A rare chance at a do-over

Medicare customers should consider it

Do-overs without penalty are a rare opportunity.

When it comes to selecting a health care plan, most people get a once-a-year crack at it.

But if you are a Medicare subscriber, you’ve got a chance at a onetime switch to another plan if you act before March 31.

This potential do-over is especially important to anyone in Western Pennsylvania where the two biggest health care and insurance providers will finalize their divorce on June 30 this year.

Though it’s been a long time coming, the post-divorce particulars of the region’s health care landscape still are taking shape. UPMC and Highmark and their provider properties (Allegheny Health Network under the Highmark banner) continue to wrangle. Patients with Highmark insurance using UPMC facilities will pay outof-network prices and may be forced to pay upfront for services. Highmark, afraid of customer defections to the competition, says it is offering enhanced out-of-network allowances for its customers that want to use a UPMC service or physician but how that exactly will work is unclear. The entire arrangement is under the scrutiny of the state attorney general’s office. Consumers are swimming in waters of turbulent uncertainty.

Customers of the UPMC and Highmark plans must be prudent. If you don’t want to change plans, the safest course is to stick with your designated system. If you have UPMC insurance, use only UPMC services and providers. If you have Highmark insurance, stay within the AHN system.

Or take a different path entirely: select a national insurance brand that is accepted by both health care systems and providers. There are plenty of them. Check with your doctors to ensure participation.

The Centers for Medicare and Medicaid Services is offering a threemonth extended Medicare Advantage open-enrollment period nationwide this year. It wasn’t this way last year when anyone unhappy with his “advantage” plan selection had only the option of switching to traditional Medicare coverage with a supplemental insurance plan.

This year, a do-over is being offered. Weigh it seriously.

If consumers choose to bypass Highmark and UPMC, perhaps these health care giants will be spurred by the bottom line — if not actual concern for their customers — to reach a sensible agreement that allows crossnetwork benefits. That’s what the patients want. That’s what the doctors want.

Until these purportedly missiondriven nonprofits actually begin putting the mission above their respective business plans, consumers must beware. And, at least this year, if you’re feeling buyer’s remorse, you have a chance to change course and perhaps even change the health care landscape of the region.