Highmark Health holds onto top spot in Medicare Advantage market

Feb. 22--Highmark Health clung to its dominant position in the statewide Medicare managed care market with about 245,000 members, virtually flat from 244,000 members for plans that were effective Jan. 1, the Pittsburgh health insurer reported Monday.

In the 29 counties of Western Pennsylvania, Highmark increased enrollment in its Medicare Advantage plans to 183,000 from 178,000, or 3 percent, said Tim Lightner, the vice president of senior markets.

The biggest gains were in Highmark's Community Blue Medicare Advantage plans, which were rolled out in October 2015. Membership in the plans increased by 6,000 to about 15,000 members.

"The real growth engine in Western Pennsylvania has been Community Blue," Mr. Lightner said. Nationwide, Highmark serves about 500,000 seniors with Medicare Advantage, Medigap and pharmacy plans.

Highmark rival UPMC Health Plan last week reported an 8.2 percent gain in Medicare Advantage in Western Pennsylvania, to 153,862 members in 2016 from 142,139 last year.

Highmark's numbers mean that the insurer has 40 percent of the Medicare Advantage market in Western Pennsylvania, UPMC has 33 percent and the rest of the market is split between Aetna and UnitedHealthcare based on Medicare numbers, a Highmark spokesman said.

Highmark's membership gains came despite a lawsuit that challenged UPMC's decision to bar Highmark Medicare Advantage members from the UPMC network of hospitals and doctors. The state Supreme Court ruled in favor of Highmark, just days before the start of open enrollment in October.

Pennsylvania has the third highest enrollment in Medicare Advantage plans in the country. In such plans, the government pays insurers a flat monthly fee to provide health care coverage for seniors. Enrollment rates in Allegheny County exceed 50 percent, among the highest rates in the country, according to Medicare.

Nationwide, there are some 16 million members people who receive Medicare benefits, with nearly 30 percent enrolled in Medicare Advantage plans.

Kris B. Mamula:[email protected], 412-263-1699

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