As one UPMC for Life Medicare Advantage plan is pulled from Cambria County, options remain for residents

When a letter notified Roger Courter that his UPMC for Life health plan was being terminated, the West Taylor Township retiree figured he would just need to re-enroll for a few more dollars.

Then Courter realized that UPMC was pulling his Medicare Advantage Prescription Drug plan from Cambria County altogether – and it sent him and his wife, Denise, into a panic, he said.

“It says ‘for life,’ but I guess that’s not true,” he said. “We were devastated when we found out. It’s the only plan we’ve had since I retired” nearly 10 years ago.

The move has left thousands of plan recipients across Cambria and Clearfield counties looking for answers – and new health coverage – as Pennsylvania’s open enrollment period for 2027 begins Thursday.

But local health insurance brokers said this week that there are plenty of similar Medicare Advantage plan options from which eligible residents can pick that also offer a combination of medical and prescription coverage.

“A lot of people were impacted here across Cambria County. It surprised a lot of people, but they have options regardless of their medical (needs),” said Jill Duvall, managing director for The Health Insurance Place in Richland Township.

The 508 Luray Ave. business is one of the health insurance brokers serving the region – and each works with clients to help them navigate which plans are available and how each might best fit their unique needs.

Duvall said that nationally known carriers, as well as regional ones, serve the area, and most offer their own Medicare Advantage with Prescription Drug plans – often called MAPDs – that compare to UPMC’s departing plan. That includes prominent providers such as Highmark, Aetna, Humana and UnitedHealthcare. Each has its own unique elements to consider, she said.

“I think brand is a big reason so many people choose UPMC,” Duvall said. “They know the name. They see their signs on buildings. They see their ads on TV. It’s what they think of when they think about health insurance, but it’s not the only option that serves this area.”

Some Medicare recipients – specifically veterans or people making certain income levels – may still qualify for a nearly identical UPMC plan to the UPMC for Life Medicare Advantage Prescription Drug plan they currently use.

But for other people losing their UPMC for Life Medicare Advantage Plan, they will see that there are other options under some of UPMC’s competitors, Duvall said.

It will come down to their individual needs – such as their routine medications, physicians and specialists they see – and reoccurring treatments, such as dialysis, that they will want to check into before making a decision, Duvall added.

“They might be surprised at how well some of these plans would work for them,” she said.

For Roger and Denise Courter, who have their own unique medical needs, it’s a lot to absorb, they said during an interview Wednesday.

Denise Courter said she was disappointed UPMC chose to terminate coverage in an area where “so many older people use it.” She acknowledged that many Americans go online for open enrollment to explore their coverage choices, “but we’re not computer-savvy,” she said.

“We don’t have a clue which one is right for us,” Roger Courter said.

It’s a reason why they decided to look for a health insurance broker to help them Wednesday.

Duvall said The Health Insurance Place alone had approximately 4,000 clients across Greater Johnstown who are now impacted by UPMC’s Medicare Advantage Prescription Drug plan exit from Cambria County. It’s likely there are thousands more served by other brokers across the area, she added.

A UPMC spokesperson described the company’s move as a business decision needed to ensure “we can continue providing high-quality, affordable coverage and access to care for the members and communities we serve.”

“As health care needs, market conditions and program requirements evolve, we periodically adjust our plan portfolio,” the spokesperson said in an email to The Tribune- Democrat. “These adjustments enable us to strengthen our offerings in core markets and maintain the benefits and services that matter to our members.”

UPMC officials did not elaborate on their core markets – but a list detailing areas still served by the UPMC for Life Medicare Advantage Prescription Drug program showed most are in counties with UPMC hospitals in their community.

The plan remains in place in Somerset, Bedford and Blair counties, while it has exited from areas such as Clearfield, Centre and Jefferson to the north, as well as counties further east such as Fulton and Juniata.

UPMC officials and Duvall both noted that “dual-eligible” UPMC for Life plans in Cambria and Clearfield counties remain in place for those on both Medicare and Medicaid. UPMC officials described them as UPMC “special needs” plans.

And UPMC continues to offer a long menu of other plans, including employer plans, HMOs and other offerings.

Duvall advised local residents not to panic – but also to start taking steps now to ensure they don’t have a lapse next year after coverage expires Dec. 31.

Available appointment dates were already filling up toward the end of the year at Duvall’s office, she said. And given the large number of people facing the need to select a brand-new health plan locally, that could be the case for other brokers as well.

Making an informed decision takes time and research for both plan-holders and the agents, Duvall said. Her office provides forms to visitors that must be filled out, identifying their doctors, specialists and other caregivers – to enable agents to begin looking for options that would fit clients’ needs prior to scheduled visits – so “people shouldn’t wait” if they are planning to seek a broker’s help.

For some people who want to pick their next health insurance provider from home, The Health Insurance Place also has a dedicated call center set up to handle Cambria County cases.

Because Cambria County and Clearfield County residents were hit with a sudden “service area reduction,” they can extend their enrollment into a new plan to Dec. 31. But people should be taking steps to secure coverage now, Duvall said.

“People should be proactive,” she said.

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