Pennsylvania Medicare Advantage plans offer an alternative way to receive your Medicare benefits through private insurance companies approved by Medicare. This comprehensive Pennsylvania Medicare Advantage guide covers available plan types, top carriers, star ratings, costs, enrollment periods, and how to decide whether Medicare Advantage or Original Medicare with Medigap is right for you. Whether you are turning 65, exploring options during Annual Enrollment, or helping a parent compare plans, understanding the Pennsylvania Medicare Advantage landscape helps you make the best decision.
All information verified against CMS data as of April 2026.
In This Pennsylvania Medicare Advantage Guide:
Pennsylvania Medicare Advantage Market Overview
| Total MA Plans Available | 334 |
| Total Medicare Beneficiaries | 2800000 |
| Enrolled in MA | 1484000 |
| MA Penetration Rate | 53% |
| Most Common Plan Type | HMO |
Medicare Advantage Plan Types in Pennsylvania
Medicare Advantage plans in Pennsylvania come in several types:
- HMO (Health Maintenance Organization): Requires using in-network providers except in emergencies. Usually lower premiums. Often requires referrals to see specialists.
- PPO (Preferred Provider Organization): Allows out-of-network care at higher cost. No referrals needed for specialists. More flexibility but typically higher premiums.
- PFFS (Private Fee-for-Service): You can see any Medicare-approved provider that accepts the plan’s payment terms. Less common.
- SNP (Special Needs Plans): Designed for specific populations — dual-eligible, chronic conditions, or institutional care.
HMO plans are the most common type of Medicare Advantage plan in Pennsylvania.
Rural access note: Some rural counties in Pennsylvania may have limited Medicare Advantage plan choices. If you live in a rural area with few MA options, Original Medicare with a Medigap supplement may provide broader provider access.
Top Medicare Advantage Carriers in Pennsylvania
Top Medicare Advantage carriers in Pennsylvania by enrollment:
- UPMC for Life
- Highmark
- Aetna
- UnitedHealthcare
- Geisinger Gold
UPMC for Life has the largest Medicare Advantage enrollment in Pennsylvania.
Pennsylvania Medicare Advantage Costs
The average monthly premium for Medicare Advantage plans in Pennsylvania is approximately 22.99.
Many Pennsylvania MA plans offer $0 monthly premiums (you still pay your Part B premium).
Every MA plan has a Maximum Out-of-Pocket (MOOP) limit, which caps your annual spending on covered services. This is a key advantage over Original Medicare, which has no out-of-pocket cap.
CMS Star Ratings in Pennsylvania
CMS rates Medicare Advantage plans on a 1-5 star scale based on quality of care, member satisfaction, customer service, and other factors. When comparing plans in Pennsylvania, prioritize plans with 4 or more stars.
Extra Benefits Beyond Original Medicare
Most Medicare Advantage plans in Pennsylvania include benefits that Original Medicare does not cover:
- Dental, vision, and hearing: Most MA plans in Pennsylvania include dental cleanings, eye exams, and hearing aids.
- Prescription drug coverage (Part D): MOST Medicare Advantage plans in Pennsylvania include integrated Part D drug coverage.
- Fitness programs: Many plans include SilverSneakers or similar gym memberships.
- Transportation: Some plans cover rides to medical appointments.
- Meal delivery: Some plans provide meal delivery after hospital discharge.
- Over-the-counter allowance: Many plans provide quarterly OTC benefit cards for health supplies.
Special Needs Plans (SNPs) in Pennsylvania
Special Needs Plans are available in Pennsylvania for beneficiaries with specific health conditions or circumstances:
- D-SNP (Dual-Eligible): For people who qualify for both Medicare and Medicaid.
- C-SNP (Chronic Condition): For people with specific chronic conditions such as diabetes, heart failure, or ESRD.
- I-SNP (Institutional): For people living in nursing facilities or requiring an institutional level of care.
SNPs provide coordinated care tailored to your specific needs. Contact your local SHIP office to determine if a SNP is right for you.
Medicare Advantage vs Original Medicare in Pennsylvania
| Feature | Medicare Advantage | Original Medicare + Medigap |
|---|---|---|
| Monthly Premium | Often $0 (+ Part B premium) | Part B + Medigap ($100-300+/mo) |
| Out-of-Pocket Max | Yes (MOOP cap) | No cap on Original Medicare |
| Provider Network | Network required (HMO) or preferred (PPO) | Any Medicare-accepting provider nationwide |
| Drug Coverage | Usually included | Separate Part D plan needed |
| Extra Benefits | Dental, vision, hearing, fitness often included | Not included |
| Best For | Budget-conscious, healthy, urban areas | Frequent travelers, rural areas, chronic conditions |
Additional Pennsylvania Medicare Advantage regulations: Pennsylvania operates PA MEDI (Medicare Education and Decision Insight) through the Department of Aging as its SHIP counseling program (1-800-783-7067). Lancaster County has the most MA plan options of any county in the U.S. (82 plans). Highmark terminated plans affecting approximately 148000 enrollees in 2025, requiring transitions to new plans for 2026.
Pennsylvania Medicare Advantage Enrollment Periods
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday. You can join an MA plan during this period.
- Annual Enrollment Period (AEP): October 15 through December 7. Switch between MA plans or return to Original Medicare.
- Medicare Advantage Open Enrollment Period (OEP): January 1 through March 31. Switch MA plans or drop MA and return to Original Medicare (and add a Part D plan).
- Special Enrollment Periods (SEP): Available for qualifying life events such as moving, losing employer coverage, or qualifying for Medicaid.
Compare Pennsylvania Medicare Advantage Plans
Ready to compare Medicare Advantage plans in Pennsylvania? The official Medicare Plan Finder lets you compare plans by cost, star rating, drug coverage, and extra benefits in your zip code.
Official Sources & Resources
- Medicare.gov Plan Finder: medicare.gov/plan-compare
- CMS Medicare Advantage Data: cms.gov
- Pennsylvania Insurance Department: https://insurance.pa.gov/
- KFF Medicare Advantage Data: kff.org
Last verified April 2026. Contact us if you notice outdated information.