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UnitedHealthcare will enter Western Pa.’s market for Medicare Advantage plans |

UnitedHealthcare will enter Western Pa.’s market for Medicare Advantage plans

| Tuesday, September 29, 2015 12:13 a.m

The nation’s largest health insurer will make Medicare Advantage plans widely available to Western Pennsylvania seniors for the first time this fall, adding an option for thousands of people caught in the middle of the bitter feud between UPMC and Highmark Inc.

UnitedHealthcare has two HMO-style plans listed on the Centers for Medicare and Medicaid Services, or CMS, website for 2016 — a development health insurance brokers said could benefit seniors by helping to control costs.

“More options, more benefits usually dictate competitive pricing among the plans,” said Brian Breisinger, president of Pittsburgh-based national insurance marketing firm Gateway Strategies.

United likely will include UPMC and Allegheny Health Network hospitals and doctors in its network, experts said. The plans will give another option to seniors trying to navigate a shifting market as Highmark, which owns the Allegheny Health Network hospital system, competes with UPMC Health Plan, which was founded by the area’s dominant hospital system. Medicare Advantage is a private alternative to traditional Medicare.

A United spokeswoman said the company could not discuss specifics of the 2016 plans before Oct. 1, the date Medicare allows insurers to begin marketing plans. But the insurer is expected to announce Tuesday that it is including UPMC hospitals and doctors in its 2015 network for a small group of senior citizens in nursing homes to whom United sells Medicare Advantage plans in Western Pennsylvania. The network for those seniors — about 100 people in Allegheny and Westmoreland counties — did not include UPMC, according to the spokeswoman.

“The addition of UPMC to our Medicare Advantage care provider network expands access to an important provider of health care services for our Medicare Advantage members,” said Steve King, CEO of UnitedHealthcare in Pennsylvania. “We look forward to collaborating with UPMC in the years ahead as we pursue our shared goal of enhancing the health and well-being of seniors and other beneficiaries.”

United joins national insurers Aetna and Humana in competing for a share of a market dominated by Highmark and UPMC. The feuding companies together had about 71 percent of the Pittsburgh-area market as of March, according to a Kaiser Family Foundation analysis of CMS enrollment files. The next-biggest player is Aetna, which in March had a 20 percent market share.

A dispute playing out in the state Supreme Court between the health care giants has the potential to force about 180,000 seniors enrolled in Highmark plans to change doctors or switch insurers. The court will hear arguments Oct. 6 in Pittsburgh on whether UPMC is obliged to continue providing health care at in-network rates to seniors with Highmark plans.

A lower court judge ordered UPMC in May to maintain in-network rates for seniors through 2019; the hospital system claims Highmark violated contract agreements, and that frees it from contractual obligation to provide care for Highmark’s Medicare Advantage members at in-network rates.

If the justices side with UPMC, seniors on Highmark plans could lose in-network access to their doctors. The court scheduled its hearing nine days before the start of Medicare Advantage’s annual open enrollment period, during which seniors can switch plans, raising the possibility of a quick court decision. Open enrollment runs from Oct. 15 to Dec. 7.

“It’s an unfortunate situation with the feuding between UPMC and Highmark,” Breisinger said. “But we also believe that this is creating a pivotal period in the health insurance marketplace in Pennsylvania.”

Monthly premiums for Medicare Advantage plans for 2016 in Allegheny County range from zero to about $300, according to CMS data. United’s plans, listed at $19 and $49, likely will offer similar benefits to higher-cost plans from other carriers as the insurer attempts to attract members, Breisinger said.

As of June, United had 34.8 million members across its insurance offerings, making it the nation’s largest insurer, according to health industry analysts Mark Farrah Associates. Anthem, part of the Blue Cross Blue Shield Association, was second-largest with 31.1 million members.

Robert Nelson, an Ambridge-based broker, said other insurers have tried and failed to enter the Western Pennsylvania market. He expects few Medicare Advantage members to switch plans for cheaper premiums.

“I think each company’s going to keep their same market share,” Nelson said.

Wes Venteicher is a Trib Total Media staff writer. Reach him at 412-380-5676 or

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