Stable pricing, but narrowing networks seen for Medicare Advantage

The image of a changing Medicare Advantage marketplace emerged Thursday during a lively Downtown session looking at insurers’ offerings for 2018.

Premium prices for most plans being offered in the Pittsburgh area next year are stable, or even lower, than this year’s rates, as panelists representing six insurers said they’ve taken notable steps to keep premiums affordable.

But to keep monthly premium costs down, insurers are narrowing their provider networks on the cheapest plans.

Medicare Advantage plans are Medicare-approved plans offered by private insurers.

UPMC Health Plan now offers a narrow network, zero premium plan similar to Highmark’s Community Blue product — a development that Paul Carbone, senior director of sales and marketing for UPMC Health Plan, said “is a response to the market” rather than a competitive counterpunch to its PIttsburgh-based rival.

National insurers such as Aetna/Coventry/HealthAmerica, UnitedHealth Group and Humana have their own lowcost, broader network plans, while Gateway Health targets its coverage to the elderly poor.

“You guys have kept the costs down for two years in a row,” congratulated moderator William McKendree, coordinator for Apprise, a program operated by the Family Services of Western Pennsylvania that helps seniors select Medicare plans.

Apprise and Allegheny Link sponsored Thursday’s event at the Allegheny County Human Services Building on Smithfield Street, with more than 100 providers, government entities, senior center and senior care facility staff attending.

While the emergence of more

narrow network plans makes Medicare Advantage an affordable option for lowincome households, the restrictions are hardening on which doctors those covered the plans can see and where they see them.

With Highmark and UPMC Health Plan offering low-cost plans that exclude the other’s health care providers, a marketing advantage has opened up for national insurers to heighten their presence in the market, offering plans with access to every major health system.

“We don’t own a hospital, so everyone wants our money,” said Christin Trembulak with Conventry Health Care. “We’re having a party and everyone’s invited.”

But physician Steven Lasky, who helps as a counselor for Apprise, said a client with Conventry’s zero premium Advantra Silver Plan who he helped still ran into problems.

While she was careful to choose an in-network hospital for a non-emergency surgical procedure, she learned later that both the anesthesiologist and pathologist did not accept Advantra insurance — resulting in a big medical bill.

She appealed, he said. “Unfortunately, it was not a happy result for her.” Steve Twedt: stwedt@postgazette.com or 412-263-1963.