Public exchange shoppers will have more choices this open enrollment period, and in some places, they're being courted with affordability, as insurers try to draw both first-time buyers and membership from rivals.
In western Pennsylvania, the Highmark-University of Pittsburgh Medical Center saga continues with UPMC Health Plan passing Highmark as the issuer of the most affordable public exchange plans -- a move that could spur sizable membership shifts.
In the region's two largest counties, in greater Pittsburgh and Erie, UPMC Health Plan will be selling the lowest-priced bronze, silver, gold and platinum exchange plans, with some of its plans featuring premiums 40 percent lower than last year, if only a few dollars less than Highmark's lowest cost options.
"While this is the second year of the Marketplace, this year is very different with the variety of choices and pricing changes," said UPMC Health Plan president and CEO Diane Holder.
Highmark, a Blue Cross insurer of more than 3 million western Pennsylvanians and the new operator of UPMC's rival Allegheny Health Network, was the largest underwriter of new exchange consumers in the first open enrollment period. It's premiums were priced in some cases 40 percent below UPMC Health Plan and other insurers with smaller regional footprints, and it enrolled 130,000 on the exchange and about as many in the unsubsidized individual market.
UPMC's low pricing is another dynamic for Highmark to contend with in the new western Pennsylvania healthcare market, where most Highmark members will no longer have in-network access to UPMC hospitals and physicians starting in 2015 under a consent decree brokered by state leaders.
In Healthcare.gov's plan preview, the first page of options lists eight UPMC Health Plan choices -- out of 10 health plans. Indeed, altogether across greater Pittsburgh, UPMC Health Plan is flooding the exchange market with 27 health plans, followed by Highmark with 15.
For a 40-year-old non-smoker in Pittsburgh, UPMC Health Plan's UPMC Advantage Bronze exclusive provider organization plan is the first option and the lowest cost, priced at $152 per month before any subsidies, along with three other UPMC bronze options.
Highmark's lowest-price bronze plan is the Community Blue PPO, priced at $160 per month and featuring the Allegheny Health Network and other non-UPMC providers. There will also be Aetna's Coventry and two other insurers selling exchange plans in the region for the first time, Assurant Health and UnitedHealthcare, which is pricing its Bronze HSA-eligible HMO at $167 per month.
In the silver tier, UPMC Health Plan's Advantage EPO is priced at $170 per month, before subsidies, with a $1,750 deductible, while Highmark's lowest cost silver plan costs $179 per month with a $2,750 deductible. That Highmark plan has actually an out-of-pocket maximum of $4,000, quite a bit less than the $6,600 for UPMC's lowest-cost silver plan, although other UPMC plans have low deductibles and out-of-pocket maximums, such as a "select network" plan priced at $180 per month with a $2,000 deductible and $3,500 out-of-pocket limit.
All in all, western Pennsylvania's exchange market is proving to be at once unique and reflective of national trends.
There are many health plan choices across benefit levels -- perhaps too many choices given that some first-time insurance buyers with low-incomes may have limited financial literacy. Across provider organizations, there is the specter of choices being limited to Highmark and its Allegheny Health Network or UPMC.
That, however, may end up spurring competition to the benefit of consumers, as in lower-premiums and newer services. UPMC Health Plan, now the second largest provider-owned insurer in the country and the second largest in the region, offers its members free use of online and telephone consults, a 24/7 nurseline, walk-in clinics and a number of other community-based services. Highmark, too, is betting on services like telemedicine, and is set to become the first insurer in the country to offer teledermatology as a covered benefit for all its members starting next year.