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Highmark’s 2016 lineup holds some big changes for consumers.

For Medicare Advantage, the insurer’s lowering premiums by 6 to 37 percent and beefing up benefits.

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For the federal Affordable Care Act marketplace, by contrast, it’s cutting plan options on healthcare.gov from about 25 to eight or 10 and likely raising premiums.

Both moves are a result of changing market dynamics, according to Highmark leaders.

Tim Lightner, the insurer’s vice president of senior markets, said federal reimbursement rates for Medicare Advantage plans are “much more favorable than we've seen in the past few years.”

That’s allowing Highmark to court seniors with options like $3 copays on preferred generic drugs; hearing aids for $499 to $999; and in-home end-of-life palliative care through a partnership with Tenessee-based Aspire Health.

“Frankly,” Lightner said, “we think we're going to be much better positioned in the market this year to capture new enrollment.”

Growing pains

It’s a different story on healthcare.gov, where the insurer’s suffering what Michael Radeschi, director of product management, called “growing pains.”

Insurers didn’t know what to expect when the marketplace opened in 2014, offering insurance and often subsidies to people who couldn’t get health coverage through their jobs.

Highmark jumped in with attractive premiums and won the majority of Pennsylvania enrollees in both 2014 and 2015.

What became apparent more slowly, Radeschi said, was that people who bought insurance through healthcare.gov used a lot more health care than those who held other Highmark plans.

“Diabetes is 19 percent more common on the ACA marketplace. ACA members consume about 58 percent more hospital days,” he said, noting that about half of them were previously uninsured. “We're seeing a lot more congestive heart failure and a lot more chemotherapy.”

All told, Highmark reported losing $318 million on healthcare.gov plans in the first half of this year.

The ACA includes provisions intended to help insurers recoup those losses during the first several years of healthcare.gov, but Radeschi said despite repeated conversations Highmark still doesn’t know how much of its losses will be covered.

So, he said, in addition to paring back its offerings for 2016 and requesting higher premium, Highmark’s planning to get more proactive with ACA members.

“We're going to interact with them more regarding the things they need help with,” he said.

Examples include regular health coaching through calls, emails or texts, and embedding Highmark employees at hospitals to help with follow-up care planning when a member is discharged.

Highmark’s also going to extend its telephone service hours to run from 8 a.m. to 10 p.m.

“Our commitment to this market segment is very strong,” Radeschi said, noting that projections suggest strong growth for healthcare.gov. “We're still optimistic that we'll maintain a very strong presence.”

The Pennsylvania Insurance Department, which has veto power on health insurance rates, has not year released the approved premiums for 2016 plans on healthcare.gov.

However, open ACA enrollment begins Nov. 1, and the federal website says plans and prices for 2016 will be available “by late October.”