Askthe Medicare Specialist
QUESTION:
What do you anticipate for this year’s AEP and what do you think plans will look like in 2020? Will the new UPMC and Highmark agreement have any effect on what we can expect? Are there any major changes that we should be worried about?
ANSWER:
Let me begin by stating that the agreement between UPMC and Highmark should not have any effect as Advantage Plan companies had to have their benefits and premiums for 2020 submitted to the Centers for Medicare and Medicaid ( CMS) in the Spring, well before the deal was consummated.
Now, what I anticipate happening and how I’m going to advise my current and prospective clients during AEP, which runs from October 1st to December 7th, are two separate topics. I will address both as best I can without having seen specific plan details and pricing. Only Advantage Plans can have changes in benefits from year to year. Those can be in the form of increases or decreases in co- pays, deductibles, coinsurance, and/ or the annual Maximum Out of Pocket ( MOOP). Supplements are regulated, and with the exception of one seldom chosen plan, can’t have those types of changes year to year.
Let’s start with what I anticipate as far as Advantage Plan HMO’s and PPO’s are concerned. Again, I’m speculating here. I think this could be a very competitive market between the four major players in Southwest PA, which would be great news for consumers. I’m hoping in 2020 we see lower premiums, co- pays, and/ or MOOP, as well as better ancillary benefits such dental, vision, and the newly introduced Over the Counter ( OTC) allowance in several plans.
My reasoning is twofold. One, Highmark lost tens of thousands of members in 2019 due to what was then the impending “divorce” with UPMC, which would have resulted in the loss of access to UPMC doctors and hospitals for those on Highmark Advantage Plans. I have written on a number of occasions, that in recent years, I felt Highmark has relied on loyalty rather than making their plans competitive to keep their membership numbers up. If they want those folks who changed to another company to come back, it’s my opinion they must “sharpen their pencil” so to speak, get in line with rival companies, and reduce hospital co- pays and MOOP on their lower priced plans. Secondly, UPMC was likely expecting to be the biggest beneficiary of the exodus from Highmark plans. However, one company in particular who offers network access to both of our major health systems, had a very affordable plan with some of the lowest co- pays for hospitalizations and other services, as well as comprehensive dental and other generous ancillary benefits. A large number of people who would have otherwise chosen UPMC, opted for the plan I’m referring to. If UPMC felt pressure to increase their enrollment in 2020, they may also have determined that lowering premiums and co- pays, as well as supplying these value- added benefits such as comprehensive dental and the OTC allowance might be the best way to achieve their goals.
As far as if I foresee the possibility for major changes in 2020 on Advantage Plans that might be concerning? I don’t. If I’m wrong, believe me. I’ll discuss it here! There is one piece of upsetting news. We’ve been told since 2014 that the dreaded Prescription Drug “Doughnut Hole” was scheduled to end in 2020. However, it’s going away in name only. People will still have to pay a lot more for their brand name drugs after they have received $ 4,020 worth of medications. Those who do will have to spend more money out of pocket than they did in 2019 before moving out of the Doughnut Hole and into the Catastrophic Stage, when costs are dramatically less. I’m extremely troubled that seniors were led to believe the financial burden for those who take expensive drugs would be reduced, when in fact it’s increased. I will discuss this topic more in a future column.
Now, my advice for current and prospective clients who want Advantage Plans will be the same as always. Shop for the plans( s) that have the best combination of premiums, hospital co- pays, and MOOP and stay away from plans that have a higher MOOP, as well those with “per day” hospital co- pays that can result in a bill of over $ 1,000 or more for a 5- day or longer stay. If plans have similar value, then compare who has the best dental, vision, and OTC benefits, but don’t ever choose a plan based on those factors alone. And for 100th time. Don’t let the name of the company or how long you have been with them determine what plan you choose! It has no bearing on what we recommend to our clients every year. Nor should it for you. As always, myself and the other agents at The Health Insurance Store will be providing no cost consultations this AEP. We can review your current plan, compare benefits side by side, and help guide you to the plan or plans we feel are most worthy of your consideration.