Enrollment in UPMC plans soar

| Wednesday, Feb. 15, 2012

UPMC Health Plan said Tuesday that enrollment for its Medicare Advantage plans -- an increasingly popular insurance alternative for seniors -- grew at a double-digit rate over last year.

The insurance company, a subsidiary of Pittsburgh hospital system UPMC, said membership in its six Medicare Advantage products on Jan. 1 was 92,617, an increase of 13.6 percent, or 11,072 members, over 2011 enrollment.

"Western Pennsylvania is a very competitive landscape for Medicare," said Eugene Scanzera, vice president of Medicare for UPMC Health Plan. "For us to have high growth, it means changing the market share, and we have done that. It's clear we're getting more than just our fair share of growth."

UPMC Health Plan said the plans, known as UPMC for Life, grew in Allegheny County by 11.2 percent to 30,564 members, as of Jan. 1. UPMC for Life is the third largest Medicare Advantage program in the state.

Highmark Inc., the state's largest health insurer, said it had about 273,000 members enrolled in Medicare Advantage and Medicare supplemental plans as of Jan. 1. The Downtown nonprofit Blue Cross company declined to provide a year-over-year comparison.

But according to Mark Farrah Associates, a Maine consulting company that tracks insurance enrollment, Highmark had 294,236 Medicare Advantage members in Pennsylvania as of Feb.1, a 0.4 percent increase over Feb. 1, 2011, when Highmark had 292,969 members. Mark Farrah Associates uses the Feb.1 comparison because it captures "all changes for the entire Medicare Advantage annual open enrollment period," said Debra A. Donahue, vice president of market analytics.

By the same measure, UPMC had 108,182 Medicare Advantage members in the state, up 11.7 percent. UPMC is ranked second behind Highmark by Mark Farrah Associates. UPMC is followed by Aetna Inc. and Independence Blue Cross, a Philadelphia nonprofit insurer, both which showed year-to-year declines.

The federal government's Medicare program for retirees pays a fixed amount to private insurance companies that offer Medicare Advantage plans to pay for care of members. While the insurers must follow rules set by the government, they can charge different out-of-pocket costs and set their own rules on referrals and network providers.

Nationally, enrollment in Medicare Advantage plans is up about 10 percent over last year, according to the Health and Human Services Department. About 12.7 million people were enrolled in the plans at the start of this year, up from 11.7 million at the beginning of last year, the department said this month. Premiums also are down about 7 percent on average, the department said.

UPMC and Highmark are involved in a battle over dominance of the health care industry in Western Pennsylvania. UPMC refuses to negotiate new reimbursement contracts with Highmark, which means UPMC's doctors and hospitals will be out-of-network for Highmark's commercial insurance members after June 30, 2013. Highmark is trying to buy Pittsburgh's No. 2 hospital network, West Penn Allegheny Health System for $475 million and spend another $500 million to create an integrated health care system to compete against UPMC.

UPMC Health Plan started this year with a total of 1.79 million members, up 14.5 percent from the 1.56 million members it had at the beginning of 2011.

Included in its total membership are 666,000 people covered by mental health benefits paid through the government's Medicaid program. Enrollment in the behavioral health programs was up 7 percent at the beginning of this year.

UPMC Health Plan also provides health insurance through employers and those commercial plans had 373,621 members as the beginning of January, up 11.1 percent over last year.

The remainder of its members are covered under workers compensation insurance or ancillary insurance plans, such as pharmacy, vision or dental.

Highmark said it had 3.1 million members at the beginning of this year, basically flat from last year. Within that total are 2.5 million members who receive insurance through their employers, which includes regional companies and national companies with headquarters in the Pittsburgh region and employees in other locations. Highmark added 41,000 members to its commercial business, it said.

Highmark, which is facing stiffer competition from national insurance carriers in the Pittsburgh market, retained "nearly 90 percent" of its small-employer business, which "is better than historical results despite the strong competition from commercial insurers and the UPMC dispute," spokesman Michael Weinstein said.

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