Oct. 2 – The still growing demand among seniors in western Pennsylvania for Medicare Advantage plans has sparked a slew of new health insurance options with lower costs and better perks as insurers compete to grow their market share.
“This is a mature market in Western Pa. And we can take those dollars and invest them in really smart ways to keep these plans affordable,” said Ellen Galardy, senior vice president of consumer markets for Highmark Health’s health insurance division. It competes with UPMC by being one of the largest Medicare Advantage plan membership lists in the region.
Among the expanded offerings, summed up in dozens of plan details for 2022 released on Friday: quarterly allowances of $ 50 to $ 75 for personal care items ranging from toothbrushes to electronic scales; discounted sleep apnea and home health equipment; advanced eyesight and dental benefits up to $ 6,000 per 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 additional government-provided plans. They have long been popular in the region with people 65 years of age or older or have a disability, and membership continues to grow.
In Allegheny and Westmoreland counties, insurance premiums for 2022 for dozen of Medicare Advantage plan options range from $ 0 to $ 302 per month.
Many up-and-coming Medicare Advantage plans retain previously popular perks such as free Silvers Sneakers fitness classes, telemedicine appointments, transportation to doctor’s appointments, and post-hospital meals.
Most plans offer reduced premiums and co-payments, as well as additional perks and benefits, although buyers should definitely consult with a lawyer, broker, or insurance agent to determine the best plan for their specific needs.
“All of our plans include broad access to quality doctors and hospitals across Pennsylvania, with many plans starting as low as $ 0 a month, and a new plan in 2022 that will allow members to customize their coverage by adding opting for one of these additional benefits: dental, ophthalmic, or over-the-counter health products, “said Angela Perri, chief Medicare officer of UPMC Health Plan.
Open registration runs October 15th through December 7th for all Medicare-related coverage beginning January 1st.
Seniors who choose a Medicare Advantage plan as opposed to traditional Medicare and additional Medigap plans will have the option to switch to a different Medicare Advantage plan between January 1 and March.
Interest in Medicare Advantage grows
According to a report by research firm The Chartis Group last March, participation in Medicare Advantage plans rose from 32% five years ago to 42% in 2021. Meanwhile, traditional Medicare plans fell 2.6%.
In terms of the number of people, approximately 950,000 fewer people signed up for the original Medicare plans and 2.25 million more for the Medicare Advantage alternatives.
United Healthcare and Centene achieved some of the largest increases nationally, with a combined 1.6 million membership.
“Medicare Advantage has always been very popular in southwest Pennsylvania, but it’s getting better,” said Bob O’Connor, vice president and chief Medicare officer for Aetnas Keystone Market, members of Pennsylvania, West Virginia and Delaware. “Even people who have traditionally been on traditional Medicare or Medicare supplementation plans are really looking around because the benefit packages have become really very comprehensive. We even added chiropractic and acupuncture to some of our county-level plans. “
Aetna ranks third in the western Pennsylvania region, including the city of Pittsburgh and the surrounding suburbs, where UPMC and Highmark continue to be the dominant insurers. Aetna now insures 346,000 seniors across Pennsylvania on Medicare Advantage plans, including more than 33,000 in western Pennsylvania – an increase of about 11% between 2020 and 2021.
Consumers beware of copays, network access
All Medicare Advantage plans offer more services and perks than the original Medicare, and like Medicare, consumers are not allowed to charge more than 20% of most outpatient services.
However, the scope of benefits, the amount of co-payments, and the access restrictions in the Medicare Advantage plans vary widely.
“Copays are certainly different. You can see maybe $ 10 more to see a specialist or go to the hospital, but these are still very affordable copay plans,” Galardy said. “They all have lots of zeros in them – $ 0 to see your PCP. $ 0 for Tier 1 drugs. $ 0 for a lot of tests that are done in the doctor’s office, such as things like laboratory work. “
For those who want a lower premium combined with guaranteed wider access, Highmark is offering a new $ 0 Premium Monthly “Complete PPO” plan.
“The word ‘complete’ refers to the fact that it has solid coverage – think of all the typical medical benefits, as well as things like over-the-counter medications, eyesight, comprehensive dental treatments. And a very complete network, not only all AHN doctors and hospitals, but also UPMC and local community hospitals .. “
The “sister plan” Complete Blue Distinct has cut the price from $ 35 to $ 25 per month.
Consumers should also be aware that most major insurance providers have plans that may restrict access to certain medical providers, such as most UPMC doctors excluding.
Medigap plans could be a great option for people who travel frequently and have high costs. The option, which can be purchased directly from government or private insurers, offers a higher monthly premium, but also includes fixed annual cost caps and almost “complete flexibility,” Galardy said. Under Medigap, as well as the original Medicare insurance, a doctor who accepts Medicare plans cannot turn a patient away.
Compare plans by zip code using Medicare’s plan finder available at Medicare.gov.
Natasha Lindstrom is a contributor to Tribune Review. You can contact Natasha at 412-380-8514, [email protected] or via Twitter.
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