Competition spurs better bang-for-buck in Western Pa.'s Medicare Advantage market

Seniors across Western Pennsylvania enrolling in Medicare Advantage plans this year no longer have to confront the uncertainty of heated litigation embroiling Pittsburgh’s two largest health system rivals nor feel forced to switch insurers to avoid the threat of a prepay rule.

Instead, the 2020 enrollment period looks to prove historic for another reason — it’s serving up a buffet of options across several insurance providers featuring reduced-cost plans packed with levels of high-quality benefits, flexibility and other perks not available at such prices in years, several insurance brokers told the Tribune-Review.

The 2020 Medicare Advantage open enrollment period starts Tuesday and ends Dec. 7 for coverage that takes effect Jan. 1. Medicare Advantage plans are privately offered alternatives to original fee-for-service Medicare coverage, which is available to seniors and people with disabilities.

Medicare Advantage plans, which often bundle perks such as dental and vision care, prescription coverage, transportation to medical appointments and Silver Sneakers exercise classes, are proving increasingly popular nationwide and increasingly competition in the region.

Brokers said everyone who is eligible for Medicare should closely consider their best individual choice by reviewing strong options presented by nearly every insurance provider, including not only UPMC and Highmark but national competitors such as Aetna, United Healthcare and Cigna.

“Anybody who is paying over $150 per month on their premium must review their plan options this year,” said Sean Horn, a manager at Medi-Connect, a Pittsburgh firm that specializes in helping seniors choose health care plans. “Many of these lower-premium plans are outperforming their current coverage — as unbelievable as that sounds.”

Plans include monthly premiums ranging from $0 to more than $300, with a wide range of price points between, including more plans below $80 per month and $20 to $40 monthly premium options with expanded access and benefits.

Last year’s Medicare Advantage enrollment season marked the most pivotal shift in market share among insurers and plan-switching among seniors that Western Pennsylvania had seen in decades.

Amid confusing robo-calls, heated litigation and intensifying efforts by state Attorney General Josh Shapiro to intervene, many patients reluctantly switched plans last year in fear of UPMC’s prepay-in-full rule that was set to impact Highmark-insured patients in July. In late June, nonprofit health-system rivals UPMC and Highmark struck a 10-year contract that preserved access to both networks for the vast majority of Highmark’s patients.

Most of the drama has dissipated and, now, most Highmark-insured patients may go to UPMC doctors and facilities in the region. Exceptions include patients who choose narrow or limited network plans such as Community Blue offerings.

The competition is as fierce as ever for insurers to pick up a larger slice of the growing market share available for Medicare Advantage plans. Highmark, in particular, will seek to woo former members back after losing a substantial share of the market last fall to UPMC and Aetna under the threat of UPMC’s prepay rule, which was never imposed.

Nearly four months after the announcement of Highmark and UPMC’s 10-year contract, Horn and his Pittsburgh firm’s fellow brokers still expect to see “significant movement” in the plans that Medicare-eligible patients choose this time around.

“Now that just about every insurance company is on the same playing field, it has really sparked these organizations to step up their game on these insurance plans,” Horn said. “Some of the benefits we are seeing — like much-enhanced dental coverage and generous over-the-counter allowances — are at levels we haven’t seen for the normal Medicare beneficiary before.”

Some clients reported feeling bullied into moving away from Highmark to UPMC and say they want to go back to Highmark now that most Highmark plans provide access to UPMC facilities at in-network rates, Horn said. UPMC plans still continue to exclude most Allegheny Health Network hospitals. Others continue to express interest in moving to national alternatives like Aetna and United Healthcare, which provide access to UPMC and AHN facilities and doctors.

Other brokers agreed that benefits have been enhanced across the board, but expressed skepticism over whether consumers will do nearly as much plan-switching this period.

“I do not believe there will be a big migration from UPMC to Highmark or the other way around,” said Robert Nelson of the Robert Nelson Agency, a health care insurance broker based in Ambridge, Beaver County. “We may see a few carriers lose a few clients back to Highmark due to their loyalty to Highmark.”

Highmark has work to do to make up for last fall, when the insurer lost 21,000 members of Advantage plans while UPMC gained 8,000 and Aetna gained more than 20,000.

Highmark’s market share fell from a commanding 46.5 percent share of the Medicare Advantage market in Western Pennsylvania to UPMC’s 27.6 percent just five years ago.

With last year’s gains, UPMC eclipsed Highmark at 51 percent of the market while Aetna grew to 23 percent.

RELATED: UPMC says it’s eclipsed Highmark in Medicare Advantage insurance market, Aetna gains

“We’re already hearing both directly from members and from brokers that they have specific clients who are waiting for the application right now,” said Ellen Galardy, Highmark’s vice president of senior markets strategy. “This should be about what the members are looking for in a plan, and I hope a lot of the drama that came around last year can instead be funneled into all of us figuring out what’s best for each of those members.”

UPMC executives are similarly optimistic about continuing to grow their membership.

“We continue to offer strong products that help our members stay as healthy as they can be,” said Helene Weinraub, vice president of Medicare at UPMC Health Plan. “Almost all of our products have no premium increases.”