Pennsylvania holds special Medicare enrollment period because of LVHN and UHC contract dispute

In late October, LVHN, part of Jefferson Health, announced that due to continued decreases in reimbursements and stalled negotiations on a new contract with the health insurance giant, it would stop accepting UnitedHealthcare plans. No progress has been made between either party in securing a new deal, and in late January, 5,400 Medicare Advantage patients became out of network with LVHN doctors.

The Shapiro administration said it was able to secure this special open enrollment period, which lasts through April 30, by directly petitioning the federal government. UHC Medicare Advantage policyholders also will have more choices than usual during this period, including the option to move to a traditional Medicare product and buy a Medicare Supplement policy, without having to worry about being denied coverage for pre-existing conditions.

During this special enrollment period, older adults impacted by the contract dispute can get help through Pennsylvania Medicare Education and Decision Insight to find the insurance that will best fit their needs. The program is available through the Area Agencies on Aging; in Lehigh County, call 610-782-3034; in Northampton, call 610-829-4540.

The ongoing dispute between LVHN and UHC has lasted for several months and neither party has backed down.

Jefferson has cited financial difficulties, increased costs and decreased reimbursement rates as motivating factors behind its decision. The network also says UHC canceled scheduled meetings, ignored LVHN’s proposals and only offered one-sided solutions during negotiations.

UnitedHealthcare, one of the country’s largest insurers, has said that it’s Jefferson and LVHN that don’t want to play fair. LVHN’s hospitals are already among the most expensive in eastern Pennsylvania and the network is seeking a more than 20% increase in reimbursements, according to the insurance giant.

Even more will lose insurance coverage at LVHN hospitals if neither party comes to an agreement. As many as 50,000 patients with commercial plans would become out of network at LVHN starting April 26, the day after the contract between LVHN and UHC ends.

Patients seeking care from legacy Jefferson Health providers will not see a change in their benefits.

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