The Evolving Healthcare Landscape in Pittsburgh

jimBy Matt Kandrach, Vice President of 60 Plus

The news is full of predictions about the future of healthcare and it seems that everybody has something to say about the changing landscape – a landscape that is shifting rapidly, especially here in Pittsburgh.

Pittsburgh has long been home to world-class medical and research facilities and skilled and caring healthcare professionals, a situation that will only improve as the door is finally open to consumer choice and a competitive health insurance market.

Perhaps at no other time have consumers been so in control of their healthcare future. While it’s exciting to have these choices, it also can be confusing and overwhelming. There are new providers in the market for Medicare Advantage plans for seniors, and while the added competition can spur increased benefits and lower prices, it’s important for consumers to truly understand the details in the options available to them.

The Medicare Open Enrollment period is in progress now until Dec. 7, and it’s vital that everyone does their homework. It’s important to know whether the doctors you want to see are considered in-network or out-of-network for the plan you’re considering. Trust me; you’ll pay for the difference.

And, since this is western Pennsylvania, it’s important to keep our eyes on the news because the courts are reviewing health care issues specific to the region. The outcome of these decisions could have a big impact the choices seniors   eventually make for health insurance.

This is the time to shop and compare.  It’s strongly urged that you go to each company’s website and read – not just the overviews with the pictures of healthy seniors, but the fine print about coverage. Some insurance plans offer access to a wide variety of facilities and doctors. Others restrict access to specific locations. Some plans offer free gym memberships and access to general medical advice over the phone from registered nurses. None of these aspects make one plan better or worse than another, but seniors need to ensure that they are choosing a plan that provides access to the doctors they prefer, in the setting they desire, and at a price they can afford.

As long as we all compare the proverbial apples to apples and oranges to oranges, western Pennsylvanians will remain among the most well informed patients, receiving the care they need from the medical professionals they prefer. If, on the other hand, consumers don’t take a good look at the options laid out before them, they could find themselves in an unwanted situation.

So during this open enrollment, make sure to stay informed and make the best choice by asking yourself these three important questions:

  • Which options offer me in-network coverage for my doctors?
  • What are the out-of-pocket costs (co-pays, deductibles or coinsurance) associated with each option?
  • Does my plan offer any other additional benefits not offered in Original Medicare? If so, is there an additional cost?


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