Hundreds of thousands of individuals rely on Pittsburgh, Pennsylvania, Medicare to relieve the financial burden of healthcare costs. There are 633,470 Medicare beneficiaries, most of whom have Medicare Advantage plans.
Recent data revealed that 223,714 Medicare beneficiaries in Pittsburg, Pennsylvania, are enrollees in the Original Medicare Plan, while 409,756 have Medicare Advantage. Let’s explore the supplemental plans available to such individuals.
Medicare Plans in Pittsburgh, Pennsylvania
Standalone Medicare policies don’t always cover 100% of an individual’s healthcare expenses. Supplemental insurance plans cover the remaining health care costs that beneficiaries would be liable for otherwise.
Medicare beneficiaries can enroll in a Medigap or Medicare Advantage plan to supplement Parts A and B. In Pittsburgh, 54.08% of enrollees who choose to participate in supplemental Medicare plans are women aged 71 years and older.
Medicare Advantage plans
Exactly 64.68% of the individuals with Medicare in Pittsburgh also have Medicare Advantage plans. The average beneficiary has access to 39 Medicare Advantage plans, a significant increase from previous years.
Aetna is a widely accepted HMO with a maximum out-of-pocket (MOOP) rate of $5900. Aetna is popular because it has the lowest MOOP and a $0 monthly premium, and Aetna coverage includes emergency room and urgent care visits nationwide. Humana is available in all 50 states, and its Part C program provides coverage for prescription drugs.
UPMC is another excellent option. This HMO has a five-star rating and a $0 monthly premium cost. However, the MOOP rate is $6700.
Humana is a local PPO insurance that’s one of the top five Medicare Advantage plans this year. This plan has a four-star rating, and beneficiaries have a $0 monthly premium fee. Yet, the MOOP is $6,700.
The average cost of Medicare Advantage plans in Pittsburgh, Pennsylvania
| PLAN | PREMIUM | MOOP | Plan Type | Star Rating |
| Wellcare | $0 | $6,700 | HMO | 3 |
| Humana | $0 | $6,700 | LOCAL PPO | 4 |
| UPMC | $0 | $6,700 | HMO | 5 |
| Aetna | $0 | $5,900 | HMO | 4 |
| Highmark | $0 | $7,550 | LOCAL PPO | 5 |
Medicare Supplement plans
Individuals enrolled in Medicare in Pittsburgh are eligible for Medigap. Medigap is extra insurance that covers the services that the Original Medicare Plan doesn’t. A Medigap policy covers copayments, deductibles, and coinsurance.
The benefits of these standardized government plans remain the same countrywide. The monthly premium rate varies depending on the state.
Many patients opt for Medigap Plan HDG, which has the lowest premiums, ranging from $38.19 to $ 83.18. Although the monthly premium is low, patients must pay a higher deductible before getting 100% coverage.
Medigap Plan G is an excellent alternative to Medigap Plan HDG. The premium rates are $111.62-$414.10. One advantage of this plan is that it covers 100% of everything that Medicare Parts A and B cover except for the Part B deductible.
Medigap Plan F also provides comprehensive coverage and has many enrollees. Patients with Plan F have very little to no out-of-pocket fees. The Medigap Plan F monthly premium ranges from $134-$430.75. If your premium rates are higher, you’ll have savings to cover the deductible in an emergency.
The average cost of Medicare Supplement plans in Pittsburgh, Pennsylvania
| LETTER PLAN | LOWEST PREMIUM | HIGHEST PREMIUM |
| PLAN A | $80.57 | $332.91 |
| PLAN B | $106.25 | $334.49 |
| PLAN C | $157.42 | $429.62 |
| PLAN D | $139.98 | $262.05 |
| PLAN F | $134.00 | $430.75 |
| PLAN HDF | $40.20 | $182.90 |
| PLAN G | $111.62 | $414.10 |
| PLAN HDG | $38.19 | $84.18 |
| PLAN K | $57.19 | $131.87 |
| PLAN L | $82.42 | $274.29 |
| PLAN M | $94.45 | $311.31 |
| PLAN N | $87.52 | $353.30 |
Medicare Part D prescription drug plans
There is no coverage for prescriptions in Medicare Advantage plans or Medigap plans. Medicare Part D drug coverage lowers the cost of generic and name-brand medications. This optional insurance plan will be useful if you require regular prescription medication.
The monthly premium for an Aetna plan is $7.20, with a deductible of $480. Wellcare is the next affordable plan with a monthly premium of $12.90 and a $480 deductible. A Clear Spring Health plan has a $480 deductible with an $18.20 monthly premium.
The average cost of Medicare Part D plans in Pittsburgh, Pennsylvania
| PLAN | PREMIUM | DEDUCTIBLE | STAR RATING |
| Aetna | $7.20 | $480.00 | 3 |
| Wellcare | $12.90 | $480.00 | 3 |
| Clear Spring Health | $18.20 | $480.00 | 2 |
| Elixir | $20.30 | $480.00 | 3 |
| Humana | $22.70 | $480.00 | 4 |
Special Needs plan
Medicare in Pittsburgh also provides coverage for individuals with special needs and chronic diseases under Medicare Advantage plans. Special Needs plans aren’t available in every area of Pittsburgh, Pennsylvania.
Patients can choose a UPMC (HMO) plan, which offers dual eligibility and has a zero-dollar premium. The MOOP rate is $3,400. Vista Health (HMO) is very affordable, with no monthly premium and a $3,400 MOOP. Humana (Local PPO) is a dual eligibility plan with a $0 premium and $3,450 MOOP.
The average cost of Medicare Special Needs plans in Pittsburgh, Pennsylvania
| PLAN | PREMIUM | MOOP | Plan Type | Eligibility |
| Wellcare | $0 | $3,450 | HMO | Dual |
| Humana | $0 | $3,450 | LOCAL PPO | Dual |
| UPMC | $0 | $3,400 | HMO | Dual |
| Aetna | $0 | $7,550 | HMO | Dual |
| Vista Health | $0 | $3,400 | HMO | Dual |
How to sign up for Medicare plans in Pittsburgh, Pennsylvania
If you have Medicare in Pittsburgh, you may want to consider enrolling in Medigap or Medicare Advantage and Plan D for comprehensive medical coverage. Our agents can help you select the best insurance plan based on your needs and budget. Complete our form to obtain free quotes, or give us a call at the number above.
