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Highmark lowers Medicare Advantage premiums for 2016 |
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Highmark lowers Medicare Advantage premiums for 2016

| Thursday, October 1, 2015 11:33 p.m
The Highmark sign sits atop Fifth Avenue Place in downtown Pittsburgh.

Highmark Inc. is lowering premiums for seven of nine Medicare Advantage plans the insurer is selling for 2016, part of an effort to keep and attract members as rival UPMC grows its insurance business.

The decreases follow a year in which the Blue Cross Blue Shield affiliate increased costs and shrank networks for the plans, which are private alternatives to traditional Medicare. Premiums will decrease by 3 percent to 35 percent for the seven plans, while networks will remain largely the same, said Tim Lightner, Highmark’s vice president of product and marketing for senior products.

Favorable reimbursement rates for Medicare Advantage plans from the Centers for Medicare and Medicaid Services, combined with quality bonus payments, helped the insurer decrease premiums for 2016, Lightner said. Highmark has about 182,000 Medicare Advantage members in Western Pennsylvania.

Highmark added benefits for its Community Blue plan, the only plan that does not include any UPMC hospitals or doctors, he noted.

The insurer added no-cost primary care visits and $0 generic drug co-pays to a Community Blue plan with a $0 premium. Highmark added an acupuncture benefit for the Community Blue plans, which Lightner said appeals to younger enrollees.

“We expect to see continued growth in the market gravitating to that plan,” he said.

Monthly premiums for the insurer’s 2016 Security Blue HMO plans range from $49 to $269.50 for Southwest Pennsylvania, and its Freedom Blue PPO plan premiums range from $79.50 to $299.50.

UPMC is increasing premiums for five of the six plans it is offering for 2016. The premium for its most popular plan, UPMC for Life HMO Deductible with Rx, is increasing from $18 to $22. Its UPMC for Life PPO Rx Enhanced plan will have a $152 monthly premium, up from $139. A $0 UPMC for Life plan again will be offered.

UPMC Health Plan has about 145,000 Medicare Advantage members in Western Pennsylvania, according to spokeswoman Gina Pferdehirt.

Medicare Advantage’s annual open enrollment period, during which seniors may switch plans, runs from Oct. 15 to Dec. 7.

A contract dispute between Highmark and UPMC threatens to disrupt plan selection depending on the outcome of an Oct. 6 state Supreme Court hearing. If the court sides with UPMC, overturning a lower court’s decision from May, UPMC hospitals and doctors no longer would be in-network for Highmark plans.

UnitedHealthcare, which is entering the Allegheny County Medicare Advantage market for all seniors for the first time in 2016, will offer HMO plans for $19 and $49 per month.

Aetna and Humana also offer Medicare Advantage plans.

Wes Venteicher is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or

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