Highmark Health on Monday reported a surge in sign-ups for a Medicare Advantage plan that excludes UPMC hospitals, saying the increase boosted total enrollment among Western Pennsylvania seniors from last year.
About 15,000 people were enrolled in Highmark's Community Blue plan as of Jan. 1, up from 9,000 at the end of 2015, said Tim Lightner, Highmark's vice president of product and marketing for senior products.
“The real growth engine here in Western Pennsylvania has been Community Blue,” Lightner told reporters. “We expect to see that into the future.”
UPMC spokesman Paul Wood wrote in an email that the Community Blue enrollment of 15,000 members was about 3 percent of the Medicare Advantage market in Western Pennsylvania, with the rest retaining access to UPMC.
About 183,000 people were enrolled in Highmark's Medicare Advantage plans on Jan. 1, up from about 178,000 at the end of 2015. In February of last year, Highmark reported having about 182,000 Medicare Advantage members for 2015. It had about 203,000 members in 2014.
The enrollment total for Community Blue, whose network covers Highmark-owned Allegheny Health Network and some community hospitals, includes sign-ups from Medicare Advantage's open enrollment period, which ran from Oct. 15 to Dec. 7.
Ambridge-based insurance broker Robert Nelson said many seniors told him during the open enrollment period that they were frustrated with UPMC, partly because of legal battles.
That frustration led some seniors to switch to Highmark, he said, while some kept other plans because they wanted or believed they need access to UPMC specialists and doctors.
The enrollment period was shadowed with uncertainty as seniors awaited a Pennsylvania Supreme Court ruling on a Highmark-UPMC contract dispute that did not occur until Nov. 30, a week before the enrollment period's end.
A Medicare Advantage contract that gave seniors with Highmark insurance access to UPMC doctors was set to expire at the end of 2015, but a state-brokered consent decree had been drafted to protect “vulnerable” populations, such as seniors and disabled individuals, from losing access to UPMC doctors.
UPMC argued that the vulnerable population language excluded seniors with Medicare Advantage plans. The court ruled that the decree did apply to seniors with the plans, which allowed them to keep access to UPMC doctors until 2019.
Younger, healthier seniors most commonly chose Community Blue, which advertised a $0 monthly premium, Nelson said.
UPMC offers a $0 premium plan, but it does not include prescription drug coverage, he said.
According to Highmark's analysis, the 183,000 members for 2016 give it a 40 percent share of Western Pennsylvania's Medicare Advantage market. UPMC Health Plan has 33 percent of the market, according to Highmark's analysis, with other insurers — including UnitedHealthcare and Aetna — retaining the rest.
All plan changes made during the open enrollment period took effect Jan. 1.
UPMC Health Plan last week reported an 8.2 percent gain in Medicare Advantage enrollment: from about 142,000 patients in February 2015 to about 154,000 patients in February 2016.
Wes Venteicher is a Tribune-Review staff writer. Reach him at 412-380-5676 or wventeicher@tribweb.com.
