As of June 30th, members of Highmark Medicare Advantage plans will no longer have in-network access to UPMC doctors and hospitals. This means that anyone concerned about losing access to their UPMC providers needs to look at their options during the 2019 Medicare Annual Enrollment Period. The AEP runs from Oct 15th – Dec 15th, 2018.
If you are currently in a Highmark Medicare Advantage plan, here are our recommendations based on specific scenarios:
I have no UPMC Doctors or Hospitals:
There is no reason to change from Highmark. We recommend that you stay in your current plan or look at one of the other Highmark Medicare Advantage . For instance, there is a Community Blue HMO plan that does not allow you to go out-of-network but is very inexpensive for the provided benefits.
I have both UPMC Providers and Allegheny Health Network (AHN) Providers:
There will be several Medicare Advantage Plans that provide in-network access to both networks . The one we like best is the AARP sponsored one through United Healthcare. Contact us for information on their three Medicare Advantage plans.
I see only UPMC Doctors:
Although Highmark greatly improved their out of network benefits for 2019, in most cases it is still impractical to continue with them for 2019. You should consider the AARP sponsored plans through United Healthcare (mentioned above) as well as UPMC’s HMO and PPO plans.
I am tired of worrying about who is in what Network:
If you are willing to pay a higher monthly premium, and if you can qualify health wise, there are many advantages to Medigap Policies:
• All providers that accept Medicare accept Medigap.
• Much lower potential out of pocket exposure on claims.
• No insurance company “managing” your care.
You would need to complete a medical questionnaire if you are moving from a Medicare Advantage plan to a Medigap plan. Your premiums could be higher, or your may not be accepted based on your health status.
We have lots to talk about! Whatever you do, do not lose sleep over any of this as there are lots of good solutions.