Upmc For Life
Avg Star Rating
4.5 ★
Plan
Premium
MOOP
Stars
Type
Compare & Enroll — Part C & Part D
Compare & Enroll in Medicare Plans in 19104, PA
With 97 Medicare Advantage options from 17 insurers, 19104, PA has significantly more plan choices than the national average, suggesting a highly competitive market where insurers often lower premiums to attract members. Approximately 88% of local MA plans charge $0 beyond the standard Part B premium, reflecting strong price competition. With 10 hospitals within 25.0 miles, most local plan networks should offer strong provider access. We've organized the CMS data below to help you cross-reference plan costs, quality ratings, and local provider access. Compare plans below, and when you're ready, enroll directly at Medicare.gov.
📊 Direct from CMS
🚫 No agents or commissions
✓ Just the data, no sales pitch
Compare Plans at Medicare.gov →
Data freshness: CMS data as of February 2026 •
ACS data as of 2023 •
Reviewed & approved on 2026-02-16
Reviewed by: Wes Ward, Founder & Data Lead •
View our methodology
Important: We are not affiliated with Medicare or any government agency. This site displays publicly available CMS data to help you compare plans. We do not sell insurance or represent any insurance company. For official enrollment and complete plan information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Important: Plan availability, benefits, and CMS Star Ratings shown here come directly from CMS public files. Plan details can change—always verify with the insurer and at Medicare.gov.
Part C Plans
97
Part D Plans
12
Top MA Star
4.5
Top Drug Star
3.5
Medicare Eligibility in 19104, PA
Approximately 4,174 residents (7.1% of the population) in 19104, PA are 65 or older and likely Medicare-eligible. Whether you're approaching 65, already enrolled, or a caregiver comparing options, the plan data below is organized to help you evaluate Part C (Medicare Advantage) and Part D (prescription drug) coverage side by side.
The median household income in 19104, PA is $47,526 (36.8% below the National Average), which may affect eligibility for Extra Help with Part D drug costs.
Part C: Medicare Advantage Plans
Medicare Advantage (Part C) replaces Original Medicare through private insurers who bundle hospital, medical, and often drug coverage into a single plan. 19104, PA's 97 Medicare Advantage plans are a mix leaning toward HMO networks (60 HMO, 36 PPO). 85 plans offer $0 monthly premiums. The average local star rating is 3.7 out of 5, with the top plan earning 4.5 ★.
Top Medicare Advantage Plans in 19104, PA
We organize CMS plan data into separate leaderboards so you can compare based on what matters most to you. Part C premiums in 19104, PA range from $0 to $155/month. Among rated plans, 43 plans rated 4+ stars.
Highest CMS Star Ratings
Star Ratings are assigned by CMS based on quality measures including customer service, preventive care, and managing chronic conditions.
| Plan Name | Insurer | Star Rating | Premium | Type | |
|---|---|---|---|---|---|
| Aetna Medicare Advantra Signature Giveback (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Aetna Medicare Signature (PPO) | Aetna Medicare | 4.5 ★ | $0.00/mo | PPO | Enroll |
| Aetna Medicare Advantra Premier (PPO) | Aetna Medicare | 4.5 ★ | $1.00/mo | PPO | Enroll |
| Aetna Medicare Enhanced (PPO) | Aetna Medicare | 4.5 ★ | $8.00/mo | PPO | Enroll |
| Upmc For Life Ppo Salute (PPO) | Upmc For Life | 4.5 ★ | $0.00/mo | PPO | Enroll |
Lowest Monthly Premium
Lower premiums can save money, but check total costs including deductibles, copays, and MOOP.
| Plan Name | Insurer | Monthly Premium | MOOP | Star Rating |
|---|---|---|---|---|
| Aetna Medicare Advantra Dual Care (HMO D-SNP) | Aetna Medicare | $0.00/mo | $9,250 | 3.5 ★ |
| Keystone 65 Basic Rx (HMO) | Independence Blue Cross | $0.00/mo | $8,500 | 4.0 ★ |
| Keystone First Vip Choice (HMO D-SNP) | Vista Health Plan Inc. | $0.00/mo | $9,250 | 4.0 ★ |
| Jefferson Health Plans Special (HMO D-SNP) | Jefferson Health Plans | $0.00/mo | $9,250 | 3.5 ★ |
| Healthspring Totalcare Plus (HMO D-SNP) | Healthspring | $0.00/mo | $9,250 | 3.0 ★ |
Lowest Maximum Out-of-Pocket (MOOP)
MOOP caps your financial risk. Once you hit this limit, the plan covers 100% of covered services for the rest of the year.
| Plan Name | Insurer | MOOP (In-Network) | Premium | Star Rating |
|---|---|---|---|---|
| Humana Gold Choice H8145-163 (PFFS) | Humana | $1,500 | $155.00/mo | 3.5 ★ |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plans | $2,600 | $0.00/mo | N/A |
| Humanachoice Giveback H5216-116 (PPO) | Humana | $4,150 | $0.00/mo | 3.5 ★ |
| Keystone 65 Preferred Rx (HMO) | Independence Blue Cross | $4,200 | $108.30/mo | 4.0 ★ |
| Keystone 65 Preferred Medical Only (HMO) | Independence Blue Cross | $4,200 | $111.00/mo | 4.0 ★ |
Plan Type Mix in 19104, PA
HMO plans require referrals and in-network care. PPO plans offer more flexibility. SNP (Special Needs Plans) serve specific populations. MAPD plans include drug coverage.
| Plan Type | Count | Percentage | Description |
|---|---|---|---|
| PPO | 32 | 33.0% | No referrals; in and out-of-network |
| HMO | 18 | 18.6% | Requires referrals; in-network only |
| HMO D-SNP | 14 | 14.4% | Medicare Advantage plan |
| HMO-POS | 13 | 13.4% | HMO with some out-of-network options |
| HMO I-SNP | 6 | 6.2% | Medicare Advantage plan |
| HMO C-SNP | 4 | 4.1% | Medicare Advantage plan |
| HMO-POS D-SNP | 4 | 4.1% | Medicare Advantage plan |
| Regional PPO | 2 | 2.1% | Medicare Advantage plan |
| PFFS | 1 | 1.0% | Private Fee-for-Service |
| HMO-POS C-SNP | 1 | 1.0% | Medicare Advantage plan |
| PPO D-SNP | 1 | 1.0% | Medicare Advantage plan |
| PPO I-SNP | 1 | 1.0% | Medicare Advantage plan |
Choosing the Right Medicare Advantage Plan
The best Part C plan depends on your doctors, medications, and budget. Key factors to evaluate:
- Provider network: Verify your doctors and hospitals near 19104, PA are in-network before enrolling
- Total cost: A $0 premium may have higher copays—calculate your annual cost
- Star Ratings: 4+ stars indicate above-average quality and member satisfaction
Read our full guide on choosing Medicare Advantage → · Print our enrollment checklist →
Medicare Glossary: HMO, PPO, MOOP & more →
Medicare Advantage Insurers in 19104, PA
17 insurance companies offer Medicare Advantage plans in 19104, PA. Below, we group plans by insurer so you can compare options from each company. More insurers generally means more competition and better benefits for consumers.
Independence Blue Cross
Avg Star Rating
4.0 ★
Plan
Premium
MOOP
Stars
Type
Geisinger Gold
Avg Star Rating
4.0 ★
Highmark Blue Cross Blue Shield Or Highmark Blue Shield
Avg Star Rating
4.0 ★
Vista Health Plan Inc.
Avg Star Rating
4.0 ★
Plan
Premium
MOOP
Stars
Type
Unitedhealthcare
Avg Star Rating
3.9 ★
Plan
Premium
MOOP
Stars
Type
Aetna Medicare
Avg Star Rating
3.8 ★
Plan
Premium
MOOP
Stars
Type
Humana
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Jefferson Health Plans
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Wellcare
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Clover Health
Avg Star Rating
3.5 ★
Highmark Wholecare Medicare Assured
Avg Star Rating
3.5 ★
Upmc For Life Complete Care
Avg Star Rating
3.5 ★
Plan
Premium
MOOP
Stars
Type
Devoted Health
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Healthspring
Avg Star Rating
3.0 ★
Plan
Premium
MOOP
Stars
Type
Perennial Advantage
Avg Star Rating
N/A
Provider Partners Health Plans
Avg Star Rating
N/A
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Part D: Prescription Drug Plans (PDP)
Part D covers prescription drugs through standalone plans for those on Original Medicare, or as part of a Medicare Advantage bundle. Among the 12 standalone Part D plans in 19104, PA, some offer $0 annual deductibles while others charge up to the 2026 maximum of $590. 3 plans are at or below the regional premium benchmark, making them eligible for Low Income Subsidy auto-enrollment. The 2026 $2,000 out-of-pocket cap means drug costs are now more predictable regardless of which plan you choose, but formulary coverage still varies significantly—always verify your medications are covered before enrolling.
Part D Formulary Notice: Each Part D plan has its own formulary (list of covered drugs). The same medication may be on different tiers—or not covered at all—depending on the plan. Always check that your specific medications are covered before enrolling.
2026 Out-of-Pocket Cap: Thanks to the Inflation Reduction Act, your total out-of-pocket drug costs are capped at $2,000 per year in 2026. Once you reach this limit, you pay nothing more for covered Part D drugs for the rest of the year. This eliminates the old "donut hole" coverage gap that previously caused higher costs.
Low Income Subsidy (LIS / Extra Help): If you have limited income and resources, you may qualify for Extra Help paying Part D costs. Visit SSA.gov or call 1-800-MEDICARE.
Top Part D Drug Plans in 19104, PA
We organize Part D plans by CMS Star Ratings, premiums, and deductibles so you can find the best fit for your prescription needs. Part D premiums in 19104, PA range from $7 to $193/month. Remember: all Part D plans now cap your annual out-of-pocket drug costs at $2,000 thanks to the Inflation Reduction Act.
Highest CMS Star Ratings (Part D)
Part D Star Ratings measure drug pricing, customer service, member complaints, and pharmacy access.
| Plan Name | Insurer | Star Rating | Premium | Deductible | |
|---|---|---|---|---|---|
| Wellcare Value Script (PDP) | Wellcare | 3.5 ★ | $8.20/mo | $615 | Enroll |
| Wellcare Classic (PDP) | Wellcare | 3.5 ★ | $14.70/mo | $615 | Enroll |
| Silverscript Choice (PDP) | Aetna Medicare | 3.0 ★ | $22.70/mo | $615 | Enroll |
| Humana Value Rx Plan (PDP) | Humana | 3.0 ★ | $19.40/mo | $601 | Enroll |
| Humana Basic Rx Plan (PDP) | Humana | 3.0 ★ | $6.60/mo | $615 | Enroll |
Lowest Monthly Premium
Lower premiums help with monthly cash flow, but check drug tier costs and the deductible.
| Plan Name | Insurer | Monthly Premium | Drug Deductible | Star Rating |
|---|---|---|---|---|
| Humana Basic Rx Plan (PDP) | Humana | $6.60/mo | $615 | 3.0 ★ |
| Wellcare Value Script (PDP) | Wellcare | $8.20/mo | $615 | 3.5 ★ |
| Wellcare Classic (PDP) | Wellcare | $14.70/mo | $615 | 3.5 ★ |
| Humana Value Rx Plan (PDP) | Humana | $19.40/mo | $601 | 3.0 ★ |
| Silverscript Choice (PDP) | Aetna Medicare | $22.70/mo | $615 | 3.0 ★ |
Lowest Annual Drug Deductible
The deductible is what you pay out-of-pocket before the plan starts covering drug costs. The 2026 maximum Part D deductible is $590. Many plans offer $0 deductible options.
| Plan Name | Insurer | Drug Deductible | Monthly Premium | Star Rating |
|---|---|---|---|---|
| Humana Premier Rx Plan (PDP) | Humana | $0 | $123.60/mo | 3.0 ★ |
| Aarp Medicare Rx Preferred From Uhc (PDP) | Unitedhealthcare | $130 | $121.90/mo | 2.0 ★ |
| Blue Rx Pdp Complete (PDP) | Highmark Blue Shield | $200 | $164.80/mo | 3.0 ★ |
| Humana Value Rx Plan (PDP) | Humana | $601 | $19.40/mo | 3.0 ★ |
| Humana Basic Rx Plan (PDP) | Humana | $615 | $6.60/mo | 3.0 ★ |
Understanding drug tiers: Part D plans organize medications into 5 cost tiers — Tier 1 (Preferred Generic) is cheapest; Tier 5 (Specialty) is most expensive. Two plans with the same premium can have very different costs for your drugs depending on tier placement. Learn more about drug tiers →
Choosing the Right Part D Drug Plan
The right Part D plan depends on your specific medications. Key factors to evaluate:
- Formulary: Verify your drugs are covered before enrolling
- Preferred pharmacies: Lower copays at certain locations—check your pharmacy is in-network
- Total annual cost: Premium + deductible + copays for your drugs
Read our full guide on choosing Part D →
What is a formulary? See our Medicare Glossary →
Part D Drug Plan Insurers in 19104, PA
6 insurance companies offer standalone Part D drug plans in 19104, PA. Below, we group plans by insurer.
Wellcare
Avg Star Rating
3.5 ★
Humana
Avg Star Rating
3.0 ★
Highmark Blue Shield
Avg Star Rating
3.0 ★
Aetna Medicare
Avg Star Rating
3.0 ★
Plan
Premium
Deductible
Stars
Type
Healthspring
Avg Star Rating
2.5 ★
Unitedhealthcare
Avg Star Rating
2.0 ★
Plan availability, premiums, and benefits shown are based on CMS data and may change. Always verify current details with the insurer and at Medicare.gov before enrolling.
Ready to Enroll in 19104, PA?
Compare plans side-by-side at Medicare.gov or speak with a licensed Medicare specialist.
📋 Print our Medicare Enrollment Checklist — gather your info before you compare.
📅 Enrollment Dates & Deadlines · 🩺 Questions to Ask Your Doctor
Medicare.gov is the official U.S. government site for Medicare. Available 24/7.
Pharmacy Access in 19104, PA
Part D plans have preferred pharmacy networks where you'll pay lower copays. Here's a look at pharmacy options in and around 19104, PA.
Total Pharmacies
353
within 5.0 miles
Chain Pharmacies
84
CVS, Walgreens, etc.
Independent Pharmacies
269
locally owned
| Pharmacy | Address & Phone | Distance | Type |
|---|---|---|---|
| PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEALTH S | 3737 MARKET ST PHILADELPHIA, PA 191045545 215-529-9375 | 0.1 mi | Independent |
| PENN PRESBYTERIAN MEDICAL CENTER OF THE UNIVERSITY OF PENNSYLVANIA HEA | 51 N 39TH STREET PHILADELPHIA, PA 19104 215-566-9496 | 0.1 mi | Independent |
| PENN-PRESBYTERIAN APOTHECARY | 3910 POWELTON AVENUE PHILADELPHIA, PA 191042692 215-566-9496 | 0.2 mi | Independent |
| SHWARTZ RX 4017 INC. | 4027 MARKET ST PHILADELPHIA, PA 191043002 215-592-5660 | 0.3 mi | Independent |
| PENNSYLVANIA CVS PHARMACY, L.L.C. | 3925 WALNUT ST PHILADELPHIA, PA 191043624 215-522-0829 | 0.4 mi | Chain |
| ECKERD CORPORATION | 4055-89 MARKET STREET PHILADELPHIA, PA 19104 215-538-5356 | 0.4 mi | Independent |
| PENNSYLVANIA CVS PHARMACY, L.L.C. | 3401 WALNUT ST PHILADELPHIA, PA 191046228 215-566-1333 | 0.4 mi | Chain |
| BELL APOTHECARY, INC. | 4014 LANCASTER AVE PHILADELPHIA, PA 191041712 215-538-9100 | 0.5 mi | Independent |
| TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA | 3400 SPRUCE ST PHILADELPHIA, PA 191044238 215-566-2920 | 0.6 mi | Independent |
| NEFF DRUGS 13, LLC | 4323 CHESTNUT ST PHILADELPHIA, PA 191042912 215-538-5000 | 0.6 mi | Independent |
Pharmacy data from CMS. Network participation varies by plan—always verify with your specific Part D plan.
Local Healthcare Access in 19104, PA
Before choosing a plan, consider the healthcare infrastructure in 19104, PA. Medicare Advantage plans restrict you to in-network hospitals, so understanding local hospital quality helps you pick the right plan — not just the cheapest one.
Note: The facilities below do not indicate which providers are in-network for any specific plan. Always verify network status with your plan before enrolling.
Hospitals Nearby
10
within 25.0 miles
Top-Rated Hospitals near 19104, PA
If hospital access matters to your plan choice, check quality ratings before you enroll. These are the highest CMS-rated hospitals near 19104, PA — click a hospital name to see its full profile and verify it's in your plan's network.
| Hospital | CMS Rating | Distance | Beds |
|---|---|---|---|
| Penn Presbyterian Medical Center | 5 ★ | 0.1 mi | 305 |
| Hospital Of Univ Of Pennsylvania | 5 ★ | 1.8 mi | 782 |
| Pennsylvania Hospital | 4 ★ | 2.4 mi | 475 |
| Main Line Hospital Lankenau | 4 ★ | 4.0 mi | 370 |
| Thomas Jefferson University Hospital | 3 ★ | 2.2 mi | 925 |
| Children's Hospital Of Philadelphia | Not Rated | 0.7 mi | 710 |
| Belmont Behavioral Hospital | Not Rated | 1.8 mi | 147 |
| Fairmount Behavioral Health System | Not Rated | 1.8 mi | 172 |
| Wills Eye Hospital | Not Rated | 2.4 mi | 4 |
| Kensington Hospital | Not Rated | 3.5 mi | 31 |
View all 10 hospitals near 19104, PA to check quality before you enroll →
Hospital data from CMS Hospital Compare and Provider of Services file. Distance calculated from center of 19104, PA.
Telehealth in 19104, PA: Is Your Internet Ready?
Many Medicare Advantage and some Part D plans now include telehealth benefits, making routine check-ins and prescription refills easier from home. But telehealth requires reliable internet—here's a look at connectivity in 19104, PA. For official guidance on virtual visits, see Telehealth.HHS.gov from the U.S. Department of Health & Human Services.
Check Internet Providers at Your Address
Telehealth works best with reliable internet. Use this tool (provided free by ISP Reports) to see what's available at your address.
Opens ISP Reports in a new tab. This is not a paid relationship. Special thank you to ISP Reports for allowing free use of their address tool.
Internet Coverage in 19104, PA
Fiber Available
85.6%
of households
Cable/DSL Available
98.6%
of households
Top Provider
Talkie Communications
0.4% coverage
No Broadband
9.2%
of households
Internet coverage data from ISP Reports. View full internet report for 19104, PA.
Medicare-Relevant Demographics in 19104, PA
Understanding 19104, PA's demographics helps contextualize why insurers offer the plans they do. Areas with more seniors and higher incomes tend to attract more insurer competition, while areas with higher Medicaid enrollment may have more Dual-Eligible Special Needs Plans (D-SNP) available.
Total Population
58,799
Population 65+
4,174
7.1% of total
Median Age
27
10.6 years younger than the national average
Median Income
$47,526
36.8% below the National Average
On Medicare
3,809
6.5% of residents
On Medicaid
10,441
17.8% of residents
Uninsured
2,962
5.0% of residents
Social Security Recipients
8,142
13.8% of population
Demographic data from U.S. Census Bureau American Community Survey (2023). View full 19104, PA demographics (BestNeighborhood.org).
Local Medicare FAQ: 19104, PA
Common decision points based on 19104, PA's specific plan market and local healthcare landscape.
How does 19104, PA's Medicare Advantage market compare?
19104, PA has 97 Medicare Advantage plans from 17 insurers. This is significantly above the national average of approximately 57 plans per area, indicating a highly competitive local market. More competition typically means lower premiums and better supplemental benefits for beneficiaries. The local mix includes 60 HMO and 36 PPO plans. Plan availability updates annually during the Medicare Annual Enrollment Period (October 15 – December 7).
Should I choose an HMO or PPO Medicare Advantage plan in 19104, PA?
With 10 hospitals within 25.0 miles, 19104, PA has strong provider density. HMO plans (60 available) typically have lower premiums but require referrals and in-network care. PPO plans (36 available) offer more flexibility to see out-of-network providers at higher cost. In 19104, PA, HMO plans dominate the market, which often means more competitive HMO pricing. Always verify your doctors are in-network before enrolling in any plan.
What's the real cost of $0 premium plans in 19104, PA?
85 plans (88% of available options) in 19104, PA charge $0 beyond the standard Part B premium. This high percentage reflects strong insurer competition in the area. However, $0 premium doesn't mean $0 cost. These plans may have higher copays, coinsurance, or out-of-pocket maximums. In 19104, PA, maximum out-of-pocket limits range from $1,500 to an average of $7,365. We recommend calculating your total expected annual cost (premium + copays + drug costs) rather than choosing based on premium alone.
How does the 2026 $2,000 drug cap affect 19104, PA beneficiaries?
The Inflation Reduction Act capped annual out-of-pocket drug spending at $2,000 starting in 2025, eliminating the old "donut hole" coverage gap. This applies to all 12 standalone Part D plans in 19104, PA.
What this means locally:
- Cost predictability — No matter which of the 12 Part D plans you choose, your drug costs are capped at $2,000/year
- $0 deductible options — Some local plans offer $0 deductibles, meaning coverage starts immediately
- Low-income options — 3 plans meet the regional benchmark for Extra Help/LIS eligibility
While the out-of-pocket cap standardizes maximum costs, formulary coverage still varies significantly between plans. A drug that costs $5/month on one plan's formulary might cost $50 on another. Always check that your specific medications are covered and compare tier placement before enrolling.
See all Medicare FAQs in our complete guide → · Enrollment checklist →
Medicare Glossary · Enrollment Dates & Deadlines · Doctor Questions
About the Data & Editorial Team
Wes Ward
Founder & Data Lead
Wes Ward is the founder of InsuranceDataNow.org and reviews all content for data accuracy and methodology compliance.
With 25+ years in data analytics — including work with highly regulated genomic data at Ancestry.com — Wes brings enterprise-level rigor to consumer data tools. He is also a co-founder of BestNeighborhood.org, CrimeGrade.org, and ISPReports.org.
Role: Reviews and approves all content for data accuracy, source verification, and methodology compliance.
Transparency & Disclosures
InsuranceDataNow is an advertising-supported publisher based in South Jordan, Utah. We are not affiliated with or endorsed by Medicare or the U.S. government.
TPMO Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (24 hours a day/7 days a week) to get information on all of your options.
Sources
- CMS Medicare Plan Finder Data (Part C & D): cms.gov
- CMS Provider Directory: Hospital and pharmacy data from data.cms.gov
- American Community Survey: Demographic data from census.gov
- FCC Broadband Map: Internet availability data from broadbandmap.fcc.gov
- ISP Reports: Internet provider coverage for 19104, PA from ispreports.org
- Telehealth.HHS.gov: Official telehealth guidance from U.S. Dept. of Health & Human Services
- BestNeighborhood.org: Community demographic profiles for 19104, PA from bestneighborhood.org
All data is sourced from official government databases and trusted third-party providers. Data is updated regularly—see page header for last refresh dates.