A Fortune 500 insurer intends to enter the Pittsburgh-area Medicare Advantage market next year, offering plans that provide patients with access to both UPMC and Allegheny Health Network health systems, as well as a plan for those dually eligible for Medicare and medical assistance.
PA Health & Wellness, a subsidiary of Centene Corp. of St. Louis, is expected to offer Allwell plans in 14 southwestern Pennsylvania counties, some as far north as Lawrence and Butler counties and as far east as Bedford and Blair counties.
Most notably, the plans provide access to the area’s two largest health systems — a point that becomes ever more important as the clock ticks down to the 2019 expiration of the UPMC-Highmark consent decrees that govern how the rival health giants work together.
After that — barring intervention by the state or some other development — seniors with Highmark insurance will lose in-network access to UPMC hospitals and physicians. Meanwhile, Highmark continues to market lower-cost plans that exclude UPMC enrollees from its Allegheny Health Network.
Anticipating upheaval in the local market, brokers say Centene’s arrival may be just the start.
“I do believe that you’re starting to see the beginning stages of additional carriers entering the market and contracting with both Allegheny and UPMC,” said Brian Breisinger, president of MediConnect Insurance in Kennedy Township.
“I think it’s going to be a major change in the marketplace.”
Currently, Highmark and UPMC Health Plan dominate the local Medicare Advantage and Dual Eligible Special Need Plans, or D-SNP market.
A handful of other insurers including Aetna, United HealthCare and Coventry/HealthAmerica — which also provide access to both UPMC and Allegheny Health Network systems — hold smaller shares of the market.
Pennsylvania has just over 1 million beneficiaries enrolled in Medicare Advantage plans, which are Medicare-approved plans offered by private insurers. D-SNP plans provide additional benefits for those who are eligible for both Medicare and, based on their financial situation, medical assistance.
The final break in the Highmark-UPMC relationship two years from now may shake up that dynamic during the annual fall open enrollment period.
“That annual enrollment period [leading up to 2019] will be very different than other ones,” said Shari Herrle, director of compliance at Henderson Brothers Inc. brokers, Downtown. “You may have people willing to look at other options.”
Both she and Mr. Breisinger see the additional competition as a boon for consumers.
“Another quality player in any market is a positive thing. It gives people a choice,” said Mrs. Herrle.
“And, like any other insurance product that’s sold — whether it’s Medicare, or individual insurance, or group insurance — I think consumers automatically look for the same things: What is the network? What are the types of benefits offered? Who are the doctors?”
She recommends beneficiaries use the MyMedicare.gov website to help them compare plans.
Steve Twedt: firstname.lastname@example.org or 412-263-1963.
Correction, posted July 27, 2017: The name of the insurer offering the new plans has been corrected.