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PA Health Insurance plans

Listed below are the types of plans insurers may offer throughout Pennsylvania.


HMO stands for health maintenance organization. An HMO is a type of health insurance plan that requires you to select a family doctor, often called a Primary Care Physician or PCP. You will need a referral from your PCP to see a specialist in the HMO network, such as a dermatologist. Typically, only emergency services are covered if you go outside the health plan network. 




PPO stands for preferred provider organization. A PPO is a type of health plan that allows members to see providers in and out of the network. You pay lower costs when you see network providers. But you can go outside the network and pay more for your services. PPO plans offer the most flexibility in seeking health care providers and for this reason usually cost the most.



A Point-of-Service plan (POS) is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, you must select an in-network physician to be your Primary Care Physician. But like a PPO, patients may go outside of the provider network for health care services.




There are certain health related expenses that Original Medicare does not cover, such as copays, coinsurance, deductibles, and other out-of-pocket costs. Medicare beneficiaries in Pennsylvania have the option of enrolling in a Medicare Supplement plan also known as Medigap insurance to help cover those out-of-pocket expenses. In Pa there are ten standardized Medigap plans each labeled with a single letter. Plans A,B,C,D,F,G,K,L,M and N are

available thoughout the Commonwealth. If you purchase a Medigap policy it's recommended you add seperate Part D prescription coverage.



A Medicare Advantage Plan is a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include HMO's,PPO's, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't covered under Original Medicare. Most Medicare Advantage Plans also offer prescription drug coverage. Many insurance companies in Pennsylvania that offer Medicare Advantage Plans include dental, vision and free gym memberships as a part of the benefit.



Individuals on Medicare are eligible for prescription drug coverage under a Part D plan if they are signed up for benefits under Medicare Part A and/or Part B. Beneficiaries can obtain the Part D drug coverage through private insurance companies. One option is to enroll in a stand alone Prescription Drug Plan also called a PDP. Another option for Medicare beneficiaries is to recieve Part-D-like benefits through a Medicare Advantage health plan. A large number of Medicare beneficiaries get prescription drug coverage under plans offered by former employers. 

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