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News From The Health Insurance Store

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Can a person go from a Medicare Advantage Plan to Original Medicare and a Supplement at any time during the Year? I realize medical underwriting would be a factor.

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Answer: Most people cannot switch from their Medicare Advantage Plan HMO or PPO at any time other than the Annual Election Period (AEP) which runs October 15th through December 7th, or the Open Enrollment Period (OEP) which ran January 1st through March 31st in 2019. Be advised it isn’t clear if this election period will be available in 2020 and we’ll discuss that further in today’s column.

Let’s discuss what you can do during AEP and OEP before we get into who can receive an exception to change plans anytime during the year.

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There’s no question today because I want to discuss the wonderful news that a 10-year agreement was signed by UPMC and Highmark that will grant the vast majority of those on Highmark health and Medicare plans in-network access to UPMC doctors and hospitals.

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I was extremely surprised by this announcement. In fact, in my column that ran last Monday, the same day Attorney General Shapiro and Governor Wolfe announced the new agreement, I predicted Highmark Medicare Advantage Plan members would not be able to access UPMC facilities at an affordable rate, if at all, in 2020.

I’m not sure I’ve ever been more pleased about being wrong! 

I realize the fight between Western PA’s two biggest health care and health insurance providers was very stressful. But in the end, I believe it’s going to turn out to be beneficial for tens of thousands of seniors because it forced those who were on overpriced plans to shop and change companies to one that allowed access to UPMC. In every single case we had, the result for our client was a combination of lower premiums and very similar or better overall benefits.

 

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How do I find out what Medicare covers? What about Supplements and Advantage Plans? Is there anything one covers the other doesn’t?

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I’ll make the answer to the first question very simple. There isn’t much Medicare doesn’t cover. I can count on one hand the number of treatments or services that we’ve discovered a client wasn’t covered for, and we’re talking about thousands of people over a span of more than 11 years. 

There’s only one somewhat common item or service that I’ve found isn’t paid for surprisingly; compression stockings.

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I’m hoping to retire when I turn 62 and can collect Social Security. What are my options for health insurance until I can get Medicare at age 65?

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There are five options, only three of which I’d be comfortable choosing for myself and my daughter. 

The best-case scenario, but probably the least likely, is getting offered an early retirement buyout from the company you are currently employed with, which would include no cost health insurance.

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Will people who have original Medicare plus a Highmark Supplement be able to use UPMC doctors and hospitals after July 1st?

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While I was writing this column, news broke that the PA Supreme Court agreed to rule on the Attorney General’s appeal to force UPMC to extend the “Consent Decree” and remain an in-network provider for seniors with Highmark Medicare Advantage Plan HMO and PPO’s.

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Erie County Area

1105 West 12th Street, Suite – A
Erie, PA 16501
Phone: 814-920-5275
Fax: 814-920-5276

Fayette/Westmoreland County Area

121 North Pittsburgh Street
Connellsville, PA. 15425
Phone: 724-603-3403
Fax: 724-603-3402

Pittsburgh Area

21 Yost Blvd., Forest Hills, PA 15221
Mailing Address: 128 Forest Hills Plaza, Pittsburgh, PA 15221
Phone: 412-349-8818
Fax: 878-302-3149

Albuquerque/Santa Fe, New Mexico Area

821 Coors Blvd. NW
Albuquerque, NM 87121
Phone: 505-200-0069
Fax: 505-200-0073

Serving These Areas

We proudly serve the health insurance and Medicare needs of the following Pennsylvania areas:  Connellsville, Uniontown, Greensburg, Mt. Pleasant, Scottdale, Irwin, N. Huntingdon, Murrysville, Monroeville, Plum, Lower Burrell, New Kensington, Pittsburgh, Plum, Oakmont, Penn Hills, Forest Hills, Wilkinsburg, East Liberty, Lawrenceville, Bloomfield, Natrona Heights, Leechburg, Washington, Morgantown WV, Latrobe, Monnessen, Jeanette, Erie, Edinboro, Northeast, Girard, Fairview, Union City, Harborcreek, Corey, Meadville, Waterford,  Ligonier, Kittaning, Somerset, Waynesburg, Fayette County, Westmoreland County, Armstrong County, Butler County, Somerset County, Erie County, Crawford County, Venango County, Allegheny Valley, Pennsylvania

We proudly serve the following New Mexico areas: Albuquerque, Rio Rancho, Sante Fe, Bernalillo, Belen, Los Lunas, Espanola, Moriarty, Corales, Tijeras, Cedar Crest, Edgewood, Soccoro, Sandoval County, Sante Fe County, Bernalillo County, Rio Arriba County, Valencia County, Soccoro County, New Mexico