Compare Tioga County Pennsylvania
Medicare Advantage Plans

A Medicare Advantage Plan in Tioga County, PA can provide additional benefits above and beyond Original Medicare. There are 63 Medicare Advantage Plans (Part-C) available in Tioga County from 9 different health insurance providers to compare in 2023. 28 of these Medicare Advantage Plans offer additional gap coverage to help avoid the “donut hole”. The plan with the lowest out-of-pocket expense is $3450 and the highest out-of-pocket is $8300. Tioga County Pennsylvania residents can also pick from 12 Medicare Special Needs Plans. The best Medicare Advantage Plan in Tioga County Pennsylvania received a 5 overall star rating from CMS.



Most Popular Plans by Enrollment in Tioga County, Pennsylvania

Plan Name Plan ID Marketing Name Premium Enrollment
UPMC for Life HMO Rx Choice (HMO)
H3907-049
UPMC for Life $36.00 55364
Aetna Medicare Advantra Silver (PPO)
H5522-004
Aetna Medicare $0 44838
UPMC for Life HMO Rx (HMO)
H3907-029
UPMC for Life $81.00 38455
UPMC for Life HMO Deductible Rx (HMO)
H3907-037
UPMC for Life $22.00 27737
Freedom Blue PPO ValueRx (PPO)
H3916-018
Highmark Inc. $66.00 18118


2023 Medicare Advantage Plans in Tioga County, PA

(Click the Plan Name for More Details)
(⇅ Click the Header to Sort)


Name ⇅ Premium Deductible MOOP Gap Plan
Rating
Wellcare No Premium Open (PPO)
(H2128-002)

$0 $160.00 $6,700 NoToo New
Wellcare No Premium (HMO)
(H2915-016)

$0 $0 $6,700 No
Wellcare Low Premium Open (PPO)
(H2128-003)

$29.00 $100.00 $5,000 NoToo New
Wellcare Giveback Open (PPO)
(H2128-004)

$0 $350.00 $7,550 YesToo New
Wellcare Giveback (HMO)
(H2915-012)

$0 $0 $7,550 No
Wellcare Assist Open (PPO)
(H2128-001)

$14.20 $395.00 $6,700 NoToo New
Wellcare Assist (HMO)
(H2915-011)

$13.50 $445.00 $6,700 No
UPMC for Life PPO Rx Choice (PPO)
(H5533-009)

$23.00 $0 $4,900 No
UPMC for Life PPO Premier Rx (PPO)
(H5533-011)

$0 $0 $5,900 No
UPMC for Life HMO Rx Enhanced (HMO)
(H3907-006)

$295.00 $0 $7,550 No
UPMC for Life HMO Rx Choice (HMO)
(H3907-049)

$36.00 $0 $4,500 No
UPMC for Life HMO Rx (HMO)
(H3907-029)

$81.00 $0 $5,500 Yes
UPMC for Life HMO Premier Rx (HMO)
(H3907-046)

$0 $0 $5,500 No
UPMC for Life HMO Deductible Rx (HMO)
(H3907-037)

$22.00 $0 $6,000 No
HumanaChoice R0923-002 (Regional PPO)

$71.00 $0 $6,700 No
HumanaChoice H5525-060 (PPO)

$0 $0 $7,550 Yes
HumanaChoice H5525-058 (PPO)

$0 $505.00 $7,550 Yes
HumanaChoice H5525-051 (PPO)

$0 $0 $7,550 Yes
HumanaChoice H5525-017 (PPO)

$18.00 $0 $4,900 Yes
HumanaChoice H5525-005 (PPO)

$58.00 $0 $6,700 No
HumanaChoice H5216-120 (PPO)

$123.00 $0 $6,700 No
Humana Value Plus H5216-117 (PPO)

$41.10 $505.00 $7,000 No
Humana USAA Honor with Rx (PPO)
(H5525-059)

$0 $250.00 $7,550 Yes
Humana Gold Plus H6622-052 (HMO)

$0 $0 $7,200 Yes
Humana Gold Choice H8145-052 (PFFS)

$0 $360.00 $- No
Geisinger Gold Preferred Enhanced Rx (PPO)
(H3924-062)

$45.00 $0 $7,550 Yes
Geisinger Gold Preferred Complete Rx (PPO)
(H3924-065)

$0 $0 $6,700 Yes
Geisinger Gold Preferred Advantage Rx (PPO)
(H3924-059)

$109.00 $0 $4,000 Yes
Geisinger Gold Classic Essential Rx (HMO)
(H3954-161)

$0 $0 $7,550 Yes
Geisinger Gold Classic Complete Rx (HMO)
(H3954-158)

$34.00 $0 $4,900 Yes
Geisinger Gold Classic Advantage Rx (HMO)
(H3954-157)

$144.00 $0 $3,450 Yes
Freedom Blue PPO ValueRx (PPO)
(H3916-018)

$66.00 $0 $5,500 No
Freedom Blue PPO Standard (PPO)
(H3916-015)

$171.00 $0 $5,000 No
Freedom Blue PPO Deluxe (PPO)
(H3916-005)

$285.00 $0 $4,500 Yes
Community Blue Medicare Plus PPO Signature (PPO)
(H3916-039)

$0 $0 $8,300 No
Community Blue Medicare Plus PPO Distinct (PPO)
(H3916-036)

$25.00 $0 $6,000 No
Aetna Medicare Value (PPO)
(H5521-263)

$0 $0 $7,550 Yes
Aetna Medicare Silver (HMO)
(H3931-070)

$47.00 $0 $7,550 Yes
Aetna Medicare Gold Plan (PPO)
(H5521-122)

$176.00 $0 $7,550 Yes
Aetna Medicare Advantra Silver Plus (PPO)
(H5522-013)

$18.00 $0 $7,000 Yes
Aetna Medicare Advantra Silver (PPO)
(H5522-004)

$0 $0 $7,550 Yes
Aetna Medicare Advantra Premier Plus (PPO)
(H5522-002)

$77.00 $0 $6,500 Yes
Aetna Medicare Advantra Premier (HMO-POS)
(H3959-039)

$23.00 $0 $7,550 Yes
Aetna Medicare Advantra Gold (HMO-POS)
(H3959-037)

$0 $0 $7,550 Yes
Aetna Medicare Advantra Credit Value (PPO)
(H5522-017)

$0 $0 $7,550 Yes
AARP Medicare Advantage Flex Plan 2 (HMO-POS)
(H1944-011)

$33.00 $0 $5,200 Yes
AARP Medicare Advantage Flex Plan 1 (HMO-POS)
(H1944-010)

$0 $0 $5,900 Yes
AARP Medicare Advantage Choice Plan 2 (PPO)
(H2577-029)

$0 $0 $6,900 Yes
AARP Medicare Advantage Choice Plan 1 (PPO)
(H2577-021)

$35.00 $0 $5,500 Yes






Pennsylvania Part-C Plans Without Drug Coverage





Medicare Special Needs Plans in Tioga County Pennsylvania

Plan Name ⇅ Monthly
Premium
Part D
Deductible
 Gap  Special
Needs
Type
Overall
Rating
Wellcare Dual Access Open (PPO D-SNP)
(H2128-005)
   $24.20 $505.00  No Dual-EligibleToo New
Wellcare Dual Access (HMO D-SNP)
(H2915-007)
   $29.10 $505.00  No Dual-Eligible
UPMC for Life Complete Care (HMO D-SNP)
(H4279-001)
   $41.10 $505.00  Yes Dual-Eligible
UnitedHealthcare Dual Complete Select (HMO-POS D-SNP)
(H3113-014)
   $38.10 $505.00  No Dual-Eligible
UnitedHealthcare Dual Complete Choice (PPO D-SNP)
(H1889-007)
   $41.10 $505.00  No Dual-Eligible
UnitedHealthcare Dual Complete (HMO-POS D-SNP)
(H3113-009)
   $33.90 $505.00  No Dual-Eligible
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)
(H6622-078)
   $34.20 $505.00  No Dual-Eligible
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
(H5932-009)
   $41.10 $505.00  No Dual-Eligible
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)
(H5932-001)
   $41.10 $505.00  No Dual-Eligible
Geisinger Gold Secure Rx (HMO D-SNP)
(H3954-097)
   $41.10 $505.00  No Dual-Eligible
AmeriHealth Caritas VIP Care (HMO D-SNP)
(H4227-002)
   $41.10 $505.00  No Dual-Eligible
Aetna Medicare Advantra Cares (HMO D-SNP)
(H3959-036)
   $24.60 $505.00  No Dual-Eligible



Types of MA Plan in PA


HMO - Health Maintenance Organization. A Health Maintenance Organization manages your Part A and Part B health insurance benefits. In most cases you need to choose a primary care doctor. Health Maintenance Organization's offers services through a network of contracted hospitals, doctors and other providers, and the plan pays the providers directly. You generally must receive all Healthcare from the plan providers or through referrals from the plan provider. Emergency care, and out-of-area urgent care is still covered. An HMO-POS plan allows you to get some services out-of-network.

PPO - Preferred Provider Organization. A Preferred Provider Organization offers a network of doctors, hospitals, and other providers you can choose from. Because providers are preferred, you can save money by using in network providers or usually pay a higher cost to use out-of-network providers. A primary care doctor is not required.

PFFS - Private Fee For Service. A Private Fee For Service plan allows you greater flexibility in choosing a Pennsylvania provider. You may obtain covered services from any Medicare eligible provider who is willing to accept the plan's terms. The Healthcare provider must agree to accept the plan's terms before each visit. Some of these plans have a network of approved providers that have agreed to treat plan members.

SNP - Special Needs Plan. A Special Needs Plan is for individuals who receive Medicare and Medicaid, have specific severe or disabling chronic conditions or reside in a licensed nursing home or skilled facility. SNP plans must provide prescription drug coverage to Tioga County Pennsylvania residents.

Cost - Cost Plan. A cost plan doesn't replace your Original Medicare. It offers additional benefits to Original Medicare. If the cost plan doesn't include prescription drug coverage, you can enroll in a Part-D plan separately.



What does Medicare Advantage cover in Tioga County, PA?


Medicare Advantage Plans offer both hospital (Part-A) and medical insurance (Part-B) and additional coverage. More than 90% of Medicare Advantage plans offer additional vision, fitness, hearing, telehealth, or dental benefits in 2023.

Prescription drug coverage. While this isn’t usually covered under original Medicare, almost 90% of available plans will include prescription coverage. To find out if your medications are covered, check the plan’s formulary or list of covered prescription drugs.

Dental, vision, and hearing. This includes non-medically necessary coverage, which is not offered under Original Medicare. MA plans differ in benefits offered and vary from plan to plan.

Extra benefits. Some plans may offer fitness programs, (gym memberships or discounts) meal benefits, transportation to doctor visits, over-the-counter drugs and services that help your health and wellness.



Can I get help in the coverage gap in Tioga County, PA?


Yes. 28 Medicare Advantage Plans in Tioga County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

Are there Medicare Advantage Plans in Tioga County, PA?


There are 63 Medicare Advantage Plans available in Tioga County, Pennsylvania from 9 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare. Medicare beneficiaries who are interested in a Part-C policy may choose among many plans to compare versus Union County Medicare Advantage Plans.



How much is a Medicare Plan in Tioga County, PA?


Seniors who are interested in a Medicare Advantage Plan in Pennsylvania may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $295. The deductibles in Tioga County range from $0-$505. The plan with the lowest out-of-pocket (MOOP) expense is $3450 and the highest out-of-pocket is $8300.



Things to consider when choosing a MA Plan in Tioga


  • Are you eligible for a Medicare Advantage Plan?

  • How much are the premiums, deductibles, and other costs?

  • Is there a yearly limit on what you could pay out-of-pocket?

  • Does the plan cover your prescription drugs?

  • Will you hit the prescription drug coverage gap?

  • Is your pharmacy is in the plan’s network?

  • Will your prescription drugs require prior authorization?

  • How well does the plan cover the services you need like vision, hearing, or dental?

  • Are your doctors in-network?

  • Will you need to be referred to see a specialist?

  • Does the plan cover services from out-of-network providers?

  • How does the plan compare to your current coverage?

  • Do you want to juggle multiple Medicare plans?


Special Needs Plan in Tioga County Explained


C-SNP - Chronic Condition SNP. These plans help individuals receive customized care to fit their unique health care needs. You may qualify for C-SNP if you have one or more specific severe or disabling chronic conditions like:

  • Stroke
  • Certain neurologic disorders
  • Certain chronic and disabling mental health conditions
  • HIV/AIDS
  • Certain chronic lung disorders
  • Diabetes mellitus
  • End-Stage Renal Disease (ESRD)
  • End-stage liver disease
  • Certain severe hematologic disorders
  • Chronic alcohol and other drug dependence
  • Certain cardiovascular disorders
  • Cancer
  • Chronic heart failure
  • Certain autoimmune disorders
  • Dementia

I-SNP - Institutional SNP. These plans require 90 days or longer stay in a facility, or are expected to need the level of services provided in a long-term care (LTC) skilled nursing facility (SNF), a LTC nursing facility (NF), an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

D-SNP - Dual Eligible SNP. Pennsylvania Medicare and Medicaid enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid. Eligibility is based on a percentage of Federal Poverty Levels.


When to sign up for a Pennsylvania Medicare Advantage Plan?


Below mentioned are the types of the enrollment period, along with the instructions on what to do during this period:

Initial Enrollment Period (IEP). This period starts 3 months prior to the month you will turn 65. It ends after 3 months you have turned 65. At this stage, you can sign up for a Pennsylvania Medicare Advantage Plan.

Annual Enrollment Period (AEP). Also known as the Open Enrollment Period, it starts on the 15th of October and ends on the 7th of December. At this stage, you can either sign up for the plan, switch or leave your current plan.

Special Enrollment Period (SEP). This enrollment period depends on the personal circumstances of the beneficiaries, like if you move or lose insurance coverage. Check to determine if you qualify to modify your plan.

Open Enrollment Period. Jan 1 – Mar 31. If you’re enrolled in a Pennsylvania Medicare Advantage Plan, you can switch to a different Medicare Part-C Plan in Tioga County, PA or switch to Original Medicare once during this time.

5-star Special Enrollment Period. Dec 8 - Nov 30. If a Centers for Medicare and Medicaid Services (CMS) 5-star plan is available in your area you can switch to the 5-star plan once during this period.



Check for CMS Star Ratings

Centers for Medicare & Medicaid Service (CMS) assesses the quality of medical services of Medicare Advantage Plan using a 5-star rating system. A report is released yearly for the public to assess the quality of healthcare services. Thus, if you are searching for the best Medicare Advantage Plan in your state, research the CMS ratings and costs of the plans report for further information.


Can I get a Medicare Advantage Plans in Tioga County, PA?

Yes. There are 63 Medicare Advantage Plans available in Tioga County, Pennsylvania from 9 different health insurance providers. These plans offer additional benefits that aren't available through Original Medicare.

How much is a Medicare Plan in Tioga County, Pennsylvania?

Pennsylvania residents who are interested in a Medicare Advantage Plan may choose among many cost options depending on your necessary benefits. The lowest plan premium is $0 and the highest premium is $295. The deductibles in Tioga County range from $0-$505

Can I get help in the coverage gap in Tioga County, PA?

Yes. 28 Medicare Advantage Plans in Tioga County offer additional gap coverage. Once in the coverage gap, you’ll pay no more than 25% of the cost for brand-name and generic prescription drugs. If you choose a drug plan that includes coverage in the gap, you may get a discount applied to the drug's price.

What is the best plan in Tioga, PA?

The best Medicare Advantage Plan will be different for each person, due to their specific needs and requirements. The most popular plan by enrollment in Tioga is the UPMC for Life HMO Rx Choice (HMO) with 55364 seniors enrolled.



Source: CMS. Data as of Oct 1, 2022.
Plans are subject to change as contracts are finalized.
Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded. For 2023, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit.


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