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Markowitz: Health care runaround has grown old

It’s April in November! Dining room tables are laden with papers demanding attention. There are forms to fill out and a filing deadline.

But wait! It’s not income tax time.

It’s time for seniors citizens to make decisions about their Medicare plans for 2015. November never used to treat seniors like that. Medicare enrollment seemed automatic in the past.

“Are we going to have to do this over again next year?” someone asked at a UPMC seminar the other day.

UPMC and archrival Highmark Inc. have been holding hourlong seminars across the region to round up customers for their insurance plans. Or at least to explain them so people, typically retired, can make their picks.

The selection must be made by Dec. 7 (but earlier is better).

Then, as of Jan. 1, the customer’s way of financing his or her health care will be all set for 2015. There’s a six-week “disenrollment” period for mind-changers. But after Feb. 14, you’re locked in until Oct. 14, 2015.

And then does it begin all over again?

No way of knowing, apparently. The insurers aren’t supposed to predict past 2015.

“Did Obamacare cause all this?” someone suspicious asked in one audience.

The answer seemed simpler: Medicare’s day-to-day management has gotten routed through private insurance firms.

So what plan is purchased ought to vary with individual health needs and the medicines people take.

And the pricing? It looks fairly close among competitors. But comparing apples to apples and oranges to oranges among the many services offered isn’t easy.

One “UPMC for Life” plan called “HMO Deductible with Rx,” for example, lists a premium of $18 a month, a $750 annual deductible, and $3,400 maximum out-of-pocket costs per customer in any one year.

Highmark’s offerings include a new Community Blue product: zero premium, no deductible and $6,700 a year out-of-pocket maximum.

But is that a fair comparison? So many variables come into these choices. Will a hospital charge “per day” or “per stay?” What about outpatient? And diagnostic tests? Getting sick far from home? Copays, prescription choices, specialist referrals — all of these come to bear.

Dozens of insurers are offering plans in Western Pennsylvania. A fierce battle rages between local giants UPMC and Highmark.

UPMC, a University of Pittsburgh outgrowth, owns so many major hospitals now (Children’s, Shadyside, Presbyterian and more) that a near-monopoly looms. Highmark, bearer of the Blue Cross badge, has formed its own hospital chain based on the venerable West Penn and Allegheny General brands. The rivals have been hammering each other daily in media ads, all aimed ironically at customers in the November of life.

But do seniors need this aggravation just halfway around the calendar from the income tax?

Jack Markowitz is a columnist forTrib Total Media. Email him at [email protected].


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