Pennsylvania Department of Aging at 717-783-1550.
Pennsylvania Health Law Project
The Pennsylvania Health Law Project, or PHLP, is a nonprofit organization that works to improve access to health care for the elderly, people with disabilities and low-income adults. The PHLP operates a free helpline that seniors can call to connect with a legal advocate who will review the caller’s concerns and provide legal advice. The organization also provides free legal representation to clients who are struggling to pay health care costs, need support obtaining health care services or who have been denied coverage.
Seniors can contact the Pennsylvania Health Law Project by calling the PHLP helpline at 1-800-274-3258.
Pennsylvania Assistive Technology Foundation
The Pennsylvania Assistive Technology Foundation (PATF) is a nonprofit organization that works to connect older adults and people with disabilities with affordable assistive technology devices and services. Seniors who need mobility devices and other items that are not fully covered by their Medicare Advantage plan can contact the PATF to learn about low-cost loans for medical equipment, grants and other resources that can be used to supplement their MA plan benefits.
To contact the PATF, call 484-674-0506 or toll free at 1-888-774-1938.
Local Medicare Advantage Resources
Vintage Center for Active Adults
The Vintage Center for Active Adults provides services to Pittsburgh seniors to help elders avoid institutionalization, maintain community connections and stay active. The Center offers a variety of free and low-cost programs that seniors who are considering enrolling in a Medicare Advantage plan can utilize, including preventative screening services, one-on-one health behavior counseling and chronic condition management clinics that can help seniors assess their current and future health insurance needs. The Center also holds regular information sessions to keep seniors up to date on Medicare Advantage plans, regulations and related issues.
