Medicare Advantage Plans Philadelphia 2025
Choosing a Medicare Advantage plan in Philadelphia? Our guide succinctly explains the available Medicare Advantage plans in Philadelphia for 2025, their costs, and additional benefits over Original Medicare. We focus on what you need to know to make an informed decision about Medicare Advantage plans in Philadelphia without overwhelming detail.
Key Takeaways
- Medicare Advantage plans in Philadelphia, also known as Part C, may provide additional coverage beyond Original Medicare, including Part D prescription drugs, dental, vision, hearing, and fitness benefits.
- There are a wide range of Medicare Advantage plans available in Philadelphia, offered by providers such as Independence Blue Cross and UnitedHealthcare, which vary in terms of structure, benefits, and out-of-pocket costs.
- Enrollment into a Medicare Advantage plan in Philadelphia can be done during specific periods such as the Initial Enrollment Period, Annual Enrollment Period, and Special Enrollment Periods, requiring careful plan comparison and consideration of factors like costs, coverage, provider network, and prescription drug coverage.
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Understanding Medicare Advantage Plans in Philadelphia
Medicare Advantage plans, also known as ‘Medicare Part C,’ are a popular choice for many Pennsylvania residents. These Pennsylvania Medicare Advantage plans are offered by Medicare-approved private companies, which must adhere to specific rules set by Medicare.
While they cover the benefits of Original Medicare Part A and Part B, they often include Part D prescription drug coverage and offer additional benefits not covered by Original Medicare.
In 2024, the average monthly premium for a Medicare Advantage plan in Pennsylvania was approximately $27.94, and there were 281 plans available to eligible Philadelphia residents enrolled in both Medicare Part A and Part B.
Original Medicare vs. Medicare Advantage
Original Medicare offers a broad choice of healthcare providers without the need for referrals for specialists. Beneficiaries are not restricted to a network and can see any doctor or hospital that accepts Medicare.
On the other hand, Medicare Advantage plans usually require beneficiaries to use healthcare providers within a network and may need referrals for specialists.
While Original Medicare typically requires the beneficiary to pay 20% of the Medicare-approved amount after the deductible, the out-of-pocket costs for Medicare Advantage plans vary and may also include additional premiums.
An appealing feature of Medicare Advantage plans is that they offer additional Medicare health benefits such as:
- Prescription drug coverage
- Routine hearing
- Vision
- Dental
- Fitness club memberships
These benefits are not covered by Original Medicare.
Additional Benefits Offered by Medicare Advantage Plans
Medicare Advantage plans in Philadelphia often go beyond the coverage offered by Original Medicare Parts A and B. They typically include additional coverage for vision, dental, and hearing, which can be immensely beneficial for seniors who often require these services.
Many of these plans even integrate Medicare Part D, offering prescription drug coverage as part of the plan’s benefits.
But it doesn’t stop there. Some Medicare Advantage plans in Philadelphia also include non-medical benefits, such as fitness memberships, transportation benefits, and meal delivery services. These additional perks can contribute significantly to the overall well-being and quality of life of seniors.
Medicare Advantage Plan Providers in Philadelphia
There are multiple providers in Philadelphia that offer Medicare Advantage plans, providing a range of options for individuals seeking this type of coverage. Among these, the notable plan offerings include:
- Independence Blue Cross: offers a range of plans, including PPO, HMO, and HMO-POS options
- UnitedHealthcare: offers PPO Medicare Advantage plans
- Geisinger Health Plan: offers HMO plans
- Cigna: offers HMO plans
These options offer various out-of-pocket limits and even plans with $0 premiums.
For more specific plan information, Philadelphia residents can access resources at provider websites such as:
- Independence Blue Cross
- UnitedHealthcare
- Geisinger Health Plan
- Cigna
- Clover Health
- Devoted Health
- WellCare
- Aetna
- Humana
Types of Medicare Advantage Plans in Philadelphia
Beneficiaries in Philadelphia have the luxury of choosing from a variety of Medicare Advantage plans, each with its unique structure and benefits. These options include:
- Health Maintenance Organization (HMO) Plans
- Preferred Provider Organization (PPO) Plans
- Private Fee-for-Service (PFFS) Plans
- Special Needs Plans (SNP)
Health Maintenance Organization (HMO) Plans
HMO plans are structured around a network of doctors, hospitals, and healthcare providers and require members to choose a Primary Care Physician. These plans provide:
- A local network of providers
- Referrals for specialists
- Coverage for out-of-network care only in cases of emergencies
- Prescription drug coverage
- Dental, vision, and hearing services.
A major highlight of HMO plans is their focus on preventative care, emphasizing early detection and routine health maintenance.
For those who prefer a little more flexibility, HMO-POS plans allow for some use of out-of-network providers, although in-network providers are encouraged to maintain savings.
Preferred Provider Organization (PPO) Plans
Preferred Provider Organization (PPO) plans offer a higher level of flexibility when it comes to choosing healthcare providers. Unlike HMO plans, they do not require referrals for specialists. While PPOs offer greater provider choice, in-network care usually incurs lower costs compared to out-of-network care, which involves higher costs.
PPO plans typically include coverage for in-network and out-of-network providers, hospitalization, and prescription drugs, among other benefits. Individuals who prioritize healthcare provider choice will find these plans suitable. They offer added flexibility at slightly higher costs.
Private Fee-for-Service (PFFS) Plans
Private Fee-for-Service (PFFS) plans offer a high level of flexibility, including:
- Members can choose any Medicare-approved healthcare provider that agrees to the plan’s payment terms
- Members do not need a primary care physician
- Members do not need referrals to see specialists with a PFFS plan.
However, it’s worth noting that healthcare providers have the option to accept or deny PFFS plan terms on a per-visit basis.
These plans detail member payment amounts for services in documents like the ‘Annual Notice of Change’ and ‘Evidence of Coverage’. They cannot charge more than Original Medicare for specified services such as chemotherapy, dialysis, and skilled nursing facility care.
While enrolled in a PFFS plan, members must present their plan membership ID instead of the red, white, and blue Medicare card for healthcare services. Some PFFS plans offer prescription drug coverage, but those that do not require members to join a separate Medicare drug plan (Part D) to receive medication benefits.
Special Needs Plans (SNP)
Special Needs Plans (SNPs) within Medicare Advantage are designed for individuals with specific healthcare needs. In Philadelphia, Medicare Advantage Special Needs Plans include the Dual-Eligible Special Needs Plan (D-SNP), Chronic Condition Special Needs Plan (C-SNP), and Institutional Special Needs Plan (I-SNP).
SNPs offer targeted benefits and services tailored to the specific group they serve, including mandatory prescription drug coverage (Part D). SNP eligibility is determined by specific circumstances, such as being in institutional care or having chronic health conditions, as well as being dually eligible for both Medicare and Medicaid.
These criteria help identify individuals who can benefit from SNP services. However, SNPs are not featured among the top-rated Medicare Advantage plans in Pennsylvania for 2025, suggesting a narrower availability.
Enrollment Process for Medicare Advantage Plans in Philadelphia
When it comes to enrolling in a Medicare Advantage Plan in Philadelphia, individuals have several options. They can use the Medicare.gov website, contact insurance providers directly, or seek assistance from an independent insurance agent in Pennsylvania.
It’s worth noting that individuals may be eligible for Medicare Advantage plans before the age of 65 if they have a qualifying disability, end-stage renal disease (ESRD), or ALS (Lou Gehrig’s Disease). In some cases, these individuals may also qualify for Social Security disability insurance.
Initial Enrollment Period
The Initial Enrollment Period is a 7-month period that begins three months before an individual turns 65, includes their birth month, and extends for three months after that month.
During this period, individuals can enroll in Medicare Parts A and B, a stand-alone Medicare prescription drug plan (Part D), or a Medicare Advantage plan (Part C).
It’s important to note that if individuals do not sign up for Medicare during their Initial Enrollment Period, they could face penalties such as higher premiums.
Annual Enrollment Period
The Annual Enrollment Period for Medicare Advantage plans allows beneficiaries to make changes to their current plans or enroll in a new plan. This period occurs each year from October 15 to December 7, offering a dedicated time frame for beneficiaries to assess and adjust their plan coverage.
During the Annual Enrollment Period, beneficiaries in Philadelphia can switch from one Medicare Advantage plan to another or enroll in one for the first time. Any changes made during this period become effective on January 1 of the following year.
Special Enrollment Periods
Special Enrollment Periods provide a two-month timeframe for enrollment due to exceptional situations, such as moving or losing employer coverage. These periods are designed to accommodate changes in circumstances that may affect an individual’s healthcare needs.
If a beneficiary’s circumstances change, it is crucial to be aware of Medicare rules that prohibit enrollment in multiple plans with overlapping benefits to ensure proper coverage and avoid penalties.
Evaluating and Comparing Medicare Advantage Plans in Philadelphia
Choosing the right Medicare Advantage plan requires careful consideration of several factors. To make an informed decision, it’s essential to compare Medicare Advantage plans based on:
- Costs
- Coverage
- Provider network
- Prescription drug coverage
It’s also beneficial to consider any additional benefits offered by the plans.
Costs and Coverage
The costs for Medicare Advantage plans in Philadelphia can vary greatly, typically including:
- Monthly premiums
- Copayments
- Coinsurance
- Deductibles
- Out-of-pocket limits
In 2024, the average monthly premium for a Medicare Advantage plan in Pennsylvania was approximately $27.94, and residents had the option to select from plans that offered $0 premiums.
Compared to Original Medicare with Medicare Supplement Insurance, Medicare Advantage plans can be more cost-effective.
They provide beneficiaries with yearly limits on out-of-pocket costs for covered services, offering a level of financial protection that Original Medicare does not.
Provider Network
The provider network of a Medicare Advantage plan can have a significant impact on your healthcare experience. A broad network is particularly beneficial during unforeseen medical events or serious illnesses, providing a wide range of providers to choose from.
However, out-of-network care often comes with unexpected costs, and broad-network plans typically charge higher premiums than narrow-network plans.
Before enrolling, it’s essential to verify if your preferred doctors and specialists are in the Medicare Advantage plan’s network.
Prescription Drug Coverage
Most Medicare Advantage plans in Philadelphia cover prescription drugs, although some require separate Part D coverage. If a Medicare Advantage plan does not offer prescription drug coverage, enrollees must join a separate Medicare drug plan (Part D) to obtain medication coverage.
When selecting a Medicare Advantage plan, it is important to understand the tier placement of prescription drugs and any associated coverage rules. This knowledge can help you estimate your potential out-of-pocket prescription drug costs and ensure that your medications are covered.
Resources for Medicare Advantage Plans in Philadelphia
When navigating the landscape of Medicare Advantage plans in Philadelphia, having the right resources at your disposal can make all the difference.
Certified Senior Advisors (CSAs), the PA MEDI Helpline, and a comprehensive list of resources and organizations are available to assist Philadelphia residents in finding and selecting the most suitable Medicare Advantage plan.
State Health Insurance Assistance Program (SHIP)
The State Health Insurance Assistance Program (SHIP) is an important resource that provides free information and counseling about Medicare options, processes, and costs. SHIP can help individuals understand the different types of Medicare Advantage plans, eligibility requirements, and enrollment procedures.
In addition to providing information, SHIP can also offer guidance on choosing a plan that best matches an individual’s healthcare needs and financial situation.
Whether you’re new to Medicare or considering a switch from Original Medicare to a Medicare Advantage plan, SHIP can provide the guidance you need.
Pennsylvania Department of Aging
The Pennsylvania Department of Aging (PDA) is another invaluable resource for Philadelphia residents exploring Medicare Advantage plans.
The PDA coordinates various services, including Pennsylvania Medicare education, health and wellness programs, support for caregivers, assistance with long-term care planning, and access to home and community-based services.
These Medicaid services are designed to ensure that the needs of the elderly are met in their communities.
In addition to health programs, the PDA provides transportation services for seniors to facilitate access to community resources and healthcare appointments. Through senior community centers, the PDA offers educational programs, exercise, cultural events, and social activities to engage and support the elderly population.
The PDA also implements the APPRISE program, which offers counseling and assistance services to Medicare beneficiaries to help them understand their Medicare coverage, bills, and rights.
Summary
In conclusion, Medicare Advantage plans in Philadelphia offer a variety of options to fit the diverse needs of Pennsylvania residents. These plans provide important coverage beyond Original Medicare, including prescription drug coverage, dental, vision, and hearing services, and even non-medical benefits like fitness memberships and transportation services.
With a variety of providers and types of plans available, it’s essential to understand the costs, coverage, and enrollment processes to select the best plan for your needs.
The State Health Insurance Assistance Program (SHIP) and the Pennsylvania Department of Aging (PDA) can provide valuable assistance and resources during this process.
Frequently Asked Questions
→ Is Medicare Advantage cheaper than Medicare?
Yes, Medicare Advantage can be cheaper than Original Medicare, as many Medicare Advantage plans offer affordable or $0 monthly plan premiums.
Additionally, Medicare Advantage plans must have a maximum out-of-pocket limit, which can result in lower overall costs compared to Original Medicare.
→ What are 4 types of Medicare Advantage plans?
There are 4 types of Medicare Advantage plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, and Special Needs Plans (SNPs). Each type operates differently.
→ How much does Medicare Advantage cost in PA?
On average, the monthly Medicare Advantage premium in Pennsylvania is $27.94 in 2025, but there are also Part C plans with no-cost premiums available to all residents.
→ What is the most highly rated Medicare Advantage plan?
The most highly rated Medicare Advantage plan for 2025 is offered by UnitedHealthcare, with AARP/UnitedHealthcare having the best overall plans, featuring high ratings and a large provider network.
→ What are some of the additional benefits offered by Medicare Advantage plans in Philadelphia?
In Philadelphia, Medicare Advantage plans provide additional benefits such as vision, dental, and hearing coverage, as well as non-medical perks like fitness memberships, transportation benefits, and meal delivery services.
These plans offer a wide range of supplementary services to enhance overall healthcare.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.