What is Medicare Advantage?

In Pennsylvania in 2018, 40% of Medicare beneficiaries were enrolled in Medicare Advantage plans (at that point, nationwide Medicare Advantage enrollment covered 34% of Medicare beneficiaries). But by September 2024, private Medicare coverage enrollment had grown to 53% of Pennsylvania’s Medicare population.[efn_note]“<a href="https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment/data?query=%7B%22filters%22%3A%7B%22list%22%3A%5B%7B%22conditions%22%3A%5B%7B%22column%22%3A%7B%22value%22%3A%22YEAR%22%7D%2C%22comparator%22%3A%7B%22value%22%3A%22%3D%22%7D%2C%22filterValue%22%3A%5B%222024%22%5D%7D%2C%7B%22column%22%3A%7B%22value%22%3A%22BENE_STATE_ABRVTN%22%7D%2C%22comparator%22%3A%7B%22value%22%3A%22%3D%22%7D%2C%22filterValue%22%3A%5B%22PA%22%5D%7D%2C%7B%22column%22%3A%7B%22value%22%3A%22MONTH%22%7D%2C%22comparator%22%3A%7B%22value%22%3A%22%3D%22%7D%2C%22filterValue%22%3A%5B%22September%22%5D%7D%5D%7D%5D%2C%22rootConjunction%22%3A%7B%22value%22%3A%22AND%22%7D%7D%2C%22keywords%22%3A%22%22%2C%22offset%22%3A0%2C%22limit%22%3A10%2C%22sort%22%3A%7B%22sortBy%22%3Anull%2C%22sortOrder%22%3Anull%7D%2C%22columns%22%3A%5B%5D%7D">Medicare Monthly Enrollment – Pennsylvania .” Centers for Medicare & Medicaid Services Data. Accessed January, 2025.[/efn_note] Pennsylvania stands out as having among the most robust Medicare Advantage markets in the country. Plan availability varies by county, but every county in Pennsylvania has at least 35 Advantage plans available in 2025, and most have more than 60.[efn_note]" Medicare Advantage 2025 Spotlight: First Look " KFF.org Nov. 15, 2024[/efn_note] Medicare beneficiaries can switch between Medicare Advantage and Original Medicare during the annual election period in the fall, which runs from October 15 to December 7 each year, with coverage effective January 1. There is also a Medicare Advantage open enrollment period in the first quarter of the year (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can change to a new Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Original Medicare has out-of-pocket costs that can be substantial and there is no out-of-pocket cap with Original Medicare. Many Original Medicare beneficiaries use Medigap plans to supplement their coverage, with the Medigap plan covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that they would otherwise have to pay themselves. There are 52 insurers that offer individual Medigap plans in Pennsylvania as of 2025.[efn_note] “ Explore your Medicare coverage options .” Medicare.gov. Accessed October, 2024.[/efn_note] According to data compiled by AHIP, 694,691 Pennsylvania residents had Medigap coverage as of 2022.[efn_note]" The State of Medicare Supplement Coverage " AHIP. May 2024[/efn_note] Medigap plans are standardized under federal rules , with ten different plan designs (differentiated by letters, A through N), but premiums vary significantly from one insurer to another . Federal rules provide a six-month guaranteed-issue window for Medigap plans, which begins when the person is at least 65 and enrolled in Medicare Part B. There’s no federally-guaranteed access to Medigap plans for people under the age of 65 who are eligible for Medicare due to a disability, but Pennsylvania is among the majority of the states that have rules ensuring at least some access to Medigap plans for enrollees who are under the age of 65. In Pennsylvania, the six-month open enrollment window for Medigap plans starts when you’re enrolled in Part B, and it applies regardless of age . Pennsylvania state law regarding Medigap plans (Chapter 89, Subchapter K) is available here . Pennsylvania statute ( Title 31, § 89.778 ) prohibits Medigap insurers from charging higher premiums based on medical history when a person enrolls during their initial six-month enrollment window, so premiums cannot be higher for disabled enrollees (in many states, Medigap coverage is guaranteed-issue for beneficiaries under 65, but premium can be higher; Pennsylvania does not allow this).

What is Medicare Part D?

Original Medicare provides fairly comprehensive coverage, but it does not pay for outpatient prescription drugs. Some Medicare beneficiaries have supplemental prescription coverage as part of an employer-sponsored plan, including retiree plans. If that’s not an option, an individual can get needed coverage for medications by enrolling in a stand-alone Medicare Part D plan or a Medicare Advantage plan that includes Medicare Part D coverage for prescription drugs. In 2025, there are 16 stand-alone Medicare Part D plans for sale in Pennsylvania, with monthly premiums that start at $0.[efn_note]" Fact Sheet: Medicare Open Enrollment for 2025 " (116) Centers for Medicare & Medicaid Services. Sep. 27, 2024[/efn_note] As of September 2024, there were 1,061,924 beneficiaries of Medicare in Pennsylvania with stand-alone Part D coverage, and another 1,406,285 had Part D coverage integrated with Medicare Advantage plans.[efn_note]“<a href="https://data.cms.gov/summary-statistics-on-beneficiary-enrollment/medicare-and-medicaid-reports/medicare-monthly-enrollment/data?query=%7B%22filters%22%3A%7B%22list%22%3A%5B%7B%22conditions%22%3A%5B%7B%22column%22%3A%7B%22value%22%3A%22YEAR%22%7D%2C%22comparator%22%3A%7B%22value%22%3A%22%3D%22%7D%2C%22filterValue%22%3A%5B%222024%22%5D%7D%2C%7B%22column%22%3A%7B%22value%22%3A%22BENE_STATE_ABRVTN%22%7D%2C%22comparator%22%3A%7B%22value%22%3A%22%3D%22%7D%2C%22filterValue%22%3A%5B%22PA%22%5D%7D%2C%7B%22column%22%3A%7B%22value%22%3A%22MONTH%22%7D%2C%22comparator%22%3A%7B%22value%22%3A%22%3D%22%7D%2C%22filterValue%22%3A%5B%22September%22%5D%7D%5D%7D%5D%2C%22rootConjunction%22%3A%7B%22value%22%3A%22AND%22%7D%7D%2C%22keywords%22%3A%22%22%2C%22offset%22%3A0%2C%22limit%22%3A10%2C%22sort%22%3A%7B%22sortBy%22%3Anull%2C%22sortOrder%22%3Anull%7D%2C%22columns%22%3A%5B%5D%7D">Medicare Monthly Enrollment – Pennsylvania .” Centers for Medicare & Medicaid Services Data. Accessed January, 2025.[/efn_note] Total Medicare enrollment and total Medicare Part D enrollment have been increasing in Pennsylvania and nationwide as the Baby Boomer population ages into Medicare. But enrollment in stand-alone Medicare Part D plans has been decreasing in Pennsylvania, while enrollment in Medicare Advantage plans (most of which include Part D coverage) has been increasing rapidly. Medicare Part D enrollment (for stand-alone plans as well as Medicare Advantage plans with integrated Part D coverage) is available during the annual election period , from October 15 to December 7 each year. Plan changes made during this window will take effect the following January 1.

Medicare in Pennsylvania

Medicare enrollment in Pennsylvania
Medicare Advantage plan availability and enrollment in Pennsylvania
Medicare supplement (Medigap) plan availability in Pennsylvania
Medicare Part D availability and enrollment in Pennsylvania
What additional resources are available for Medicare beneficiaries and their caregivers in Pennsylvania?

Medicare enrollment in Pennsylvania

As of January 2026, there were 3,017,975 Pennsylvania residents enrolled in Medicare.¹

For most people, eligibility for Medicare benefits is tied to turning 65. But Medicare eligibility is also triggered when a person has been receiving disability benefits for at least two years. (People with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) do not have to wait 24 months for their Medicare enrollment.)

As of early 2026, nearly 10% of Pennsylvania’s Medicare beneficiaries were under 65 and eligible for Medicare due to a disability.¹

Medicare Advantage plan availability and enrollment in Pennsylvania

As of January 2026, almost 55% of Pennsylvania’s Medicare beneficiaries were enrolled in private Medicare Advantage plans.¹ The remaining 1,372,096 Pennsylvania Medicare beneficiaries had Original Medicare.¹

Pennsylvania stands out as having among the most robust Medicare Advantage markets in the country. There are a total of 334 Medicare Advantage plans for sale in Pennsylvania for 2026.² Plan availability varies by county, but the average Medicare beneficiary in Pennsylvania can choose from among 53 Medicare Advantage plans in 2026, which is the highest of any state in the nation.³

Learn more about Medicare Advantage, Medicare’s annual open enrollment period, and the Medicare Advantage open enrollment period.

Learn about Medicare plan options in Pennsylvania by contacting a licensed agent.

Medicare supplement (Medigap) enrollment and regulations in Pennsylvania

There are 50 insurers that offer individual Medigap plans in Pennsylvania as of 2026.⁴ According to data compiled by AHIP, 680,688 Pennsylvania residents had Medigap coverage as of 2023.⁵

Learn more about how Medigap plans are standardized and what they cover.

There’s no federally guaranteed access to Medigap plans for people under the age of 65 who are eligible for Medicare due to a disability, but Pennsylvania is among the majority of the states that have rules ensuring at least some access to Medigap plans for enrollees who are under the age of 65. In Pennsylvania, the six-month open enrollment window for Medigap plans starts when you’re enrolled in Part B, and it applies regardless of age.⁶ Pennsylvania state law regarding Medigap plans (Chapter 89, Subchapter K) is available here.

Pennsylvania statute (Title 31, § 89.778) prohibits Medigap insurers from charging higher premiums based on medical history when a person enrolls during their initial six-month enrollment window, so premiums cannot be higher for disabled enrollees (in many states, Medigap coverage is guaranteed-issue for beneficiaries under 65, but premium can be higher; Pennsylvania does not allow this).

Medicare Part D plan availability and enrollment in Pennsylvania

In 2026, there are 12 stand-alone Medicare Part D plans for sale in Pennsylvania, with monthly premiums that start at $6.60.⁷

As of January 2026, there were 1,086,447 beneficiaries of Medicare in Pennsylvania with stand-alone Part D coverage, and another 1,462,788 had Part D coverage integrated with Medicare Advantage plans.¹

Learn how Medicare Part D prescription drug coverage works, what it pays for, how and when to enroll.

Medicare Part D plan availability, premiums and enrollment in Pennsylvania

What additional resources are available for Medicare beneficiaries and their caregivers in Pennsylvania?

Do you have questions about Medicare eligibility in Pennsylvania? Do you need help understanding your options or getting signed up for Medicare coverage? See the below list of free resources to help you access and manage your Medicare coverage.

You can contact APPRISE, Pennsylvania’s State Health Insurance Assistance Program (SHIP), with questions related to Medicare coverage in Pennsylvania. Visit the APPRISE website or call 1-800-783-7067.
For Medicare beneficiaries with limited income and assets, Pennsylvania Medicaid might be available to help make coverage and care more affordable. You can contact the Pennsylvania Department of Human Services website for more information or call 1-866-550-4355.
Medicare coverage is regulated by both federal and stage agencies, depending on the type of coverage. The Pennsylvania Insurance Department regulates Medigap plans in the state as well as brokers and agents who sell Medicare coverage, and is a great resource for Pennsylvania residents.
Visit the Medicare Rights Center. This website provides helpful information geared to Medicare beneficiaries, caregivers, and professionals.