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More than 2.7 million Pennsylvania residents receive Medicare benefits as of 20201. That’s approximately 21% of the state’s population who are enrolled in some form of Medicare2. HealthMarkets can help you learn about Medicare eligibility in Pennsylvania to access the coverage you need.

How do you qualify for Medicare in PA?

You may qualify for Medicare in Pennsylvania if you’re a U.S. citizen or a permanent legal resident who has lived in the U.S. for more than five years and one or more of the following applies to you3:

  • You are 65 or older.
  • You have been on Social Security Disability Insurance (SSDI) for two years.
  • You have end-stage renal disease (ESRD) or Lou Gehrig’s disease.

Understanding Medicare

There are four parts to Medicare in Pennsylvania:

Part A – This is hospital insurance, and it generally covers inpatient hospital care, skilled nursing facilities (not custodial or long-term care) and hospice care.

Part B – Also known as medical insurance, this covers regular doctor appointments and visits to specialists. Parts A and B together are known as Original Medicare.3

Part CMedicare Advantage allows enrollees to receive healthcare coverage through a private insurance company. Medicare Advantage bundles Part A and Part B coverage into a single plan, and it is an alternative to Original Medicare. Plans often include prescription drug coverage, plus other benefits such as vision and dental.More than 1.2 million Pennsylvania residents are enrolled in Medicare Advantage.1

Part D– This is prescription drug coverage, which is sold through private insurance companies.You can add a standalone drug plan to Original Medicare if you have Part A and/or Part B. Based on your Medicare eligibility in Pennsylvania, you may be able to get help with your prescription drug costs.

Another option Pennsylvanians have is Medicare Supplement, also known as Medigap. Plans are generally used to help pay your Original Medicare Part A and Part B out-of-pocket costs, such as your deductibles, copays, and coinsurance. You can get Medicare Supplement plans in Pennsylvania in one of 10 standardized options.6 

Get Help With Medicare Eligibility in Pennsylvania

HealthMarkets can help you learn more about the various Medicare options that are available.

In 2020, 51.2% of Medicare-eligible Pennsylvania applicants who applied qualified for Extra Help, which helps you pay less for prescription drug coverage.7 We can help you find out if you qualify.

HealthMarkets can help you find a Medicare plan in Pennsylvania that fits you with our FitScore®. Answer a few quick questions about your needs, and we can instantly scan the health insurance marketplace to find recommendations from recognized insurance companies.

Get your free FitScore® and start comparing Medicare plans today.

HMIA008135 4-2020

1. Total Number of Medicare Beneficiaries, KFF. 2020. Retrieved from,%22sort%22:%22asc%22%7D | 2. QuickFacts Pennsylvania, U.S. Census Bureau. 2019. Retrieved from | 3. Original Medicare (Part A and B) Eligibility and Enrollment, CMS. 2020. Retrieved from | 4. Understanding Medicare Advantage Plans, Medicare. 2020. Retrieved from | 5. What Medicare Part D drug plans cover, Medicare. 2020. Retrieved from | 6. How to compare Medigap policies. 2020. Retrieved from | 7. Extra Help with Medicare Prescription Drug Plan Costs. SSA. 2020. Retrieved from  
HealthMarkets’ FitScore intends to identify plans that fit your needs. You should carefully review official plan materials.

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