Wednesday, August 8, 2012

Pittsburgh Vs. Philadelphia - Compare Health Care Options

Pittsburgh and Philadelphia are of course the two largest cities in Pennsylvania. More people buy health insurance plans in these two cities than any other area of the state. There are multiple options, both private and through an employer. So what are the differences and does one side of Pa offer better health care than the other? Let's find out.

But before discussing some of the best options, it's important to recognize the changes from the Affordable Care Act. In addition to instant approval underwriting and mandated "essential health benefits," the federal Obamacare subsidy has provided thousands of dollars of financial relief for many consumers.

Depending on your income (as it relates to the Federal Poverty Level),  your new rates could be considerably less than expected. It's not unusual to see premiums reduced by up to $500-$800 per month, resulting in $1000 monthly rates reducing to less than $300. The federal subsidy is based on your projected household income for that year. If you receive a raise, or lose your job, the amount of the subsidy will change.

Highmark Blue Cross Rates In Western Pa
Highmark Offers Affordable Western Pa Healthcare Rates


Highmark Blue Cross Blue Shield is available to Western Pennsylvania residents only. So, of course, if you live on the other side of the state, you won't be able to purchase a Highmark plan. And that's a shame, since their rates are very competitive, especially for policies that cover one person. They offer various high-deductible plans which are very popular with small business owners.

Not only are Highmark rates competitive, but they also include maternity coverage on all plans, which is required by the Affordable Care Act. By purchasing a low deductible policy with maternity benefits, you will pay far less than you would for similar coverage in most of the state. Highmark's Network is impressive too, covering a vast number of doctors and hospitals.

When it comes to negotiating lower prices for their customers, they are very adept at it. Of course, they are $50,000 poorer now since they were recently fined $50,000 by the Department Of Insurance for denying claims (considered a minor violation). They are also in the process of merging with Northeastern Blue Cross, which will give them an additional 500,000 new customers.

UPMC is also only available in the Western portion of the state. Although their rates aren't as competitive (in most zip codes) as Highmark, they are indeed a new, but reputable and reliable carrier. Their HSA rates are very attractive to both single and family situations. There are multiple coinsurance and deductible options so there's no shortage of plans.



 UPMC also has comprehensive policies that are suitable for persons looking for "high end" types of options. These plans will offer richer coverage with additional benefits such as office visits (specialists included), prescriptions and  may other needed items. However, they also feature a few policies that are lower in cost and limit the number and type of covered office visit and RX benefits.

Lately UPMC and Highmark have been waging a war of supremacy for the area. UPMC may be making up some market share with some acquisitions, but we'll see how things shake up when Marketplaces are operational. Highmark's purchase of Northeastern Pa Blue Cross will expand their market share further.

Aetna and UnitedHealthcare are two large reputable insurers and both provide medical coverage for individuals and families in all parts of the state. UnitedHealthcare seems to have more competitive rates in the Western and Central parts of Pa. Aetna has very good rates in Reading and the Philadelphia areas, especially their HMO plans with maternity coverage. Both carriers have extensive network provider coverage in most of the state.

In the Eastern part of the state, Keystone (Independence Blue Cross) offers about 8-10 different affordable plans including, HSAs, comprehensive coverage and HMOs. Maternity coverage is available on the HMOs and some of the PPOs and prices are very affordable. Keystone also offers health care in other states. Most physicians and hospitals are very familiar with their policies.

You must live in the Philadelphia area (six counties), but the Network of doctors and hospitals is extensive. Most policies are underwritten although a "Personal Choice" plan can be applied for that is a "guaranteed issue"  contract. This specific plan is ideal if you have been denied by previous insurers or have multiple existing conditions. In 2014, all policies became "guarantee issue." Therefore no medical questions required and pre-existing conditions covered.

So...Which city is the best to buy health insurance? Actually, both Philadelphia and Pittsburgh have multiple insurers that can offer affordable premiums, generous benefits and large provider networks. You can't go wrong with either city! New plans are always being developed and network discounts continue to grow. Blue Cross has great options on both sides of the state.