We recommend the plans from Aetna and UnitedHealthcare as the best overall Medicare Advantage plans in Pennsylvania due to cheap rates, wide availability and good customer satisfaction ratings.
UPMC for Life and Highmark are better for customer satisfaction, but their prices are among the most expensive in the state.
Pennsylvania Medicare Advantage plans cost $40 per month on average, but everyone has access to $0 plans.
How we chose these Medicare plans: To find the best Medicare Advantage plans in Pennsylvania, we reviewed cost, availability, benefits and quality of service. Our analysis focuses on HMO and PPO plans that include prescription coverage.
How the Centers for Medicare & Medicaid Services (CMS) rates Medicare plans: CMS measures several areas of plan performance, including customer service, health care quality and access to care. When comparing Pennsylvania plan options, we focused on state-specific CMS ratings rather than nationwide numbers.
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Compare Medicare Advantage plans in Pennsylvania
Highmark and UPMC for Life have the highest customer service rating in Pennsylvania, but their plans are more expensive than most competitors' plans.
Aetna offers more plan options, lower average rates and customer service that is virtually on par with Highmark and UPMC.
Pennsylvania residents can choose a Medicare Advantage HMO or PPO plan from among 14 providers. Our top four companies offer a combined 64 HMO and PPO policy options and collectively sell at least one free Medicare Advantage plan in every Pennsylvania county.
You may want to avoid Wellcare by Allwell and Clover Health, which have the lowest customer satisfaction scores in the state. Wellcare by Allwell might be appealing, as it offers the cheapest plan in the state, but its policyholders don't tend to be happy with their plan. Clover Health has rates that are around average, but you can only get it in a small part of the state: Bucks, Delaware or Philadelphia county.
If you don't find a Medicare Advantage plan to meet your needs, you may consider keeping your Original Medicare and supplementing it with a Medigap plan and a Medicare Part D plan. Medigap plans are also sold throughout Pennsylvania.
A note about HMO and PPO plans
Most Medicare Advantage insurers provide HMO and PPO options, so it may help to understand the differences when shopping for a plan.
-
With an HMO, you must use network health providers, except in emergencies, so you pay the full cost of care received outside the network. HMOs also require that you coordinate your care through a primary care physician and get referrals for specialty services.
-
PPOs also have plan networks but cover both in-network and out-of-network health care. You usually pay more and have a higher
out-of-pocket maximum
when you get care outside the PPO network. But with a PPO, you don't need a referral from your primary care doctor to see a specialist.
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Best cheap Medicare Advantage plans in Pennsylvania
If you're looking for a cheap Medicare Advantage plan in Pennsylvania, we recommend UnitedHealthcare for its high customer satisfaction rating and low average rates.
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UnitedHealthcare offers 12 HMO and PPO plans at an average monthly rate of $16, which is considerably cheaper than the average rate in the state.
If you have few health care needs, UnitedHealthcare's AARP Medicare Advantage HMO is a good, cheap option with no monthly costs or deductible. This plan lets you pay for care as you need it rather than pay monthly for benefits you may not use. The $6,700
out-of-pocket maximum
is the lowest among UnitedHealthcare plans that include drug coverage.
For those who want plans that offer doctor flexibility or those who have more frequent health care needs, UnitedHealthcare offers well-rated PPO plans. The best we found is the AARP Medicare Advantage Choice Plan 1 PPO. It costs $21 per month — a bit above UnitedHealthcare's average rate — and has no deductible.
The UnitedHealthcare Plan 1 PPO is cheaper than comparable plans like Aetna's Value PPO and the UPMC Flex PPO. UnitedHealthcare also has a larger provider network than Aetna or UPMC for Life, with more than 1.3 million doctors and 6,500 hospitals nationwide.
Along with standard medical and hospital coverage, many UnitedHealthcare plans include benefits for vision, dental, hearing, fitness, worldwide emergency care and telehealth services. Some plans also cover limited
nonemergency transportation
for medical needs. UnitedHealthcare is a good choice for those who expect to need help getting to routine medical visits, as UPMC and some Blue Cross Blue Shield plans don't offer this benefit in Pennsylvania.
Best alternative to UnitedHealthcare
If you live in a more remote part of Pennsylvania, Aetna offers multiple plan options with reasonable rates across the whole state.
Aetna customers are happy with their plans, and while rates are cheaper than average, they are not the cheapest in Pennsylvania. If UnitedHealthcare isn't available in your area, Aetna plans are a good alternative.
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Aetna's Medicare Advantra Value HMO is good if you want cheap rates and don't mind staying in the network and getting referrals for specialists. With the Value plan, you pay no premium, no medical or drug deductible, and
$7,550
each year before the plan pays for 100% of your care. Primary doctor visits are free, and specialist visits cost $45.
If you want the flexibility to pick your doctors and specialists, the Aetna Medicare Value PPO is a good option. If you stay in the network, there's no premium, drug deductible or medical deductible. If you use nonnetwork providers, your costs are higher: You'll pay up to $12,300 each year before the plan covers your medical costs in full.
Many Aetna plans include dental coverage, a fitness benefit, prescription delivery and an over-the-counter program that provides select pharmacy items at no cost. Some Aetna plans include limited nonemergency transportation benefits.
Aetna's nationwide provider network includes more than 700,000 primary care doctors and specialists and over 5,700 hospitals, but it's smaller than the UnitedHealthcare and Blue Cross Blue Shield networks. It's a good idea to check the provider listing before you commit to an Aetna plan.
Top-ranking Medicare Advantage plans in Pennsylvania
UPMC for Life and Highmark offer Medicare Advantage plans with the highest rating in Pennsylvania.
UPMC for Life
-
-
Average cost: $70/month
-
Available in 54 counties
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UPMC for Life members gave their plans the highest ranking available for overall customer service. Customers also reported being happy with their prescription coverage.
Patients on a budget who want drug coverage should look at the UPMC for Life HMO Premier Rx plan, which is available in much of the state. The plan has no monthly premium and no medical or drug
deductible.
Primary care visits are free, and you'll pay $40 for each specialist visit.
The UPMC for Life PPO Flex Rx plan is good for those who want the flexibility to use providers of their choice without the need for referrals. For in-network care, there is no deductible, no primary care doctor copay and a $35 specialist copay.
UPMC plans can offer extras like vision, dental, hearing and fitness coverage. But UPMC plans we analyzed did not pay toward the cost of transportation for routine health care, like a ride to your doctor's office for a checkup. UnitedHealthcare and Aetna plans offer that service.
UPMC offers 12 Medicare Advantage plans in most but not all of Pennsylvania. In 2022, the company added several new plans, including an option for veterans who already have drug benefits through the U.S. Department of Veterans Affairs (VA) called the UPMC for Life HMO Salute plan.
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Highmark has the top rating for overall customer satisfaction. Members reported having good access to needed care, including screening tests, vaccinations and blood sugar monitoring services. With 18 HMO and PPO plans to choose from, Highmark gives you some of the broadest options in Pennsylvania, but these plans are also the most expensive and have the highest out-of-pocket maximum — $7,550 — allowed by Medicare.
Highmark's Community Blue Medicare HMO is a good option for those who need frequent specialist care but prefer an HMO over a PPO. If you want to see both your primary care doctor and a specialist at no cost, the Community Blue HMO is a rare Medicare Advantage plan with that option. But if extras like vision, dental or fitness benefits are important to you, the Community Blue HMO is not a good choice.
The Community Blue Medicare PPO Signature plan works well for those who want extra benefits and the freedom to choose their health care providers. The PPO offers free primary doctor visits; specialist visits at $30; and extra benefits like vision, dental, hearing and fitness coverage.
Most Medicare enrollees in Pennsylvania have access to the Community Blue HMO and PPO plans. Both options have no monthly premium, no medical or drug deductible and a $7,550 out-of-pocket maximum, which is higher than most competitors' plans.
?
Highmark, headquartered in Pittsburgh, is native to Pennsylvania and is the largest health insurer in the state. The company is part of the Blue Cross Blue Shield Association (BCBSA) and has an extensive Medicare Advantage provider network in Pennsylvania. Of the four BCBSA-affiliated Medicare Advantage providers in Pennsylvania, Highmark's plans stand out in terms of cost, customer satisfaction and availability. But while plans are sold in all but five Pennsylvania counties, you can't get Highmark Medicare Advantage coverage in cities like Downingtown, Norristown or Chester.
How do I choose a Medicare plan?
When choosing a Medicare plan, it's best to have a list of questions ready to guide your research. You first need to decide between Original Medicare and a Medicare Advantage plan, then narrow your options from there.
Here are a few things to keep in mind when searching for your plan:
-
Do you need drug coverage?
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Are your health care providers in the plan's network?
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Do you need the freedom to work with any health care provider, in or out of the network?
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Do you have a chronic illness or a condition that needs intensive or long-term treatment?
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What is your budget for health care costs, including monthly payments and out-of-pocket charges?
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Are past and present members happy with the plan you're considering?
You'll have the chance to choose a Medicare plan when you first become eligible for Medicare and again each year during open enrollment. With the number of options available, it's a good idea to start your search early.
How many people are on Medicare in Pennsylvania?
Medicare-eligible residents in Pennsylvania: 2,817,192
Medicare Advantage enrollees in Pennsylvania: 1,369,175
Number of Medicare Advantage providers operating in Pennsylvania: 14
Average monthly cost of Medicare Advantage in Pennsylvania: $40
Medicare Advantage enrollment varies by county. In Pike County, for example, 22% of Medicare recipients are on Medicare Advantage plans, while in Armstrong County, the rate is 67%.
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Frequently asked questions
Does Pennsylvania have Medicare Advantage?
Yes, Medicare Advantage plans are available throughout Pennsylvania and cost an average of $40 per month. At least one free Medicare Advantage plan is offered in each Pennsylvania county.
What are the top-rated Medicare Advantage plans in Pennsylvania?
Highmark and UPMC for Life offer some of the top-rated Pennsylvania Medicare Advantage plans. Each plan received a customer service score of 5, the highest rating awarded by CMS.
Is Medicare Advantage sold everywhere in Pennsylvania?
Yes, Medicare Advantage plans are sold in each of Pennsylvania's 67 counties. Some companies offer plans in only three counties, whereas others (for example, Aetna and Humana) sell policies across the entire state.
How can I get help with choosing a Medicare Advantage plan in Pennsylvania?
For help choosing a Medicare plan or for other Medicare-related questions, you can contact the Pennsylvania Department of Aging. From the website, you can search for your local State Health Insurance Program (SHIP) for one-on-one insurance counseling and help with Medicare.
Methodology and sources
Medicare plan data is sourced from the Centers for Medicare & Medicaid Services (CMS) public use files and from Medicare.gov. We compared 2022 plans based on cost, coverage, quality and availability. When calculating insurer rate averages, we combined affiliated companies in the state.
Our analysis of Medicare Advantage plans in Pennsylvania excludes plans that do not provide prescription drug coverage, employer group plans and Special Needs Plans (SNPs).
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Invitations for application for insurance may be made through QW Insurance Solutions, LLC ("QWIS"), a subsidiary of QuoteWizard.com, LLC ("QuoteWizard"), a LendingTree subsidiary, or through its designated agents, only where licensed and appointed. Licensing information for QWIS can be found here. QWIS is a non-government licensed health insurance agency. Not affiliated with or endorsed by any government agency.
Callers to QWIS will be directed to a licensed and certified representative of Medicare Supplement insurance and/or Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations. Calls to QWIS will be routed to a licensed agent who can provide you with further information about the insurance plans offered by one or more third-party partners of QWIS. Each of the organizations they represent has a Medicare contract. Enrollment in any plan depends on contract renewal.
Availability of benefits and plans varies by carrier and location and may be limited to certain times of the year unless you qualify for a Special Enrollment Period. QWIS does not offer every plan available in your area. Any information provided is limited to those plans offered in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
Deductibles, copays, coinsurance, limitations, and exclusions may apply.
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