Gateway Health cancels 2 plans for seniors

Oct. 11--Gateway Health Plan is canceling two plans the insurer sold to Medicare-eligible seniors with chronic health conditions in Pennsylvania, forcing about 5,000 people to find new health insurance for 2017.

Coverage ends Dec. 31 for Gateway's Medicare Assured Gold and Platinum plans, the insurer told policyholders in letters mailed last week. The plans featured lower costs for drugs and specialist visits for people with diabetes, chronic heart failure or a cardiovascular disorder.

Rising drug prices and other costs associated with the plans drove Gateway to cancel them, said spokeswoman Paula Yurkovich.

"It was becoming increasingly difficult to keep those costs down for the member," Yurkovich said.

No other Western Pennsylvania insurer sells Medicare Advantage plans designed for people with the same health conditions, said Brian Breisinger, president of Pittsburgh-based GS National Insurance. Affected policyholders will have to shop around for a general Medicare Advantage plan or enroll in traditional Medicare. They have until Dec. 31.

Breisinger said his firm has about 2,600 clients with the plans, many of whom have been placing angry calls to his office.

"It's disappointing that these folks are losing coverage and being forced to have to make a decision of moving to another plan," Breisinger said. "I want them to know though that there are other options available."

Gateway, which is 50 percent owned by insurer Highmark Inc., does not sell general Medicare Advantage plans in Western Pennsylvania, so many people with the plans may have to switch insurers. Highmark, Aetna, UPMC Health Plan and Humana have about 400,000 people enrolled in Medicare Advantage plans in the area, according to the companies.

Those who don't make a choice will automatically be enrolled in original Medicare and in a prescription drug plan, for which they would be charged monthly premiums, Yurkovich said.

Monthly premiums for Gateway's Gold plan ranged from about $32 to $67 in 2016, while premiums for the Platinum plans ranged from $62 to $97, according to plan details on Gateway's website.

Next year's premiums for Medicare Advantage plans the other insurers offer in Allegheny County range from $0 to nearly $300 depending on benefits. Prices are similar for neighboring counties.

People with chronic health conditions should pay close attention to how much their drugs will cost under any given plan's drug formulary and what specialist visits will cost, Breisinger said.

Some plans in the Pittsburgh area -- specifically UPMC For Life plans and Highmark Health's Community Blue plans -- have limited doctor networks that might exclude a person's doctors. Aetna, UnitedHealthcare and Humana generally have broader networks.

Gateway will continue to sell plans designed for people who are eligible for both Medicare and Medicaid, the state-federal health program for poor and disabled people, Yurkovich said. UPMC Health Plan and UnitedHealthcare also offer plans for that population.

The insurer canceled the lines of insurance across its markets in Pennsylvania, Ohio, North Carolina and Kentucky, but the bulk of the plans were sold in Pennsylvania starting in 2006, she said.

About 3,800 Pennsylvanians were enrolled in the Platinum plans and about 1,300 had the Gold plans as of September, according to the most recent Centers for Medicare and Medicaid enrollment data. That includes about 1,200 residents of Allegheny County and another 1,400 people in Washington, Westmoreland, Beaver and Butler counties.

Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or [email protected].

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