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Pennsylvania Medicare Insurance Plans

Medicare Supplement Insurance (Medigap) Policies

Pennsylvania has a requirement by law for insurers to sell Medicare Supplement Insurance policies to people under the age of 65.

High-Risk Pool

The Pennsylvania Fair Care coverage, which existed for individuals who experienced difficulty acquiring health insurance, ended on June 30, 2013, replaced by the Federal Pre-Existing Condition Insurance Plan (PCIP) or high-risk pool. The PCIP plan was a temporary program established under the provisions of the Affordable Care Act (ACA) and ended coverage for enrollees on April 30, 2014. Under the provisions of the ACA, all individuals, regardless of income or health status, may participate in the health insurance exchange (found at HealthCare.gov) for their important health insurance benefits.

Mini-COBRA Policies (Small Group)

Pennsylvania does mandate insurance continuation coverage for small employers (those with two to 19 employees).

Medicare Savings Program In Pennsylvania

Pennsylvania has four Medicare Savings Programs based on need:

  • Qualified Medicare Beneficiaries (QMBs): Categorically Needy Program: For individuals with a monthly income of up to $981 plus a $20 deductible limit ($1,001) and couples with a monthly income of up to $1,328 plus a $20 deductible limit ($1,348), the state pays all premiums for Medicare Part B and all copays and deductibles for Medicare Parts A and B.
  • Qualified Medicare Beneficiaries (QMBs):Medicare Cost Sharing Program: For individuals with a monthly income of up to $981 plus a $20 deductible limit ($1,001) and couples with a monthly income of up to $1,328 plus a $20 deductible limit ($1,348), the state pays all premiums for Medicare Part B and all copays and deductibles for Medicare Parts A and B.
  • Specified Low-Income Medicare Beneficiaries (SLMBs): For individuals with income under $1,177 per month plus a $20 deductible limit ($1,197) or couples with income under $1,593 a month and a $20 deductible limit ($1,613), the state pays premiums for Medicare Part B only.
  • Qualified Individuals Group 1 (QI-1s): For individuals with income under $1,325 per month plus a $20 deductible limit ($1,345) or couples with a monthly income under $1,793 plus a $20 deductible limit ($1,813), the state pays premiums for Medicare Part B only.

State Health Insurance Assistance Program (SHIP)

The state of Pennsylvania's SHIP Program (APPRISE) is available to help you understand your Medicare benefits. APPRISE is a confidential and personal Medicare beneficiary counseling service available to older Pennsylvanians.

APPRISE provides education, counseling, and information concerning:

  • Medicare Parts A and B (Original Medicare) as well as Part C (Medicare Advantage Plans)
  • Medicare Part D (Medicare Prescription Drug Plans)
  • Medicare Supplement Insurance (or Medigap)
  • Prescription assistance programs
  • Long-term care and payment options
  • People with Medicare and the Health Insurance Marketplace
  • Low-income assistance and other programs for seniors

APPRISE advocates on your behalf with claim questions and disputes through its specially trained staff and volunteers. Pennsylvania SHIP receives its funding in part by a grant from the Centers for Medicare and Medicaid Services (CMS).

Low-Income Subsidy (Extra Help) for Prescription Drugs

For 2015, the low-income subsidy for Extra Help with prescription drugs in Pennsylvania is $33.90, based on current benchmark premiums for the state.

Pennsylvania residents should consult with one of our MedicareSolutions.com insurance specialists for personal assistance specific to your area. One of our knowledgeable professionals can compare Pennsylvania medicare insurance plans specific to Pennsylvania medicare insurance plans, and can also help you locate the Medicare insurance benefits most aligned to your needs.