Still-growing demand among Western Pennsylvania seniors for Medicare Advantage plans has spurred a slew of new health coverage options featuring lower costs and better perks as insurers compete to grow their market shares.
“This is a ripe market in Western Pa., and we’re able to take those dollars and invest them in some really smart ways to keep these plans affordable,” said Ellen Galardy, senior vice president of consumer markets for the health insurance division of Highmark Health. It rivals UPMC by touting among the largest Medicare Advantage-plan membership rolls in the region. “And that’s a lot to do with the partnerships we’ve got with local providers.”
Among expanded offerings folded into the dozens of 2022 plan details made public Friday: $50 to $75 quarterly allowances for personal care items ranging from toothbrushes to electronic scales; discounted sleep apnea and home health devices; expanded vision and dental benefits as high as $6,000 a year; discounts for diabetes-related care and testing; and newly covered services such as hospice care, therapeutic massage and acupuncture.
Medicare Advantage plans are privately offered alternatives to traditional Medicare and supplemental government-provided plans. They’ve long been popular in the region among those who are 65 or older or have disabilities, and membership continues to grow.
In Allegheny and Westmoreland counties, 2022 insurance premiums across dozens of Medicare Advantage plan options range from $0 to $302 per month.
Many Medicare Advantage plans up for grabs retain previously popular perks such as free Silvers Sneakers gym classes, telehealth appointments, transportation to doctor appointments and post-hospital stay meal services.
A majority of plans appear to be offering reduced premiums and copays along with extra perks and benefits, though shoppers should be sure to consult with advocates, brokers or insurance company representatives to determine the best plan for their specific needs.
“All of our plans include broad access to high-quality doctors and hospitals across Pennsylvania, with many plans starting as low as $0 per month, and a new plan in 2022 that gives members the ability to customize their coverage by choosing one of these additional benefits: dental, vision, or over-the-counter health care products,” said Angela Perri, chief Medicare officer for UPMC Health Plan.
Open enrollment runs Oct. 15 through Dec. 7 for all Medicare-related coverage that begins on Jan. 1.
Seniors who select a Medicare Advantage plan, as opposed to traditional Medicare and supplemental Medigap plans, will have a chance to switch to a different Medicare Advantage plan between Jan. 1 and March.
Interest in Medicare Advantage on the rise
Nationwide, participation in Medicare Advantage plans has climbed from 32% five years ago up to 42% in 2021, according to a report last March by The Chartis Group research firm. Meanwhile, traditional Medicare plans declined by 2.6%.
In terms of people: About 950,000 fewer individuals enrolled in original Medicare plans and 2.25 million more enrolled in Medicare Advantage alternatives.
United Healthcare and Centene made some of the greatest gains nationally, for a combined 1.6 million members.
“Medicare Advantage has always been very popular in southwestern Pennsylvania, but it’s improved more and more and more,” said Bob O’Connor, vice president and chief Medicare officer for Aetna’s Keystone Market, which spans members in Pennsylvania as well as West Virginia and Delaware. “Even people that would have traditionally been under traditional Medicare or Medicare supplement plans are really taking another look, because the benefit packages have really become very comprehensive. We even added chiropractic care and acupuncture to some of our plans. We offer $0 plans in every county in the state.”
Aetna ranks No. 3 in the Western Pennsylvania region, including the city of Pittsburgh and surrounding suburbs, where UPMC and Highmark continue to reign as the dominant insurers (as well as providers, since unlike Aetna UPMC and Highmark own both insurance and hospital arms). Aetna now insures 346,000 seniors across Pennsylvania in Medicare Advantage plans, including more than 33,000 in Western Pennsylvania — a roughly 11% increase between 2020 and 2021. In Central Pennsylvania, Aetna claims a 40% market share. Aetna also is popular in the Philadelphia area, an area that UPMC and Highmark have not targeted like the pair of Downtown Pittsburgh-based rival provider-insurers have so many other regions of the state and neighboring states.
Consumers beware of copays, network access
All Medicare Advantage plans come with more services and perks than included in original Medicare, and like Medicare may not burden consumers with more than 20% of most outpatient services.
“By law, the Medicare Advantage plan has to include everything that the basic Medciare plan includes,” Galardy said. “The government plan is the minimum that we start from. So with a $0 premium, it’s hard for me to imagine someone that wouldn’t find more value in a Medicare Advantage plan.”
Still, the scope of benefits, amounts of copays and access restrictions across Medicare Advantage plans vary widely.
“Copays are certainly different. You may see maybe $10 more to see a specialist or go to the hospital, but these are still very affordable copay plans,” Galardy said. “They’ve all got a lot of zeroes in them — $0 to go see your PCP. $0 for Tier 1 drugs. $0 for a lot of tests done at the doctor’s office, so things like lab work.”
For those who want a lower premium coupled with guaranteed broader access, Highmark is offering a new $0 monthly premium “Complete PPO” plan.
“The word ‘complete’ refers to the fact that it’s got robust coverage — think about all the typical medical benefits, plus things like over-the-counter drug, vision, comprehensive dental. And a very complete network, so not only all the AHN doctors and hospitals, but also UPMC and local community hospitals. So it’s really a $0 plan that offers complete coverage for anything you would need.”
Its “sister plan,” Complete Blue Distinct, the price has been dropped from $35 to $25 a month.
“Those two are the ones that I predict are going to be fastest-selling in Western Pennsylvania this year, giving what the consumers what they said they wanted more of — more choices, lower premiums but still access to all of the doctors that they can trust.”
Consumers also should beware that most major insurance providers offer plans that could restrict access to certain medical providers, such as UPMC and Aetna plans linked to Excela Health providers that may not cover providers of Highmark’s Allegheny Health Network, and Highmark offers narrow-network plans that exclude most UPMC doctors.
Medigap plans could be a good option for people who travel frequently and have high-cost needs. The option, which is available for purchase directly from the government or private insurers, comes with a higher monthly premium but also hard caps on annual costs and almost “complete flexibility,” Galardy said. Under Medigap as well as original Medicare coverage, no doctor who accepts any Medicare plans can turn a patient away.
“So if you’re someone that has grandchildren who live in one place and you live in another, or you don’t want to have to think about provider networks because you’re constantly on the go,” said Galardy, “we know some people who Medigap plans work well for them.”
Compare plans by zip code via Medicare’s Plan Finder available at Medicare.gov.
