Insurers unveil Medicare Advantage offerings for 2017

Oct. 02--Insurers are largely holding the course with their Medicare Advantage offerings for 2017, as details on the plans have been released for seniors to review before the annual open enrollment period begins Oct. 15.

Highmark, with 182,877 Medicare Advantage members in Western Pennsylvania, will once again be offering nine Medicare Advantage plans for 2017, with minimal or no premium increases. All of the plans include dental, vision and hearing aid coverage with no annual deductible.

UPMC Health Plan, which has 121,000 members in the region, is staying with its offerings of four HMO and two PPO options, too, with a new feature: members in its HMO plans will have full in-network coverage while staying in Florida.

"We have a lot of members go down there for the winter," said John Lovelace, president of government programs for UPMC Health Plan. "It has been kind of a hold back for people."

The most notable change for Highmark is the roll out of a preferred pharmacy network for two plans, Community Blue Medicare HMO Signature and Security Blue HMO ValueRx. Those members will see lower or no cost for prescriptions filled at one of the network pharmacies.

For example, a member in those plans might pay nothing for some generic medications at a network pharmacy but, if they want to stay with a pharmacy not in that network, they might face a $5 co-payment.

"We are always looking at ways we can help the members from a choice and price perspective," said Lori Rund, vice president of senior markets at Highmark.

Major pharmacies in the preferred network include Walgreens, Rite Aid and Wal-Mart as well as Costco and Kmart, but not CVS.

Ms. Rund said their two Community Blue plans, which exclude UPMC physicians and hospitals, remain their most popular offerings.

The Signature Community Blue plan will again carry no premium and no co-payment for primary care physician visits. There is a $50 co-payment to see a specialist and a $300 daily co-payment for in-patient hospital stays. The Prestige Community Blue plan has a $199 monthly premium, up $6 from this year, with a $100 co-payment per hospital admission.

Ms. Lund said premiums and co-payments are "up slightly" for its four Security Blue HMO plans. The basic plan has a $60 premium but does not include prescription coverage. Premiums for the other three are $71 for the Value Rx plan which does include prescriptions; $207.50 for the Standard plan; and $274.50 for the Deluxe plan which offers more enhanced coverage.

Similarly, the three Freedom Blue PPO plans show minimal or no increases, with premiums for Value Rx going from $79.50 this year to $81 in 2017; the Select Plan premium going from $174.50 to $176; and the Classic plan premium goes down from $299 this year to $297 in 2017.

All Highmark plans have a yearly maximum out-of-pocket cost of $6,700.

UPMC Health Plan's four HMO and two PPO plans next year will provide full in-network access to UPMC facilities and physicians as well as most community hospitals, while expanding its service area into the Steubenville, Ohio, area.

UPMC for Life HMO Deductible with prescription plan, the insurer's most popular plan, will keep its $22 monthly premium and the premium for UPMC for Life HMO Rx will stay at $83. There will be a $13 a month increase to $255 for the UPMC for Life Rx Enhanced Plan.

UPMC for Life also offers a zero premium plan with no prescription drug coverage.

For its PPO products, UPMC for Life PPO Rx Enhanced plan will have a monthly premium of $137, a $15 decrease from this year, and UPMC for Life PPO High Deductible with Rx plan will carry a $37 premium, $7 less than this year.

Most plans include preventive dental coverage, with a $15 copayment for twice yearly exams and cleanings and a $15 copayment for one yearly bitewing x-ray.

Yearly out-of-pocket maximum costs for the UPMC HMO plans range from $3,400 to $4,000 and its PPO plans have a $6,700 maximum.

Two other insurers offer plans for those enrolling in Medicare Advantage, which is administered by private insurers under contract with Medicare.

According to its website, United Healthcare, with 8,500 members in Western Pennsylvania, is offering three HMO Medicare Advantage plans in our region, AARP Medicare Complete Plans 1, 2 and 3, with monthly premiums ranging from a low of $16 for Plan 1 to $86 for Plan 3.

Plan 1 has a $10 co-payment for an office visit with your primary care physician and a $40 co-payment to see a specialist while Plan 3 has no co-payment for the office visit and a $30 co-payment for a specialist. All three plans include prescription coverage.

Details for plans offered by Aetna and subsidiary Coventry/HealthAmerica, with a combined 83,500 Medicare Advantage members in Western Pennsylvania, were not immediately available.

Steve Twedt: [email protected] or 412-263-1963.

___

(c)2016 the Pittsburgh Post-Gazette

Visit the Pittsburgh Post-Gazette at www.post-gazette.com

Distributed by Tribune Content Agency, LLC.