Medicare in Pennsylvania: 2026 Plans, Costs, and Enrollment Guide

Pennsylvania Medicare Snapshot

Pennsylvania has a well-developed Medicare market — 248 MA plans from 20 carriers covering 67 of 68 counties for 2026 (CMS CY2026 Landscape). Unlike many large states where HMOs dominate, Pennsylvania's MA market is led by PPO plans (96 PPOs vs. 55 HMOs), reflecting beneficiary preference for broader provider networks.

The average consolidated MA premium is $34.85/month(median $18.50) — notably higher than national comparators, partly driven by Pennsylvania's higher healthcare costs and its PPO-heavy plan mix. The standard Medicare Part B premium is $202.90/month standard in 2026. Pennsylvania's average star rating of 4.05 is above the national average, and 46 Medigap carriers give beneficiaries strong plan options.

Plan Types Available in Pennsylvania

Medicare Advantage (Part C)

In Pennsylvania, 248 MA plans are available for 2026 from 20 carriers (CMS CY2026 Landscape). Plan type mix: 96 PPO, 55 HMO, 34 HMO-POS, 27 HMO D-SNP (dual-eligible special needs), and 12 HMO C-SNP (chronic condition special needs), among others.

County availability ranges from 114 MA plans in Lancaster County to 46 plans in Pike County — strong rural coverage compared to many states.

Medigap (Medicare Supplement)

Pennsylvania has 46 Medigap carriers offering all 12 standardized plan letters. Plan G is available from 45 carriers — among the widest Plan G selection in the country. Plan F is closed to new enrollees as of January 1, 2020 (MACRA).

Pennsylvania does not have a Birthday Rule. Medigap Open Enrollment Period is the federal standard 6-month guaranteed-issue window. See our MA vs Medigap comparison →

Standalone Part D (Prescription Drug Plans)

Pennsylvania is in CMS PDP Region 6 (Pennsylvania and West Virginia). For 2026, there are 12 standalone PDP plans from 6 carriers. Average total premium is $71.27/month (CMS CY2026 Landscape).

Costs in Pennsylvania

Medicare Advantage Premiums

The average consolidated MA premium in Pennsylvania is $34.85/month (median $18.50) — noticeably higher than many other large states (CMS CY2026 Landscape). The standard Medicare Part B premium is $202.90/month in 2026.

The top three carriers by plan count are Aetna Medicare (39 plans), Highmark Blue Cross Blue Shield or Highmark Blue Shield (38 plans), and Devoted Health (26 plans) (CMS CY2026 Landscape). Average star rating is 4.05 — above the national average.

Medigap Premiums — Plan G and HDG

Medigap premiums vary by carrier, age, gender, tobacco use, and rating method. Across the 43 carriers offering Plan G in Pennsylvania (non-tobacco rates, ages 65–85), monthly premiums range from approximately $118 to $603/month (TPP internal data, CY2026; methodology: non-tobacco rates, ages 65–85, all carriers offering Plan G).

High-Deductible Plan G (HDG) is offered by 29 Pennsylvania carriers; premiums range from approximately $105 to $850/month across ages 65–85, non-tobacco rates (TPP internal data, CY2026). HDG works well for beneficiaries who want catastrophic protection at a lower monthly cost and can absorb the $2,950 deductible (2026).

Part D Costs and the LIS Benchmark

For 2026, Pennsylvania Part D premiums average $71.27/month across 12 standalone PDP plans. The CMS Low Income Subsidy (LIS / Extra Help) benchmark premium for PDP Region 6 (Pennsylvania and West Virginia) is $32.71/month (CMS CY2026 Regional Rates and Benchmarks).

Pennsylvania-Specific Medicare Rules

Pennsylvania Medigap Protections

Pennsylvania follows standard federal Medigap rules. You have a 6-month Medigap Open Enrollment Period that starts the month you are both 65 or older and enrolled in Medicare Part B. During this guaranteed-issue window, insurers cannot deny you coverage or charge higher premiums based on your health history.

After this window closes, medical underwriting applies and coverage is not guaranteed. Pennsylvania does not have a Birthday Rule. Enrolling in Medigap during the initial Open Enrollment Period is especially important.

Medicare Savings Programs (MSPs)

Pennsylvania offers Medicare Savings Programs (MSPs) administered by the Pennsylvania Department of Human Services:

• QMB (Qualified Medicare Beneficiary): Covers Part A and Part B premiums, deductibles, and cost-sharing.
• SLMB (Specified Low-Income Medicare Beneficiary): Covers Part B premiums only.
• QI (Qualifying Individual): Also covers Part B premiums; subject to annual appropriations.

Apply through the Pennsylvania Department of Human Services or contact Pennsylvania APPRISE (1-800-783-7067) for free enrollment assistance. MSP enrollment also automatically qualifies you for Extra Help / LIS on Part D. Learn more about MSPs →

Pennsylvania APPRISE

Pennsylvania APPRISE (Aging & Disability Resource Center Medicare Assistance Program) provides free, unbiased counseling on all Medicare options statewide.

Phone: 1-800-783-7067
Website: Pennsylvania APPRISE

Enrolling in Medicare in Pennsylvania

Standard Enrollment Periods

• Initial Enrollment Period (IEP): 7-month window centered on your 65th birthday month. Enroll at ssa.gov or call 1-800-772-1213.
• Annual Election Period (AEP): October 15 – December 7 each year.
• Medicare Advantage Open Enrollment Period (OEP): January 1 – March 31.
• Medigap Open Enrollment Period: 6-month guaranteed-issue window starting when you are 65+ and enrolled in Part B. After this window, medical underwriting applies (Pennsylvania has no Birthday Rule).
• Special Enrollment Periods (SEPs): Learn more →

Pennsylvania APPRISE Counseling

Contact APPRISE at 1-800-783-7067 for free one-on-one Medicare guidance statewide.

Frequently Asked Questions