Medicare Eligibility in Pennsylvania

Medicare is the federal government’s health insurance program for adults over 65. It is also available to people under 65 who have certain health conditions.

Pennsylvania follows federal government guidelines to qualify for Medicare.

You must be:

  • Sixty-five years old or older.
  • A U.S. citizen or legal resident who has lived in the U.S. continuously for at least five years.

If you are younger than 65 and a legal resident,
you may qualify for Medicare healthcare coverage by meeting at least one of these criteria:

  • Received disability benefits from Social Security or the Railroad Retirement Board for 24 months or more.
  • Have end-stage renal disease.
  • Have Lou Gehrig’s disease.

Medicare is not the same as Medicaid. However, those in a Medicaid program may be eligible for help with Medicare premiums, prescription drug costs, and other health assistance programs. The Department of Human Services manages Pennsylvania Medicaid and associated medical assistance services for qualified individuals.

How Do I Apply for Medicare in Pennsylvania?

You will be automatically enrolled if you receive Social Security benefits at least four months before you turn 65. Otherwise, you must sign up during your seven-month Initial Enrollment Period, which starts three months before you turn 65 and ends three months after the month you were born.

A few ways to sign up with the Social Security Administration;

1. Sign up online for Medicare

2. By post or over the phone, Call 1-800-772-1213. TTY users can call 1-800-325-0778.

3. In person at a local Social Security Office.

Resource links 

Health Care/Medical Assistance in Pennsylvania
Pennsylvania Medicare Education and Decision Insight – PA MEDI
Medicare.gov

Choosing a Medicare Plan in Pennsylvania

All Medicare beneficiaries must enroll in Parts A and B and pay monthly premiums even if they opt for an Advantage Plan or Part D coverage. Original Medicare lets you choose any provider in the U.S. It does not cover vision, dental or hearing services, prescription drug coverage, or long-term care.

Part A covers inpatient hospitalization costs. It also includes:

  • Skilled nursing facility care.
  • Home health care.
  • Hospice care.

If you or your spouse have worked 40 qualifying quarters, Medicare Part A is free.

Part B covers outpatient health care services, including:

  • Durable medical equipment.
  • Medically necessary services.
  • Preventive care, annual checkups, and screenings.
  • Mental health services.

Enrollees must pay Medicare Part B premiums. Rates are set by the federal government and deducted from Social Security benefits.

Medicare Part C

  • Medicare Advantage plans include all the benefits of the Original Medicare
  • Often include prescription drugs and dental, vision, and hearing services.
  • Many are in-network healthcare plans with lower costs and copays.

Qualified individuals can enroll in a Medicare Advantage health plan sold by private insurance companies. An insurance company offering plans must meet federal requirements.

Medicare Part D

  • Offers prescription drug plans. There are several Part D plan options.

Pennsylvanians can also enroll in a Medicare Supplement insurance plan that pays expenses Medicare does not cover, such as copayments, deductibles, coinsurance, and other out-of-pocket costs. However, you cannot enroll in an Advantage Plan and a Medigap plan at the same time.

Evaluate your health care needs to choose a proper plan for you. For example, an Advantage Plan may be better if you want lower out-of-pocket costs, prescription drug services, or special needs. On the other hand, if you prefer to have the most freedom in provider choices, Original Medicare and a Medicare Supplement plan may be your best option.

Ready to Learn More?

Choosing between Medigap insurance plans is not an easy decision. However, educating yourself about the differences between the two types of insurance coverage, comparing different Medicare Health plans and policies, and talking to a licensed insurance agent will help you make the right choice.