I have been involved with insurance for the past 35 years. The single biggest insurance change with Medicare in Pittsburgh in that time is happening right now in 2019. With Medicare’s open enrollment period running through December 7th, you have a golden opportunity to make changes that could alter not only the cost but the care you can receive. If you are one of the many that find this whole process confusing, we can help! Our private pay Life Care Managers are available to help you navigate choosing the insurance to meet your needs.
On June 30, 2019, UPMC and Highmark will be dissolving the longtime in-network relationship between what has been the Pittsburgh region’s major provider and insurer. Although there are some exceptions to this, what that means in simple, broad terms is if you have a Highmark Medicare Advantage plan (Medicare part C) insurance, you cannot see UPMC MD’s or go to UPMC Hospitals and vice a versa.
1. Do you currently have a Highmark Medicare Advantage Plan?
If you or a loved one is among the 175,000 Western Pennsylvania seniors who has a
Highmark Medicare Advantage HMO or PPO (Security Blue, Community Blue, Freedom Blue) you are losing network access to UPMC doctors and hospitals. This means that you cannot see a UPMC MD or go to a UPMC hospital unless you privately pay for the services up front. Following private payment, you can attempt to file for reimbursement. Consequently, this change makes this already complicated insurance even more confusing.
In my professional opinion, many are already overpaying for the majority of Highmark plans in comparison to other Medicare Advantage plans available in Pittsburgh.
More information on Highmark’s Medicare Advantage plans is available at 866-871-7710.
2. UPMC Medicare Advantage Plan?
In comparison to Allegheny Health Network/Highmark in Western PA, UPMC’s network is more widely available. UPMC is currently offering five Medicare Advantage HMO and two PPO plans. We have found over the years that UPMC Medicare Advantage Plans can be an economical choice. We also find working with their utilization review department in approval for days in the hospital or SNF to be a fair process, unlike other insurance providers.
If you choose a UPMC Medicare Advantage plan you will not be able to receive care by doctors that only participate in the Allegheny Health Network or their prospective hospitals.
Further information on UPMC for Life’s 2019 offerings is available by calling 1-877-381-3765.
3. Alternatives to UPMC & Highmark Medicare Advantage Plans in Western PA:
If you are upset about the whole UPMC monopoly or would prefer access to both UPMC and Highmark MD’s and Hospitals, there are Medicare Advantage plans offered by Aetna, United Healthcare or Humana that offer access to both networks. The Center for Medicare (CMS) mandates that everything original Medicare covers, Medicare Advantage plans have to cover so you will not find a difference in coverage from one Medicare Advantage plan to the next. What you will find is a difference in the cost including co-pay, out of pocket, medication coverage and monthly fees. Many Medicare Advantage plans have added some dental and eye care packages to their plans this year.
More information on Aetna Coventry plans is available at 1-833-859-6031
More information on Humana plans is available at 1-877-877-0714
More Information on United Healthcare plans at 1-844-752-9204
4. Supplement option referred to as Medigap insurance:
Most people don’t realize this, but the Advantage Plan does not pay the 20% that Medicare doesn’t pick up.
They are designed to take the place of Medicare. With most Medicare Advantage plans you will have an out-of-pocket expense around $6000.00/year. Supplements pay all or virtually all of what Medicare does not. All Medigap plans such as the more popular Highmark or AARP Medicare Supplement Plans insured by United Healthcare, can receive care in both Highmark/Allegheny Health Network and UPMC.
When selecting a Medigap plan you also need to purchase a Part D drug plan. Medicare Advantage Plans include varying drug coverage. The one caveat to a Medigap plan is most insurance plans apply medical underwriting for Medigap plans, which means they can either deny coverage due to pre-existing conditions or charge a higher premium. This comes into play when switching from a Medicare Advantage plan to a Medigap plan. They also are typically have a higher monthly cost than Medicare Advantage plans.
When selecting a Medicare part D coverage, you need to select a plan that will provide the most coverage for the medication you are currently on.
For more information and to view specific plan details, visit Medicare.gov
Please share this information with the 200,000 Western PA seniors; is it so important to get the word out! If you need assistance please call our office to set up a private pay consultation. We are located in Hampton Township in Allison Park. 412-443-1365 Holistic Aging (www.holisticaging.com)