Highmark Medicare Review: Great Plans but Higher Costs
Editor's Rating
Highmark, an affiliate of Blue Cross Blue Shield, sells Medicare plans in Pennsylvania, New York, Delaware and West Virginia. It offers many 5-star plans and has great customer service and add-on perks such as vision care and hearing aid coverage. As a result, Highmark's policyholders are overwhelmingly satisfied with their plans.
The downside is that even though $0 plans are offered, most plans are expensive. And other companies usually offer a better cap on your medical expenses. So, if you expect to need costly medical care, Highmark is not the best deal on coverage.
Our Thoughts: Why We Recommend Highmark Medicare Advantage
Highmark stands out as one of the country's top-rated insurance companies. All Medicare Advantage plans that are rated have either 4.5 or 5 stars which is excellent. This means with Highmark, you can generally expect good quality service and care that leads to customer satisfaction.
While the average Highmark Medicare plan is expensive, cheap plans costing $0 per month are widely available. These plans can be a great choice for those with typical medical needs who want coverage that's both affordable and good quality.
If you have more extensive medical needs, we recommend that you're cautious when choosing coverage from Highmark since many plans have a high out-of-pocket maximum. This means that policyholders who have expensive medical care, such as hospitalization, surgery or other costly procedures, could face large bills, even with their Medicare plan.
Even though Highmark has a better quality rating than many other insurance companies, shoppers who need expensive medical care may get a better deal on coverage with a plan from AARP/UnitedHealthcare or Humana. For example, in Pennsylvania, a $25 Medicare Advantage plan from Highmark has an average out-of-pocket maximum of $6,500. But a $19 Medicare Advantage plan from Humana has an average out-of-pocket maximum of $4,130. So in this case, a Humana plan could be cheaper while also saving you more than $2,000 on medical bills during the year.
Cost of Highmark Medicare Advantage
Overall, Highmark is one of the more expensive Medicare Advantage companies, with monthly costs averaging $96.
However, Highmark's cheap plans are widely available, and it sells $0 Medicare Advantage plans in 88% of the counties where it operates.
Highmark's expensive rates are clearly seen at the state level. In Pennsylvania, Highmark Medicare Advantage plans cost an average of $108 per month, while companies like Wellcare and AARP/Unitedhealthcare offer plans that average less than $20 per month.
The exception to Highmark's high prices is in Delaware, where the costs of plans average $18 per month, showing its focus on affordable coverage in the state.
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Are Highmark's Medicare Advantage plans a good value?
A cheap Medicare Advantage plan from Highmark is a good deal for those who expect to need routine or moderate amounts of health care.
Many Highmark plans have $0 deductibles for medical care and prescription drugs. This makes routine care more affordable because the plan's benefits begin right away, allowing enrollees to avoid any upfront costs.
And medical care is generally low-cost, with copayments at $20 for an X-ray, $30 for a specialist visit and $50 for urgent care.
However, Highmark plans are not a good value for those who need expensive medical treatments such as surgery.
For those who need expensive medical care, the out-of-pocket maximum is an important plan feature that caps how much you would have to pay for covered medical services during the year. So whether you need surgery that costs $20,000 or cancer treatment that costs $200,000, the most you would pay for medical care is your plan's out-of-pocket maximum.
Here, Highmark's coverage isn't great. Because of the plan’s high out-of-pocket maximum, your medical bills can add up to thousands of dollars before it starts covering 100% of the costs.
In Pittsburgh, Highmark's five cheapest Medicare Advantage plans have out-of-pocket maximums ranging from $5,500 to $10,000.
Monthly cost of Highmark Medicare Advantage plans
Plan | Cost | Out-of-pocket max. |
|---|---|---|
| Community Blue Medicare HMO Signature | $0 | $7,550 |
| Complete Blue PPO Signature | $0 | $7,550 in-network $10,000 overall |
| Complete Blue PPO Distinct | $25 | $6,550 in-network $10,000 overall |
| Security Blue HMO-POS ValueRx | $62 | $5,550 in-network $10,000 overall |
| Freedom Blue PPO ValueRx | $74 | $5,550 in-network $10,000 overall |
By paying more for a plan, those with expensive medical needs can reduce their total costs because of the plan's better out-of-pocket maximum.
For example, if someone who needed surgery chose the Highmark plan that costs $25 per month ($300 per year) instead of the free plan, they would lower their in-network medical costs by $1,000 because of the plan's lower spending cap. This would be a net savings of $700 after the cost of the plan.
Upgrading to the plan that costs $62 per month would be an even better deal because of its even lower out-of-pocket maximum. When compared to the free plan, someone who needed surgery would have a net savings of $1,256 for the year, after the cost of the plan.
However, even the $5,550 out-of-pocket maximum is still high. By choosing another company that has a lower cap on spending, those who needed expensive medical care could save even more. As compared to Highmark's free plan, a Humana plan that costs $19 per month and has an out-of-pocket maximum of $4,130 would result in a significant net savings of $3,192 for the year, after the cost of the plan.
How Do Highmark Medicare Advantage Plans Work?
Highmark is one of the top-rated affiliates of the Blue Cross Blue Shield association.
Highmark plans are offered throughout Delaware, Pennsylvania and West Virginia under the Highmark Inc. division. And plans are offered in 18 New York counties, including Buffalo and Albany, as a part of Highmark Blue Cross Blue Shield of Western New York.
The company sells multiple types of insurance products, including Medicare Advantage plans, which bundle coverage for original Medicare's Parts A and B into a single plan. Most Medicare Advantage plans also include prescription drug coverage, dental insurance, vision care and fitness benefits.
Plan benefits
On average, you will be able to choose between six Highmark Medicare Advantage plans if you live in one of the counties where the company operates.
This includes a mix of HMO plans, which limit coverage to in-network medical providers, HMO-POS plans, which provide the flexibility to go out of network for some services and PPO plans, which cover both in-network and out-of-network medical care. Benefits can include:
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Prescription drugs: In general, Highmark plans have good coverage and affordable copays for prescription drugs, and there are discounts if you use a preferred pharmacy. However, the lower-cost plans in New York have a prescription drug deductible of a few hundred dollars. This means you could have to pay for some prescriptions out of pocket before the benefits kick in.
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Large provider network: Highmark's affiliate, Blue Cross Blue Shield, has the largest network of doctors and hospitals. And even though the list of doctors varies by plans, there are options like the $0 Freedom Basic (PPO), which can give you in-network coverage even when you're not near home.
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Worldwide emergency coverage: Many plans will cover emergency or urgent care, even if you're traveling abroad.
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Companionship and non-medical support: Some plans offer the PALS program, which provides at-home help with chores, companionship to combat loneliness and non-medical support such as help shopping. Keep in mind that those participating in these programs may be encouraged to get wellness exams.
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Dental: Plans usually cover preventative dental and some non-routine dental care services. However, your costs for advanced dental care can be high, 50% of the bill, and advanced plan approval is usually required.
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Hearing: Most plans provide low-cost hearing exams and coverage for hearing aids. You could pay $699 to $999 per hearing aid, making Highmark one of the best Medicare Advantage providers for hearing aids.
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Vision: Most plans cover eye exams, lense, contacts and frames.
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Fitness: Plans include the SilverSneakers fitness program.
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Wellness debit card: Enrollees can get rewards for completing actions like cancer or diabetes screenings.
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Over-the-counter (OTC) allowance: Some plans offer an allowance of $100 to $140 per year to buy pharmacy items at the Highmark OTC store.
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Telehealth: Depending on your plan, you'll have access to virtual appointments through either the Doctor On Demand app, the Blues On Call program or a virtual appointment with your local doctors.
Customer reviews and complaints
Highmark Medicare Advantage plans have a reputation as having some of the best customer satisfaction in the country.
In J.D. Power's survey, Highmark's Medicare Advantage plans were second in the country for customer satisfaction. Only Kaiser Permanente ranked ahead of Highmark.
This high rating is not a fluke. Many of Highmark's plans have 5 stars, according to the CMS rating data. This top performance considers 40 measurements including factors like how often appeals are upheld, how the plan is changing each year and health care measurements about healthy aging.
As a part of the star ratings where policyholders share their feedback, Highmark enrollees are very satisfied with their coverage, customer service and the quality of their health care.
Notably, the Highmark Blue Cross Blue Shield division in Western New York is not as highly rated overall as the Highmark Inc. division that operates in Delaware, Pennsylvania and West Virginia.
Star ratings from policyholders | DE, PA, WV | NY |
|---|---|---|
| Rating of health plan | 5.0 | 4.5 |
| Ability to get appointments and care quickly | 5.0 | 4.5 |
| Customer service | 5.0 | 4.5 |
| Rating of health care quality | 4.3 | 4.5 |
| Rating of care coordination | 4.3 | 3.0 |
| Rating of drug plan | 4.3 | 3.5 |
| Ability to get needed prescription drugs | 4.8 | 4.5 |
While Highmark has good overall ratings and customer service ratings are between 4.5 and 5 stars, other areas of the customer experience can vary by location.
In particular, policyholders in New York gave their prescription drug coverage a rating of 3.5 stars. That lower score is likely because many of the cheaper plans offered in New York have costly prescription drug deductibles.
List of 5-star plans from Highmark
Many of Highmark's Medicare Advantage plans have received 5-star ratings from the Centers for Medicare & Medicaid Services (CMS). These top-ranking plans include both HMOs and PPOs, and costs start at just $0 per month, allowing you to get insurance that's both high-quality and affordable.
If a 5-star Medicare Advantage plan is offered in your area, you can change to it at any time of the year, even if it's not open enrollment.
Plan | Average monthly cost |
|---|---|
| Community Blue Medicare PPO Signature | $0 |
| Highmark Blue Shield Freedom Nation (PPO) | $0 |
| Complete Blue PPO Signature | $0 |
| Community Blue Medicare Plus PPO Signature | $0 |
| Community Blue Medicare HMO Signature | $0 |
Frequently asked questions
Is Highmark the same as Blue Cross Blue Shield?
Highmark is an independent company that is a part of the Blue Cross Blue Shield Association. So even though plans are affiliated with Blue Cross Blue Shield, the company is locally owned and operated.
What’s the difference between Highmark and Anthem?
Highmark and Anthem are both part of the Blue Cross Blue Shield Association, making them peer insurance companies. Anthem's Medicare Advantage plans are 80% cheaper than Highmark's, on average. But Highmark's high rating of 4.5 to 5 stars is much better than Anthem's 3.9 stars.
Are Highmark Medicare plans good?
Highmark offers good Medicare Advantage plans that have high rates of customer satisfaction and provide top-tier customer service. Its $0 plans are widely available, and coverage is best for those who need routine or moderate amounts of medical care.
Does UPMC take Highmark insurance?
With most Highmark plans, UPMC is considered in-network and will accept your insurance. However, details vary by plan, and some narrow-network plans from Highmark may not give you full access.
What states have Highmark?
Highmark operates in Delaware, New York, Pennsylvania and West Virginia, where it sells Medicare plans and traditional health insurance.
Is Highmark better than Aetna?
In general, Highmark has better-rated Medicare Advantage plans, but Aetna has more affordable coverage.
How much did Highmark pay to name the Highmark Stadium?
Highmark Blue Cross Blue Shield is paying an estimated $4 million per year for the naming rights to the Bills stadium in the Buffalo, N.Y., area. The company says this will not cause insurance rates to increase. This comes after purchasing naming rights to a Pittsburgh stadium in 2012.
Sources and methodology
Medicare Advantage data is from Centers for Medicare & Medicaid Services (CMS). Our cost analysis only considers Medicare Advantage plans that include prescription drug coverage, and we excluded PACE plans, special needs plans, Part B-only plans, employer-sponsored plans, Medicare-Medicaid plans and sanctioned plans. Each instance of a plan is considered individually when it has different monthly costs or coverages. Star ratings are averaged based on individual contracts.
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