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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?


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.

Regardless of the ruling, those who have Highmark’s Supplement product, Medigap Blue, can indeed utilize UPMC as well as any other doctor or hospital in the country that accepts Medicare. This freedom of choice is one of the benefits of a Federally regulated Medicare Supplement, aka Medigap policy. You never need to ask a provider if they will accept Highmark or any other company you may have a Supplement with. All you need to do is ask if they accept Medicare. If they do, your Supplement is also accepted.

You see, the name of the company that sold the Supplement doesn’t matter. Doctors and hospitals don’t bill Supplement companies. They bill Medicare who covers their portion and then coordinates with the Supplement company to get the balance paid in full.

Medigap policies are highly Federally regulated and can only be sold labeled with letters A through N. There are 11 policies one can buy, soon to be 9 as Plans C and F will no longer be available for purchase after 2019. With this in mind, let’s discuss how to be a smart consumer when it comes to choosing a Supplement plan and company.

Since all Medigap policies cover identical services and provide the same nationwide access to doctors and hospitals, the only difference between companies selling the same letter plan is price. The other agents and I at The Health Insurance Store advise choosing either G or N because C and F are far too expensive for the negligible extra coverage they provide. We have only two concerns when selling Plans G or N. 1) We want to use companies who have the lowest starting price, and 2) also have a history of keeping rates low over time.

Medigap companies can and do raise rates, with several having a track record of increasing them more often. We avoid those as well as others that charge more at policy inception. Highmark Medigap Blue, for instance, is much more costly than the companies we currently advise our clients to consider. For example, Plan N for a 68-year-old female with the lowest cost Supplement company in Allegheny County, Aetna, is $98/month. Highmark Medigap Blue Plan N costs $157 for that 68-year-old, over $700 more per year for the same exact coverage! AARP, probably the most commonly held Supplement, charges a 68-year-old female $137 for Plan N.

If you can pass medical underwriting, you almost certainly can save a significant amount of money by changing to one of the two companies The Health Insurance Store writes the vast majority of our Supplement business with. And unlike Advantage Plan HMO’s or PPO’s, those who have Supplements can transition to another plan or company year-round, not just during the Annual Election Period or Open Enrollment Period.

Please keep in mind if you have a Highmark Medicare product other than Medigap Blue, you more than likely don’t have a Supplement at all. In other words, your Medicare plan doesn’t pay in addition to Medicare, it pays in place of Medicare. And as it stands today, you also won’t have affordable access to UPMC come July 1st.

Many others have a Blue Cross Blue Sheild product that isn’t Highmark. There are thousands of Pittsburgh area residents in this situation, most of whom retired from the Federal government. These folks have plans that are secondary to Medicare but aren’t Federally regulated like Medigap policies. There are two Blue Cross Blue Shield options for Federal retirees and only the higher priced plan allows them access to UPMC doctors and hospitals after June 30th.

There are other people who have retired from a company based out of state and are offered another Blue Cross Plan like Anthem, Blue Cross Blue Sheild of Michigan, etc. If they are HMO’s or PPO’s it’s likely those won’t be in network with UPMC on July 1st.

This has created a tough decision for people who receive medical benefits as a reward for staying loyal to a company. Do I stay with my retirement plan that costs little or nothing and change doctors? Do I spend $1,000 or more per year for a Supplement that eliminates almost all medical bills and allows me to go to any doctor in the country?  Or do I go with a low-cost HMO Advantage Plan that allows me to keep my current doctors and hospitals but may expose me to as much as $6,700 in medical bills every year?

I believe the reality that the UPMC/Highmark split becomes official in just two months hasn’t hit home yet for many in our area. I know there are people who still don’t realize access to UPMC is scheduled to end on July 1st.  Others have been led to believe they can still maintain unfettered access to UPMC. Both groups are going to be in for a very unpleasant surprise unless the Supreme Court rules in favor of the Attorney General, an outcome that’s 50/50 at best in my opinion.

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Laurel Highlands


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