6 things you should know as Medicare enrollment begins

Oct. 15--If you are enrolled in Medicare, starting Monday you will have the chance to choose plans for 2019. The process can be particularly confusing in Western Pennsylvania, where two leading health care giants -- UPMC and Highmark -- are severing ties with each other. The end of their relationship means seniors choosing a Medicare Advantage plan from a private company should be extra careful. Here's what you should keep in mind:

1. Know the difference between in-network and out-of-network

Because UPMC and Highmark don't have a contract, Highmark members will be considered "out-of-network" when they go to most UPMC hospitals and facilities. Same goes for UPMC doctors. If you want treatment at a UPMC hospital and carry a Highmark Medicare Advantage plan, don't be surprised with what you hear. They're under no obligation to treat you, unless it's an emergency. If you're not sure if your doctor will be "in network" or "out of network," call the office and ask.

----2. UPMC will require out-of-network patients to pre-pay their care

If you have Highmark and still want to get care at UPMC, you'll have to work out some financial details before your care can be scheduled. You'll work with an estimate service and you'll have to pay in advance. If there are additional costs not included in your estimate, you may get a bill in the mail. UPMC says it will not accept partial payments from Highmark Medicare Advantage members.

----3. If you want in-network access to UPMC, you may have to switch insurers

Several insurance carriers offer Medicare Advantage plans with full in-network access to UPMC. They include Aetna, Aetna Coventry, Cigna, United Healthcare, Humana and UPMC Health Plan.

----4. UPMC rival Allegheny Health Network offers similar services

If you want to stick with Highmark, the insurer's hospital network -- Allegheny Health Network -- offers services similar to those offered by UPMC. AHN offers organ transplantation, cancer treatment and psychiatric care. So losing in-network access to UPMC doesn't mean you lose access to important health care services.

----5. Some services may be covered by UPMC, even for out-of-network members

Highmark members who show up at a UPMC emergency department will not be turned away. They will get "appropriate medical screening," according to UPMC but, once stabilized, may be transferred to a hospital in their insurance network. In addition, cancer patients will have access to many UPMC cancer care facilities on an in-network basis.

----6. If you don't like your plan, you can switch

People who enroll in a Medicare Advantage plan will be able to switch to another Advantage plan any time within the first three months of 2019.

Natasha Lindstrom is a Tribune-Review staff writer. You can contact Natasha at 412-380-8514, [email protected] or via Twitter @NewsNatasha.

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