UPMC claims to have surpassed Highmark in the Medicare Advantage insurance market, and Aetna wins

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About an hour ago

UPMC bragged on Tuesday that the health insurance branch had overshadowed the Pittsburgh-based Highmark rival by attracting Medicare Advantage insurers and now dominating the market in western Pennsylvania.

"Our growth has been spectacular," said Diane Holder, President of the Insurance Services Division of UPMC. "We are now the largest provider of Medicare Advantage in western Pennsylvania."

UPMC claims to have conquered 37% of the market and has about 50,000 older people and people with disabilities more than Highmark in the Medicare Advantage plans, the private sector alternatives to traditional Medicare and Medigap blankets.

Last fall alone, UPMC announced its second best year in terms of Medicare Advantage sales, an additional 8,000 members for 2019 compared to the previous year, according to figures provided by UPMC in its updates. financial year-end.

Highmark lost a total of 21,000 members in the same registration period, according to UPMC figures.

These numbers could still change. People enrolled in a 2019 Medicare Advantage plan have the option of switching to another AM plan until March 31st.

The summer split leads to significant changes

UPMC executives have stated that a major reason frantic plan change from last fall – Including an increase in people who fear Highmark and the choice of national alternatives like Aetna – was the concern of doctors that they could consult once UPMC and Highmark networks had separated this summer.

Highmark spokesman Aaron Billger said he would make no comment or "speculate on the data points presented by the UPMC".

He added that Highmark planned to publish in mid-March its financial information at the end of the year and the updated figures concerning the number of insured.

Aetna had the highest earnings during the AM registration period ending Dec. 7, adding a net total of nearly 20,000 Medicare Advantage members, according to UPMC figures.

Insurance brokers told the Tribune-Review Aetna and other national programs attract many clients because they will remain in the network of UPMC facilities, unlike Highmark patients.

A 2014 consent decree between the two nonprofit health giants in the health sector is expected to expire on June 30.

A new rule announced by the UPMC in October has complicated things for thousands of confused seniors. As of July 1, off-network patients, such as those provided by Highmark, must pre-pay in full and will be billed directly for all non-emergency services in most UPMC institutions. (Exceptions, at least until 2020, include hospitals in rural or underserved areas and places such as Western Psych and Children's Hospital in Pittsburgh.)

"The important thing was what doctors and hospitals expected from your network. People knew that the consent decree ended in June, "said Holder. "So, that certainly moves some market shares. And the lion's share of this market share went to the national (insurers) this year, but we still recorded one of our highest registration years. "

Market dominance in 5 years

Five years ago, Highmark held 46.5% of the Medicare Advantage market, compared with 27.6% for UPMC, according to UPMC figures.

But between 2014 and this fall, UPMC won 63,400 Medicare Advantage members. This represents a total membership of 187,000 members and an increase of 51%, according to data provided by the UPMC.

During the same period, Highmark recorded a net loss of 75,400 Medicare Advantage plans, for a total of 132,500 members currently, a 36% decrease, according to UPMC figures.

In 2019, the UPMC dominates the market with a market share of 37%, against 26,2% for Highmark, indicates the UPMC.

Highmark held more than 75% of the market in the early 2000s, before UPMC began offering Medicare Advantage plans in 2004.

The field has also become more crowded, with national insurers Aetna and United increasingly targeting the region as Medicare Advantage plans grow in popularity across the country. People enjoy MA plans for monthly premiums less than or equal to $ 0 compared to the traditional Medicare system, lower deductibles and benefits, such as transportation for medical appointments and access to SilverSneakers courses .

"What was true in Pittsburgh was a fairly consolidated insurance market. I think we now have a very competitive insurance market, I would say one of the most important, "Holder said. "Medicare Advantage has remained very healthy. … There were more packages on the Pittsburgh (market) this year than any other year in its history. "

Aetna now covers approximately 23% of the Medicare Advantage market with approximately 38,300 members, an increase of 45% over the past five years.

UnitedHealthcare acquired a market share of nearly 8% with nearly 28,000 members – an increase of 854% over 2014, while United had only 3,200 members.

Although UPMC officials see even more growth opportunities, Holder pointed out that 50% to 60% of eligible people in Western Pennsylvania were already choosing Medicare Advantage plans over traditional and complementary coverage. Medicare provided directly by the federal government. Nationally, almost 30% of eligible people enroll in health insurance plans.

"So we are among the highest in the country where people choose Medicare benefit plans," she said. "There has been healthy competition in the insurance industry, which has helped reduce the net profit of the consumer."

UPMC rejects AG Shapiro's intervention

Earlier this month, Pennsylvania's Attorney General, Josh Shapiro filed a petition amend the Highmark-UPMC Consent Decree to end the imminent dissolution and its impact on seniors and cancer patients. In particular, he demanded that UPMC waive its prepayment rule and agree to accept Highmark and any other non-network patient at affordable rates "in perpetuity".

He accused the UPMC of breaching his fiduciary duties and breaching the laws concerning charities, unfair trade and consumer protection.

Last week, UPMC fought back by asking the Commonwealth State Court to dismiss Shapiro's motion "in its entirety". On the same day, the UPMC sued the federal government alleging that Shapiro was overstepping his authority and threatening to "upset" the entire health care market – interested private parties. "

On Tuesday, UPMC Chief Financial Officer Robert DeMichiei said he would not discuss the outstanding legal issues, but asserted that Shapiro's efforts will have "no impact" on " the patient's experience ".

"We have filed our case and we will let the court system run its course," DeMichiei said.

Natasha Lindstrom is a writer for Tribune-Review. You can contact Natasha at 412-380-8514, nlindstrom@tribweb.com or via Twitter .