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Region’s major insurers talk 2021 medicare plans

Amidst the open enrollment period, which continues now through Dec. 7, area providers Highmark, UPMC Susquehanna and Geisinger have announced their medicare and medicare advantage plans.

Ellen Galardy, Highmark vice president of medicare market strategy, Crystal Kominski, Gesinger manager of medicare sales, and April Golenor, chief medicare officer for UPMC Health Plan, shared their respective options.

“We are very excited about our offerings,” Golenor said. “We are continuing our commitment to reduce financial stresses.”

UPMC offers a $0 HMO Premier RX plan, which has a $0 deductible and premium, $0 primary care physician visits, $35 specialty visits but includes enhanced services that the other plans include like: dental, vision and hearing aid allowances, over-the-counter allowance to buy drugstore needs, and fitness benefits through Silver Sneakers that allows people to get fitness kits for their homes, access to online classes and gyms.

“We have a range of product options to make sure that we can meet a variety of needs in the community,” Galardy said.

This year, Highmark has implemented $0 primary care physician appointments to all that have a medicare advantage plan.

The $0 premium community blue plan has many $0 benefits including visits with PCPs, prescriptions, labs and more.

Galardy described this plan as one that is designed for someone who wants to take care of their health, keep up with prevention and regular appointments, but needs a lower premium to fit their budget and save their money for other needs that Highmark can provide.

Geisinger also offers an HMO plan, which requires members to use in-network services unless in case of an emergency, at a $0 premium called their classic 360 RX plan, which offers $0 PCP visits, $0 outpatient lab work, $35 specialist copays, dental, vision and fitness benefits.

This plan also provides clients with an over-the-counter card, which gives them $25 per month to use on items such as antacids, toothbrushes and toothpaste, cold medicine and other necessities.

This plan offers their prescription mail order pharmacy program that gives $0 100-day supplies of tier-one and tier-two prescriptions through the mail.

Highmark offers a lower cost plan $35 community blue plan that is similar to the $0, but provides more advantages to someone who might need to see specialists or have more doctor’s appointments.

This plan offers less costs for specialists, therapies and hospitalizations and offers access to Geisinger Danville.

Both of the Highmark community blue plans also offer comprehensive dental access, which provides an allowance towards dental procedures, and access to gyms, both virtual and in person.

This year, Highmark has expanded their lists of dentists as well.

Geisinger’s lower cost premium option, a PPO, preferred enhanced RX plan, has a $45 dollar premium with $5 copays for PCP visits, $35 for specialists and $20 for outpatient lab necessities, while still including dental, vision, the $25 over the counter card and the mail order pharmacy program.

Both of Geisinger’s options also provide the diabetes insulin saver program which allows members to pay a consistent copay for their insulin instead of it increasing after the initial coverage phase.

“We want to make sure that our members are getting and taking their insulin,” Kominski said.

UPMC has a similar diabetes member program that is covered through each plan that includes a cost of $35 or less for insulin and diabetes products regardless of where the member is in their insurance coverage phase.

UPMC also has another popular plan, the HMO Choice RX plan, that provides more money for dental, vision and hearing coverage, more money per quarter in over-the-counter allowance all for less expensive premiums like $40 a month with $0 PCP visits, $2,500 for comprehensive dental needs, $175 in vision needs like glasses and $40 for over-the-counter benefits as well as a fixed specialty visit fee.

There are also more expensive plans that offer even more allowance for dental, vision and hearing aid needs.

All of UPMC’s plans have access to the UPMC provider network and programs that they have to help manage patient care needs and their conditions, telehealth, counseling benefits and the 24/7 nurse hotline.

In addition, these Geisinger Medicare plans also allow members to have access to Geisinger facilities, UPMC, Penn State Hershey, Lehigh Valley Health Network and even Johns Hopkins in Maryland.

Members who are interested in looking at new plans in Clinton County are able to get the PPO plan for a $0 premium, with the same coverage.

Highmark, Geisinger and UPMC also have a large variety of other plans available for increased coverage. Though they tend to be more expensive, there are a lot of benefits to them including more coverage for hospitalization, therapies, in-patient needs and specialties.

“We want to make sure people are protected,” Galardy said. “This is a unique year…the plans have made a real focus on finding safe options. This year shows how important it is to have a healthcare plan.”

“No plan is better than another,” she continued. “They are designed to be similar but changing the focus to match the patient’s needs.”

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