Medicare in Pennsylvania serves about 2.9 million beneficiaries, with 52% enrolled in Medicare Advantage and the remainder on Original Medicare + Medigap. Average Medigap Plan G premium for a new 65-year-old enrollee: $151/mo. Stand-alone Part D plans average $45/mo.
Medicare Beneficiaries
2.9 million
Age 65+ and disabled
MA Enrollment
52%
% on Medicare Advantage
Avg Medigap Plan G
$151/mo
New enrollee, age 65
| Topic | Detail | Notes |
|---|---|---|
| Medicare Advantage plans available | 75+ | Varies by county; check medicare.gov plan finder |
| Top MA carriers | UnitedHealthcare, Highmark Blue Cross Blue Shield, Aetna/CVS | Networks differ by county |
| Stand-alone Part D | $45/mo | Required if you have Original Medicare + Medigap |
| Annual guaranteed-issue Medigap switching | No (one-time 6-month window at 65) | No state annual GI rights; PACE (Program of All-inclusive Care for the Elderly) originated in Pennsylvania and remains prominent; APPRISE counseling program is a leading state SHIP. |
Medigap premiums vary by carrier, age, and ZIP code. The 2026 Part B premium is $202.90/month and Part B deductible is $283. Part D out-of-pocket cap is $2,100 in 2026.
Pennsylvania's Medicare market is defined by one of the most publicly visible insurer-hospital conflicts in American healthcare: the ongoing strategic competition between Highmark Blue Cross Blue Shield and UPMC (University of Pittsburgh Medical Center). This rivalry — which has at various points involved UPMC not accepting Highmark insurance — directly affects Medicare beneficiaries in western Pennsylvania who must choose between UPMC-network MA plans and Highmark plans that may or may not have UPMC access. In Philadelphia and eastern Pennsylvania, Jefferson Health, Penn Medicine, and Thomas Jefferson University Hospital are the major systems, and Independence Blue Cross (IBC) holds a dominant local market position. UnitedHealthcare competes statewide.
Pennsylvania's APPRISE program (Aging & Disability Services' free Medicare counseling) is one of the most well-funded and respected SHIP programs in the country, helping hundreds of thousands of beneficiaries navigate their options. Medigap Plan G averages about $151/month — moderate for a large Mid-Atlantic state. The 52% MA enrollment rate is above the national average, driven by competitive $0-premium plans in metro markets. Rural central and northern Pennsylvania (the Wilds region, Potter County, rural Appalachian communities) has more limited MA competition. Pennsylvania has no birthday rule or annual Medigap switching protections.
In Pennsylvania, traditional Medicare combined with a Medigap supplement (typically Plan G or N) plus a stand-alone Part D plan provides nationwide access with predictable costs. Plan G covers everything except the $283 Part B deductible.
Medicare Advantage (Part C) plans bundle Medicare Parts A, B, and usually D into one private plan, often with $0 premium beyond Part B. Trade-offs include network restrictions and prior authorization. 52% of Pennsylvania beneficiaries currently choose MA.
No state annual GI rights; PACE (Program of All-inclusive Care for the Elderly) originated in Pennsylvania and remains prominent; APPRISE counseling program is a leading state SHIP.
💡 Pennsylvania Pro Tip
Pennsylvania beneficiaries in the Philadelphia, Pittsburgh, and Allentown metro areas typically have access to 75 or more Medicare Advantage plans. Harrisburg, Scranton, and Erie generally offer 35 to 55 options. Rural north-central Pennsylvania communities may have 20 to 30 plans. The Pittsburgh market is particularly important to understand — UPMC and Highmark network issues can affect which plans include access to which hospitals.
The average Medigap Plan G premium for a 65-year-old in Pennsylvania is approximately $151 per month. Philadelphia metro premiums may run slightly higher, while western PA and rural communities are often at or below the state average. Highmark, Cigna, Aetna, and Mutual of Omaha all compete in the Pennsylvania Medigap market.
Pennsylvania does not have a birthday rule or annual guaranteed-issue protections for Medigap. Outside your 6-month initial open enrollment at 65 or qualifying federal events, insurers can use medical underwriting. Pennsylvania's free APPRISE counseling program can help you understand your options and timing for Medigap enrollment.
Beneficiary counts and MA enrollment percentages from CMS state-level Medicare data; premium averages from 2026 carrier rate filings for Pennsylvania. Verify current plan costs at medicare.gov before enrolling.
Jennifer Walsh
Editorial Lead, Health & Medicare
This article was researched and written by the Cover Forge USA editorial team against federal sources (NAIC, CMS, FEMA, DOL, SSA, state DOIs) and standard policy forms. Bylines organize content by topic — they do not assert individual licensure. See our editorial-policy for details.
Reviewed May 2026
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