Many Medicare offerings canceled; others tweaked

Medicare’s eight-week open-enrollment period begins today, allowing senior citizens to tweak their benefits plans for 2014 — and in Pittsburgh, there will be much tweaking, not all of it by choice.

“This is going to be one of our busiest enrollment years,” said William McKendree, lead counselor with the Allegheny County Apprise Program, a Medicare-funded program operated by Family Services of Western Pennsylvania in partnership with the Allegheny County Area Agency on Aging.

The program, which provides free health insurance counseling for Medicare recipients, reports that call volume to its hot line (412-661-1438) is up 300 percent compared to last year.

That’s because several popular Medicare products are being canceled in the local market. United Healthcare and Bravo Health (now operating under the Cigna flag) both canceled low-premium, low-deductible policies, as did Highmark Inc., which axed its “special needs plans,” for people eligible for both Medicare and Medicaid.

People who are currently beneficiaries in one of those plans have, by now, received letters notifying them that they’ll have to select a new plan for 2014. Those looking for similar special-needs plans can find them through Gateway, UPMC Health Plan and Advantra (owned by Coventry Health Care, which is now a part of Aetna).

While the plans may be similar in price, seniors should check to see whether their physicians are part of the new network and whether their prescription drugs are covered by the new insurer, Mr. McKendree said.

Local Medicare beneficiaries should also be aware that in several Highmark Advantage policies, the out-of-pocket maximums have been lifted from $3,400 to $6,700 next year, Mr. McKendree said.

Privately operated Medicare Advantage plans premiums are going up by about 5 percent, or $1.64, on average, according to the Centers for Medicare and Medicaid Services, the federal agency that runs Medicare. For prescription drug plans, a basic plan premium will be about $31, the same as 2013.

Avalere Health, a Washington, D.C., health industry consultancy, said many of the private insurers that sell Medicare Advantage plans are offering fewer plans and more narrow networks — meaning there could be fewer physicians and specialists to choose from.

“There’s definitely a trend toward more HMOs and fewer PPOs. That’s due to a number of the cost pressures that Medicare Advantage plans are facing,” said Matt Eyles, executive vice president at Avalere.

Seniors should also be aware of a shift toward more limited pharmacy networks.

Medicare Part A covers hospitalization and hospice care, and Part B covers doctors’ services and outpatient care; together these make up the “original” Medicare. Part C — also known as Medicare Advantage — offers plans from private insurers that cover Part A and Part B costs, as well as some prescription drug coverage, plus vision and dental coverage. Medicare Part D is the 7-year-old benefit that covers prescription drugs; it’s an optional plan and it carries its own monthly premium.

For most seniors, except for those who become Medicare-eligible in the coming calendar year, the open-enrollment period — Oct. 15 to Dec. 7 — is the main time that they can make changes to plans. The new plans will take effect Jan. 1.

For more information, call Medicare toll-free at 1-800-633-4227 or visit

Apprise is planning several Medicare-related informational meetings, including one today, from 1 p.m. to 5 p.m., at Orchard Hill Church in Franklin Park, and another from 1 p.m. to 5 p.m. Thursday at the Lemington Community Services center.


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