Lower premiums, more benefits for seniors who buy Medicare Advantage 2022 plans

The ever-growing demand among seniors in western Pennsylvania for Medicare Advantage plans has spurred a host of new health coverage options offering lower costs and better benefits as insurers compete for increased market share.

“It’s a mature market in western Pennsylvania, and we’re able to take those dollars and invest them in a very smart way to keep these plans affordable,” said Ellen Galardy, senior vice president of markets. consumption for the health insurance division. from Highmark Health. It competes with the UPMC in boasting of being among the largest members of the Medicare Advantage plan in the region.

Among the expanded offers bundled in the dozens of details of the 2022 plan made public on Friday: quarterly allowances of $ 50 to $ 75 for personal care items ranging from toothbrushes to electronic scales; discount sleep apnea and home care devices; expansion of vision and dental benefits up to $ 6,000 per year; discounts for diabetes care and testing; and newly covered services such as palliative care, therapeutic massage and acupuncture.

Medicare Advantage plans are private alternatives to traditional Medicare and supplemental plans provided by the government. They have long been popular in the region among people 65 years of age or older or with a disability, and membership continues to grow.

In Allegheny and Westmoreland counties, 2022 insurance premiums for dozens of Medicare Advantage plan options range from $ 0 to $ 302 per month.

Many Medicare Advantage plans up for grabs retain previously popular benefits such as free Silvers Sneakers gym classes, telehealth appointments, transportation to doctor’s appointments, and post-hospital meal services.

The majority of plans appear to offer reduced premiums and co-payments as well as additional perks and perks, although buyers should be sure to consult with lawyers, brokers, or insurance company representatives to determine the best. plan for their specific needs.

“All of our plans include broad access to high quality doctors and hospitals across Pennsylvania, with many plans starting at $ 0 per month, and a new plan in 2022 that gives members the flexibility to customize their coverage. by choosing one of these additional plans. benefits: dental, vision or over-the-counter health care products, ”said Angela Perri, Medicare director for UPMC Health Plan.

Open enrollment runs from October 15 to December 7 for all Medicare-related coverages that begin January 1.

Seniors who choose a Medicare Advantage plan, as opposed to traditional Medicare and Supplemental Medigap plans, will have the option to switch to another Medicare Advantage plan between January 1 and March.

Growing interest in Medicare Advantage

Nationally, participation in Medicare Advantage plans rose from 32% five years ago to 42% in 2021, according to a report last March from research firm The Chartis Group. Meanwhile, traditional health insurance plans fell 2.6%.

In terms of people: About 950,000 fewer people enrolled in original Medicare plans and 2.25 million more enrolled in alternative Medicare Advantage.

United Healthcare and Centene have made some of the biggest gains nationwide, totaling 1.6 million members.

“Medicare Advantage has always been very popular in southwestern Pennsylvania, but it’s getting better and better,” said Bob O’Connor, vice president and director of Medicare for Aetna’s Keystone market, which has members in Pennsylvania as well as West Virginia and Delaware. “Even people who would traditionally have benefited from traditional Medicare or Medicare supplement plans take another look, because the benefits have really become very comprehensive. We have even added chiropractic care and acupuncture to some of our plans. We offer $ 0 plans in all counties across the state. ”

Aetna ranks # 3 in the western Pennsylvania region, including the city of Pittsburgh and surrounding suburbs, where UPMC and Highmark continue to reign as dominant insurers. Aetna now insures 346,000 seniors across Pennsylvania under Medicare Advantage plans, including more than 33,000 in western Pennsylvania, an increase of about 11% between 2020 and 2021.

Consumers are wary of copays, network access

All Medicare Advantage plans offer more services and benefits than those included in the original Medicare and, like Medicare, may not charge consumers more than 20% of most outpatient services. .

However, the scope of benefits, co-pay amounts, and access restrictions between Medicare Advantage plans vary widely.

“The copays are certainly different. You can see maybe $ 10 more to see a specialist or go to the hospital, but these are still very affordable co-payment plans, ”said Galardy. “They all have a lot of zeros – $ 0 to go see your PCP. $ 0 for level 1 drugs. $ 0 for many tests done in the doctor’s office, so things like lab work.

For those who want a lower premium coupled with guaranteed wider access, Highmark offers a new “Full PPO” plan with a monthly premium of $ 0.

“The word ‘comprehensive’ refers to the fact that it has solid coverage – think of all the typical medical benefits, plus things like over-the-counter medications, vision, comprehensive dental care. And a very comprehensive network, so not only all the doctors and hospitals of the AHN, but also the UPMC and the local community hospitals.

Its “sister plan,” Complete Blue Distinct, has been priced from $ 35 to $ 25 per month.

Consumers should also be aware that most major insurers offer plans that might restrict access to certain health care providers, such as the UPMC and Aetna plans linked to Excela Health providers that may not cover Allegheny Health Network providers. of Highmark, and Highmark offers narrow network plans that exclude most physicians from UPMC.

Medigap plans could be a good option for people who travel frequently and have high needs. The option, which is available for purchase directly from the government or from private insurers, comes with a higher monthly premium, but also strict caps on annual costs and “almost total flexibility.” , said Galardy. Under Medigap as well as the original Medicare coverage, no doctor who accepts a Medicare plan can refuse a patient.

Compare plans by zip code via Medicare’s Plan Finder available at Medicare.gov.

Natasha Lindstrom is a writer for Tribune-Review. You can contact Natasha at 412-380-8514, [email protected] or via Twitter .

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