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Medicare Advantage prices to remain stable in Western Pennsylvania for 2018

Wes Venteicher
| Sunday, Oct. 1, 2017, 1:39 p.m.

Most Medicare Advantage plans sold in Western Pennsylvania will cost about the same or a little less in 2018 than they did this year, and seniors have a few more plans to choose from in Allegheny and Westmoreland counties, according to federal data released Sunday.

The new prices let seniors start shopping the plans, which are private alternatives to traditional Medicare, in advance of the annual enrollment period that runs from Oct. 15 through Dec. 7.

Allegheny County seniors can choose from 36 plans with premiums ranging from $0 per month for narrow-network plans to those with more generous benefits and premiums approaching $300. Westmoreland County seniors have 34 plans to choose from with a similar price range.

Medicare Advantage plans are increasingly popular among baby boomers, who retire at an estimated rate of 10,000 people per day, and the Western Pennsylvania market is competitive. New insurer Allwell, a Centene subsidiary, is entering the market this year with a $0-premium plan, competing with local insurers Highmark Inc. and UPMC Health Plan as well as national insurers Aetna, UnitedHealthcare and Humana.

Highmark expects the most growth in its Community Blue plans, which don't include UPMC hospitals, said Ellen Galardy, Highmark Inc.'s vice president of senior markets. The HMO versions of the plans cost nothing in premiums each month; Highmark is introducing a PPO version this year for $13 per month. The PPO includes network access to hospitals and doctors in other states and covers a portion of out-of-network bills, unlike the HMO. Otherwise, the PPO and HMO plans are the same, Galardy said.

β€œIt's been our fastest-growing product; we assume it's going to be the same this year,” she said of the Community Blue plans. Enrollment grew to about 20,000 from 16,000 last year, she said.

Highmark's Medicare Advantage enrollment in Western Pennsylvania shrank to about 167,000 members from about 183,000 last year, a change Galardy chalked up to heightened competition in the region.

The insurer sells plans across the state with the exception of the counties around Philadelphia. Statewide, its enrollment declined to about 225,000 from 241,000.

UPMC Health Plan grew its Western Pennsylvania membership to 156,000 from about 121,000, said John Lovelace, the plan's president of government programs.

Lovelace attributed the growth to competitive pricing and the reputation of UPMC's hospital system.

While its Western Pennsylvania membership grew, the insurer didn't see much enrollment in plans it offered for the first time in 2017 in Philadelphia County, central Pennsylvania and Ohio. Only about 2,000 people enrolled in the insurer's plans across those counties, Lovelace said.

Despite the lukewarm reception in those counties, UPMC Health Plan is expanding to 15 new counties in 2018 in central and northeastern Pennsylvania and around Philadelphia, he said. The central Pennsylvania expansion is based around UPMC's acquisitions and affiliations with hospitals in the area, he said.

UPMC Health Plan excludes from its networks most hospitals that are part of Allegheny Health Network, which is owned by Highmark Health. The exceptions are Jefferson Hospital in the South Hills and St. Vincent Hospital in Erie.

Most of Highmark's Medicare Advantage policyholders retain in-network access to UPMC hospitals through 2018, Galardy said. UPMC will be allowed to leave Highmark's networks in 2019 in accordance with a state consent decree governing some business between the feuding nonprofits.

The national insurers have promoted their access to both UPMC and Highmark-owned Allegheny Health Network hospitals, but their share of the market still lags behind the local insurers.

Officials from UPMC and Highmark said the uncertainty that has loomed over other types of health coverage β€” including individual plans sold on the Affordable Care Act marketplace, Medicaid and employer-based coverage β€” has not impacted Medicare. They emphasized that premium increases in for the ACA plans do not apply to Medicare Advantage.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676, or via Twitter @wesventeicher.

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