Highmark Health holds on to top spot in Medicare Advantage market
February 22, 2016 10:11 PM
Highmark Health has about 245,000 members in the statewide Medicare managed care market.
By Kris B. Mamula / Pittsburgh Post-Gazette
Highmark Health is still clinging to its dominance of the region’s Medicare Advantage market, despite a bruising enrollment period marked by lawsuits that reached the state Supreme Court and amid questions about which hospitals and doctors seniors could use.
On Monday, Highmark reported it had about 245,000 members in its Medicare managed care plans with an effective date of Jan. 1, virtually flat from 244,000 members a year ago.
Enrollment in the plans edged up 3 percent in the 29 counties of Western Pennsylvania, from 178,000 to 183,000 members. Highmark remained the dominant provider of the coverage both locally and statewide, according to Tim Lightner, vice president, senior markets.
“The real growth engine in Western Pennsylvania has been Community Blue,” a Medicare managed care plan that was introduced last October, Mr. Lightner said. Community Blue enrollment increased to 15,000 from 9,000 members in the western part of the state where the coverage is sold.
Highmark rival UPMC Health Plan last week reported an 8.2 percent gain in Medicare Advantage members, up to 153,862 members in 2016 from 142,139 last year in the 29 counties of Western Pennsylvania.
Highmark’s numbers mean that it has about 40 percent of the Medicare Advantage market in Western Pennsylvania, UPMC has about 33 percent and the rest of the market is split between two other carriers, a Highmark spokesman said.
Last October, UPMC Health Plan President and CEO Diane Holder said the Medicare Advantage enrollment period would be the most competitive ever, words that proved prescient. In addition to Highmark and UPMC, UnitedHealthcare and Aetna sold the coverage in the Pittsburgh area as the acrimony between Highmark and UPMC escalated.
In the spring UPMC had said it would stop treating Highmark Medicare Advantage plan members on a lower cost, in-network basis, a decision that Highmark challenged in Commonwealth Court in May. Highmark won the case and UPMC appealed to the state Supreme Court.
The Supreme Court hearing came on Oct. 6, a week before open enrollment for Medicare Advantage plans nationwide began Oct. 15, but a ruling wasn’t issued until late November as questions persisted about the network that would be available to seniors with the Highmark coverage.
In the end, the Supreme Court ruled in favor of Highmark, opening UPMC’s hospitals and doctors to Highmark senior plan members. Gov. Tom Wolf praised it as a “victory for seniors across Pennsylvania.”
Pennsylvania has the country’s third-highest enrollment in Medicare Advantage plans, where the government pays insurers a flat monthly fee to provide health care coverage for seniors. Enrollment rates in Allegheny County exceed 50 percent, among the highest rates in the country, according to Medicare.
Nationwide, there are some 16 million people who receive Medicare benefits, with nearly 30 percent enrolled in Medicare Advantage plans.
Kris B. Mamula: firstname.lastname@example.org, 412-263-1699
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