Medicare Advantage rates shuffle but remain stable for 2017 in Pittsburgh region

Sept. 23--Medicare Advantage premiums will remain stable for 2017 in the counties surrounding Pittsburgh, with monthly costs of most plans rising or falling by less than $10, according to rates published Thursday by the Centers for Medicare & Medicaid Services.

Plan benefits, such as co-payments and deductibles, are becoming a little less favorable in some cases but also are changing little, said Brian Breisinger, president of Pittsburgh-based GS National Insurance. The biggest changes will be to networks -- which doctors and hospitals are included in plans -- Breisinger said.

"Benefits are going to be marginalized a little bit. Once again, there will be increased options as far as some of these outlying counties (are concerned)," Breisinger said.

The local trend is in line with what's happening nationally, where premiums for Medicare Advantage plans are decreasing by an average of 4 percent, according to a CMS news release. The plans, a private alternative to traditional Medicare, have attracted a growing number of enrollees each year for the past seven years, according to the release.

CMS published the rates in advance of Medicare Advantage's open enrollment period, which runs from Oct. 15 to Dec. 7.

Insurers Highmark Inc. and UPMC Health Plan dominate the Medicare Advantage market in Western Pennsylvania, but UnitedHealthcare, Humana, Aetna and its subsidiary, Coventry, are competing for customers.

The insurers declined to comment on plans before Oct. 1, the date CMS allows them to begin marketing next year's plans.

Costs are dropping across the board for Aetna, UnitedHealthcare and Humana, according to the prices posted by CMS, while Highmark and UPMC each have increases and decreases across their larger plan offerings.

UnitedHealthcare, which entered the market with two plans in 2016, is adding a third plan in 2017 with richer benefits and a higher price tag.

Insurance brokers wouldn't discuss specifics either, but Breisinger said people should expect to see a shift toward plans with fewer hospitals and doctors in-network, a trend occurring in the Affordable Care Act marketplace.

Ambridge-based insurance broker Robert Nelson said he didn't expect the premium changes for 2017 to cause major market shifts.

"It's such a mild increase, you're not going to see a lot of seniors moving from plan to plan," Nelson said.

As open enrollment approaches, Nelson said seniors have been calling him with concerns about their Highmark plans. They fear that the insurer's losses in the Affordable Care Act market will affect their Medicare Advantage rates, which is not true, he said.

At this time last year, a looming state Supreme Court decision added uncertainty to the open enrollment period. The court had heard arguments from UPMC that Highmark policyholders should not retain in-network access to UPMC hospitals because of a contract dispute between the two nonprofits. The court sided with Highmark, giving its policyholders in-network access to UPMC hospitals until 2019.

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

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