Archive for the ‘UPMC’ Category

Pennsylvania Health Insurers Offer Low Cost Non-Compliant Plans Through 2017

Sunday, April 27th, 2014

Pennsylvania is one of nine states that is giving health insurance customers a break before forcing them to adhere to Affordable Care Act guidelines.  According to the Pittsburgh Business Times’ Kris B. Mamula, Highmark health insurance is the latest company offering renewals that don’t meet all of the new insurance mandates.  In “Highmark prepares new renewal plan health insurance,” we learn that Highmark is following in the footsteps of UPMC Health Plan with their new renewal options.  UPMC was the first company in western Pennsylvania to offer these non-compliant health insurance plan renewals that are lower cost.  They started offering these plans four months ago.  Highmark Inc. will be offering new renewal plans to employers who provide health insurance coverage.  The options will be available during both the July and December enrollment periods.

Plans were introduced during an insurance broker meeting last week.  Although minor details were not yet given to the public, Highmark is calling the plans “grandmothered plans”.  These lower cost plan options do not meet the requirements of the Affordable Care Act.  Insurance companies in Pennsylvania and eight other states have a three-year window where they can continue to offer their existing health insurance plans without penalty.  They will have to meet the Affordable Care Act guidelines in 2017, but the added three years gives employers some time to plan out their course of action.  More details are expected to be released by Highmark soon.

When UPMC started offering their lower cost plans, premium increases were between 0 and 48%.  Plans that incorporate the mandated coverage from the ACA had premium increases 100% and greater.  Insurance brokers who were at the recent meeting said that Highmark will be offering more flexibility with their non-compliant health insurance renewal plans.  Highmark is also likely to see a large increase in sales of their Community Blue plans, which limit the network of providers available.  It’s good news to employers and others who will benefit from the three year reprieve given in Pennsylvania and eight other states.  But eventually they will all have to meet the new guidelines put into place by the Affordable Care Act.  They will save money and have added time to determine their best plan options starting in 2017.  But in other states, health insurance companies will already be settled into their new health plans and insurers in these nine states will have to play catch up.

Highmark Hopes to Rival UPMC’s Health System

Wednesday, November 14th, 2012

Highmark, Pennsylvania’s largest health insurance company, is hoping to rival the hospital system of UPMC some day.  They have been looking to merge with West Penn Allegheny since earlier this year, but the deal soured recently.  According to Alex Nixon of The Pittsburgh-Tribune Review, leaders of both companies have been ordered by a judge to keep working on the deal, at least until the contract expires next May.  In “Highmark, West Penn Allegheny Meet to Resurrect Merger,” Nixon says that the companies put out a joint statement saying that they will work once again on the $475 million deal.

There are multiple issues that the company leaders are working through, most which pertain to the finances of West Penn.  West Penn is the second largest hospital system in the region, but is losing money and operating with a critical financial crisis.  Their pensions are underfunded by $280 million, so Highmark suggested that the federal Pension Benefit Guaranty Corp. take them over.  Bondholders are owed $750 million and Highmark is requesting that number be reduced to $400 million before the companies join forces.  William Penn’s operations lost $112.5 million during the fiscal year ending this June 30.

Highmark made these financial requests during an injunction hearing.  A judge allowed Highmark an injunction preventing West Penn from talking with other interested parties until May.  West Penn said that they had the right to talk with others because Highmark wanted them to go through bankruptcy because of the bond and pension debt.  They believed that Highmark had broken their contract with that request.  But now the two sides will be working together again and trying to secure a formal deal for West Penn’s five hospital health care system.  Acquiring the system is part of a $1 billion plan Highmark has to compete with UPMC.


Health Insurance Rates Only Part of Customer Satisfaction

Friday, April 29th, 2011

map PAPennsylvania health plans ranked higher in customer satisfaction than the national average in J.D. Power & Associates’ U.S. Member Health Insurance Plan Study.  According to “UPMC, Geisinger, Highmark lead Pa. customer satisfaction rankings” by Bob Graham of Insurance & Financial Advisor, UPMC Health Plan ranked the highest in Pennsylvania.  While health insurance rates are important to consumers, this study also looked at the coverage and benefits, customer service, communications, information, provider choice, claims processing, statements given, and the approval process.  UPMC scored 744 out of 1,000, well above the national average of 696 and significantly higher than Pennsylvania’s average of 714.

Geisinger Health Plan and Highmark BlueCross BlueShield followed UPMC in Pennsylvania’s rankings with scores of 737 and 735, respectively.  Capital Blue Cross and Independence BlueCross also scored higher than the state’s average.  Although Pennsylvania’s scores went down slightly in 2011, compared to 2010, four of the seventeen other regions surveyed saw much more significant declines.  Some of the insurance companies that scored lower than average in Pennsylvania were Highmark Blue Shield, CIGNA, HealthAmerica/HealthAssurance, Blue Cross of Northeastern Pennsylvania, Aetna, and UnitedHealthcare.  Of the 34,000 insurance plan members surveyed, 2,684 were in Pennsylvania.

Use Health Exchanges to Get Fallon Health Insurance

Sunday, December 12th, 2010

Starting in 2014, Americans will be using health exchanges to shop for their health insurance.  The exchanges were put into place by the Affordable Care Act of 2010 and are supposed to be one-stop shops for Americans to get affordable insurance coverage from companies like Fallon Health Insurance.  The goal is for the exchanges to allow individuals and small businesses looking for health insurance to join forces and be able to purchase health insurance coverage together.  With larger purchasing power, they should be able to get affordable care at the kind of discounted prices that large businesses can.  Tax subsidies and cost-sharing discounts will also be given to individuals below a minimum income level to help with financial assistance.

According to Insurance Journal’s “Midwest States Getting $1M Each for Health Exchanges,” $49 million will be given out by the U.S. Department of Health and Human Services to help establish the health exchanges in individual states.  Illinois, Nebraska, North Dakota, and South Dakota will each receive $1 million to get their health insurance exchanges up and running.  All states were given the option to run their own insurance exchanges with companies like UPMC.  States that choose not to run their own exchanges will have one created and run by the federal government.  Those states receiving a portion of the $49 million will use that money to start their exchanges and determine how they will actually operate.

Democrats vs. Republicans: What Changes Will UPMC Health Insurance & Others Have to Make?

Sunday, November 28th, 2010

In light of this month’s elections that increased the Republican strength in the Senate and saw them take over the House, there may be some tweaking of the health care bill.  In “Sen. Reid says willing to tweak healthcare law” from numerous  contributors on Reuters, U.S. Senate Majority Leader Harry Reid stresses that the tweaking will not ‘denigrate’ the health care law and that he intends to extend tax cuts to the middle class that were put in place by President George W. Bush.  He will not push to extend the tax cuts to the wealthy, however.  Due to strong opposition from Republicans, Reid and other Democrats will compare health insurance changes enacted by the reform and update the bill with Democrats and Republicans working together.

Reid stressed that they do not plan to undo the changes made that will help protect Americans from the insurance industry that he and others believe was bankrupting them.  While Republicans in the House want the entire bill to be repealed, Reid hopes that they instead will work in a partisan way to satisfy both sides.  He also stressed that he had hoped Republicans would work with the Democrats while drafting the bill instead of fighting against it.  Insurers like UPMC health insurance await the results of these talks to see what health care reform changes they will ultimately be making.

Tax cuts from President Bush will expire on January 1 of next year, so Democrats also have to figure out who will get an extension on those tax cuts.  The majority of Democrats want to extend the cuts to families with an income below $250,000 and individuals with an income below $200,000, but Republicans and a small segment of Democrats want to maintain tax cuts for everyone.  While working together seems to be the ideal solution to any problem, that is easier said than done for Democrats and Republicans.

Medicare Advantage Changes Will Effect UPMC

Friday, October 1st, 2010

There could be some drastic changes to Medicare Advantage plans after everything is said and done with the Health Care Reform Act of 2010.  According to Texas’ The Daily Tribune author Marcia Davis-Seale, “Obamacare could shut out Medicare Advantage.”  While it seems unlikely that Medicare Advantage plans will go away altogether, the number of Medicare participants enrolled in such plans is estimated to go from 24% of participants down to 14% of them.  Compare health insurance costs related to Medicare Advantage and as the government subsidizes less for insurance companies, doctors, and hospitals, they likely will not be accepting as many Medicare Advantage plans. As many of 50% of current plan participants may have to switch to traditional Medicare.

Currently about a quarter of Medicare recipients have Medicare Advantage plans, accounting for around 10 million seniors.  The plans are alternatives to Medicare and offer a combination of Medicare plans along with extra benefits like dental and vision coverage and even gym memberships.  Since the plans are heavily subsidized by the government, these extras rarely effect plan holders with extra costs.  It costs the government between 13 and 20% more to fund Medicare Advantage plans than traditional Medicare plans.  As the government cuts back the amount it is spending on these costly plans over the next ten years, insurance companies may be more likely to drop the plans.  Insurers also have to comply with the new rule that they spend 85 cents of every dollar on actual medical care for their customers so that may be a cost cutting factor as well.

Everyone on Medicare will continue to receive the same benefits they have always been guaranteed.  The extra $1000 spent per Medicare Advantage recipient has been passed along to all Medicare policy holders over the years.  Now that the government is working to “level the playing field” in regards to Medicare it remains to be seen what insurance companies like UPMC will do.  Gym memberships and other perks will likely be cut by many, but seniors don’t have to worry about losing basic Medicare benefits like hospital and doctor care.  It will continue to be a balancing act for all of those involved to maintain seniors’ health care needs, keep Medicare fiscally afloat, and pay an adequate amount to private health insurers going into the future.

UPMC Health Insurance For Retirees Abroad

Tuesday, September 28th, 2010

earthFor those looking to retire abroad, it may be difficult to find health insurance but it surely isn’t impossible.  “How to Find Retiree Health Insurance Abroad” by Kathleen Peddicord of U.S. News & World Report discusses this issue.  It’s possible that you will even find health insurance for better prices overseas than you could in the U.S. from reputable companies like UPMC health insurance.  Just as it is in the U.S., it is crucial that you understand your policy, all the details of your coverage, your deductibles and your premiums.  Especially if you are moving to a country speaking a language other than English, you need to make sure you know all the fine print.

Even within a country, all of the plan details and costs can vary significantly when you start to compare health insurance.  Some insurance carriers only accept applicants up until a certain age so that is important to research before deciding to move away for retirement.  You can get a comprehensive insurance policy in the Dominican Republic for under $90 a month as a 60-year old man.  In Uruguay, you can get top notch hospital-based coverage for $50 per month, but it can only be used at that hospital and is not technically health insurance since you can’t use it elsewhere.

Prepaid medical center programs are your best bet in countries like Ecuador.  Humana is one of the leading insurers in Ecuador offering this program, where a 75-year old man can get basic coverage for less than $90 per month.  In Ireland, there are insurance plans that even cover you out of the country for as low as $60 per month.  Malaysia has long been known as one of the  most affordable places to get health care that is excellent.  Many of their medical staff speak English and trained in Western countries.  You can find plans under $20 a month for a 50-year old man.  Regardless of the location you desire to retire, don’t forget to research your health insurance options before moving out of the U.S.

Highmark’s New iPhone App

Sunday, August 29th, 2010

phoneHighmark health insurance and A.D.A.M. have come out with a new iPhone application called Health@Hand.  A.D.A.M. provides health information and innovative solutions for benefits technology in the health industry.  They partnered with Highmark to launch this application which will be available to all members of Highmark through the online iTunes store.  Health plan members can now get a wealth of information right from their iPhones including articles, information on first aid, discounts on services, and local provider and facility information.

The Pennsylvania-based health insurance company’s Health@Hand was based off of their member’s specific plan and provider information.  It is possible that other Pennsylvania-based health insurers like UPMC health insurance could come out with similar plans through A.D.A.M. in the future.  Current Highmark plan members can use the GPS in their phone to locate specific doctors, specialties and facilities near them.  They can even get a map of the location and connect directly to the office via their phone.  Another unique option members have is the availability of information by simply touching a specific body part.  Members can even change the gender or age for specific information.  The product can also be downloaded by non-Highmark members through A.D.A.M. and iTunes.

UPMC Covers High Risk Pools

Tuesday, August 10th, 2010

obama2In the past month approximately 2,400 Americans have signed up for President Obama’s high risk health insurance pools.  This information comes from Gene Rickman’s “2,400 Apply for High Risk Health Insurance Pool,” in Top News. The exact state by state data is not yet available, but this number includes members in both states that are running their own high risk pools and states like South Carolina that are letting the government run the high risk pools for them.  Beginning in 2014, health insurance companies like UPMC will not be able to deny insurance coverage because of any preexisting conditions.  To bridge the gap between now and then, the U.S. federal government has required these high risk health insurance pools.

The Affordable Care Act passed earlier this year calls for the mandatory stop to preexisting condition denials by health insurers in less than four years.  Preexisting conditions can include cancer, asthma, diabetes, HIV or AIDS, and even pregnancy.  It is currently almost impossible to get health insurance coverage from companies like Fallon Health Insurance if you have one of these or another preexisting condition.  Within the last month, Americans have been able to sign up for individual state high risk health insurance pools where they will be able to obtain some type of health insurance coverage.  The federal government offers the states subsidies for this program, but states do have to utilize their own government funds as well.

UPMC Health Insurance Could Suffer From Reform

Friday, July 30th, 2010

kill the billWhile the health care reform bill passed by President Obama means well, the state of Massachusetts has already tried something similar without much success.  According to The Washington Post article “As Massachusetts health ‘reform’ goes, so could Obamacare,” columnist Robert J. Samuelson doesn’t believe that Obama’s plans will do much to solve the health care crisis.  By putting caps on premium increases for companies like UPMC health insurance and other small and large insurers, it could easily put them out of business or into bankruptcy.

Massachusetts started by expanding the state-subsidized insurance coverage, but failed to get health care costs under control or make sure that people’s overall health actually is improving from this policy.  Currently, the federal government plan has begun the same way.  Most individuals in Massachusetts are required to compare health insurance coverage and purchase some form.  Middle class families earning too much to qualify for Medicaid but with incomes less than three times above the poverty level receive state subsidies.  Insurance coverage has increased from 87.5% of the (non-elderly) population in 2006 to 95.2% in 2009.

It’s hard to tell whether there has been any improvement in health since many uninsured people were young and healthy.  It will likely take many years to determine that.  But emergency rooms are still full, workers are taking home less pay because of their insurance costs, and less money is being spent on schools, police, prisons, roads, and more because of the increase in health care spending.  While ideas have come about to help decrease overall health care costs and spending, such as per-patient fees combining doctors to make treatments higher quality rather than quantity, nothing has had enough of a blueprint to actually be tried.  There is a dangerous possibility that this unchecked spending on healthcare will increase taxes and budget deficits and hardly show any health gains.