Highmark Medicare Advantage 2023 Review

Highmark Medicare Advantage plans are highly rated but available in only four states.
Kate Ashford, CSA®
By Kate Ashford, CSA® 
Edited by Dawnielle Robinson-Walker

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Highmark is a member of the Blue Cross Blue Shield family, which includes 34 independent companies that together form the third-largest provider

of Medicare Advantage plans.

Highmark’s plans get high marks on both member satisfaction and plan performance, but its Medicare Advantage plans are available in only four states.

Here’s what you should know about Highmark Medicare Advantage.

Highmark Medicare Advantage pros and cons

Highmark’s offerings have advantages and disadvantages.

Pros

  • Of nine Medicare Advantage providers (including three Blue Cross Blue Shield companies), Highmark ranks third in J.D. Power’s 2022 Medicare Advantage Study, scoring 811 out of 1,000 points. It’s also the highest Blue on the list.

  • Weighted by enrollment, Highmark’s Medicare Advantage contracts get an average Medicare star rating of 4.76 out of 5 from the CMS.

  • Highmark plans offer a number of benefits, from Part B Premium Giveback perks to medication management and 24/7 access to nurse advice.

Cons

  • Highmark offers Medicare Advantage plans in only four states: Delaware, New York, Pennsylvania and West Virginia.

  • Highmark offers the highest-priced Medicare Advantage plans of all the Blues and has the smallest percentage of $0-premium plans (40%) of the bigger providers.

Available Highmark Medicare Advantage plans

Highmark Medicare Advantage plans vary in terms of structure, costs and benefits available. The company offers HMO and PPO plans as well as stand-alone prescription drug plans. New in 2023, Highmark’s Valor PPO plans are designed with veterans in mind.

Plan offerings include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor to see a specialist, and out-of-network benefits are usually limited.

Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

Special needs plans, or SNPs, restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Highmark offers one type of SNP:

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

Available Part D prescription drug plans

Most of Highmark’s Medicare Advantage plans include Part D drug coverage, but the company also sells stand-alone Part D prescription drug plans, or PDPs, in two states: Pennsylvania and West Virginia. These plans provide drug coverage for people enrolled in Medicare Part A and Part B, so they don’t provide medical coverage.

Highmark offers two plan options in each state where it sells PDPs: a standard option and a “complete” option with enhanced coverage. For example, if you live in Erie, Pennsylvania, you have these two options from Highmark:

  • Blue RX PDP Plus.

  • Blue RX PDP Complete.

Here’s how those two plans compare:

Plan feature

Blue RX PDP Plus

Blue RX PDP Complete

Monthly premium

$121.10.

$192.60.

Annual deductible.

$505.

None.

Drug copay, Tier 1*

$0.

$0.

Drug copay, Tier 2*

$7.

$5.

Drug copay, Tier 3*

20%.

$40.

*For up to a 31-day supply of a covered Part D prescription drug at a preferred retail pharmacy after meeting any applicable deductible.

Premiums, deductibles, covered drugs, costs for each tier and pharmacy arrangements all differ by plan. You can enter information about your prescriptions and choose your pharmacy on Anthem’s website to check how each available plan would cover your medications.

Additional benefits

Highmark Medicare Advantage offers members access to dental, vision and hearing benefits. Many of its plans offer other benefits, as well. Here are a few standouts:

  • Part B premium giveback: Some Highmark plans offer money each month that can be put toward a member’s Part B premium.

  • Low copays: Some Highmark plans offer $0 copays for visits with a primary care doctor, labs, some mail-order prescription drugs and preventive dental care.

  • Fitness benefits: Many plans include the SilverSneakers fitness program, which gives members access to a large network of gyms and fitness facilities as well as local classes and events.

  • Home health benefits: Members have access to a free House Call Visit, in which a licensed health professional comes to your home to perform a health check.

  • Social connection. Highmark offers some members access to the Blue Neighbors program, in which people can request that a volunteer call or visit, or participate in virtual events like bingo or trivia games.

  • 24/7 nurse lines: Through Blues On Call, members can access registered nurses 24/7 by phone who can answer questions.

  • Medication management: Members with chronic conditions such as osteoporosis, rheumatoid arthritis, diabetes or depression have access to a Medication Therapy Management program that can ensure they’re managing meds correctly and able to afford their prescriptions.

Customer service

Highmark Medicare Advantage members can contact their plan’s customer service (managed by UnitedHealthcare) in the following ways:

  • Call the number on their member ID card from 8 a.m. to 8 p.m. local time seven days a week.

  • Request a call from a Highmark Medicare Advisor.

  • Connect with Highmark on Twitter or Facebook.

Highmark service area

Highmark Medicare Advantage plans are available in four states — Delaware, New York, Pennsylvania and West Virginia — and about 375,000 people are enrolled in Highmark plans as of October 2022.

Highmark is tied with a few other health insurance companies for seventh place in terms of market share, and it saw the most Medicare Advantage growth in 2022 among the Blues plans, adding 78,000 new members for the 2022 plan year

. (The Chartis Group, a health care consulting firm, attributes nearly all of this growth to Highmark’s new affiliation with HealthNow, which was rebranded as Highmark Blue Cross Blue Shield of Western New York and Highmark Blue Shield of Northeastern New York.)

Costs

Costs for Medicare Advantage plans will depend on your plan, geographic location and health needs. One of the costs to consider is the plan’s premium. Four in 10 of Highmark’s Medicare Advantage plans offer $0 premiums. Of Highmark plans that have a premium, the monthly consolidated premium (including Part C and Part D) ranges from $22 to $285

Centers for Medicare & Medicaid Services. 2023 MA Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 18, 2022.
. Of all the Blues, Highmark has the highest-priced Medicare Advantage plan in 2023.

For special needs plans, or SNPs, monthly premiums are $41.10 for all Highmark plans

Centers for Medicare & Medicaid Services. 2023 SNP Landscape Source File (v 10 14 2022) (ZIP). Accessed Nov 18, 2022.
.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $164.90 per month in 2023. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)

Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network or how often you may go out of network for care.

  • Whether you require extra benefits and whether the plan charges for them.

To get a sense of costs, use Medicare’s website to compare information among available plans in your area. You can select by insurance carrier to see only UnitedHealthcare plans or compare across carriers. You can also shop directly from UnitedHealthcare’s website by entering your ZIP code, and you’ll be able to compare the plans available.

Highmark Medicare star ratings

Average star rating, weighted by enrollment: 4.76

The Centers for Medicare & Medicaid Services maintains its own database of star ratings on every Medicare Advantage and Medicare prescription drug plan, ranging from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

All Medicare Advantage plans are evaluated on health plan measures, and Medicare Advantage plans that include prescription drug coverage are also evaluated on drug plan measures.

Based on the most recent year of data and weighted by enrollment, Highmark Medicare Advantage plans get an average rating of 4.76

Centers for Medicare & Medicaid Services. 2023 Star Ratings Data Table (ZIP). Accessed Nov 18, 2022.
.

For comparison, the average star rating for plans from all providers in 2023 is 4.15

Centers for Medicare & Medicaid Services. 2023 Medicare Star Ratings Fact Sheet (PDF). Accessed Nov 18, 2022.
.

Of the Highmark Medicare Advantage contracts with star ratings in 2023, two-thirds are rated 5 out of 5 and the other third are rated 4.0. There are no contracts rated lower than 4 stars.

To get an overall star rating, the CMS ranks contracts on 40 different plan factors. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here are the measures for which Highmark contracts scored an average of 4.5 (out of 5) and above:

  • Colorectal cancer screening.

  • Diabetes care — blood sugar controlled.

  • Getting needed care.

  • Getting appointments and care quickly.

  • Complaints about the health plan.

  • Health plan: Members choosing to leave the plan.

  • Plan makes timely decisions about appeals.

  • Reviewing appeals decisions.

  • Health plan: Call center — foreign language interpreter and TTY availability.

  • Drug plan: Call center — foreign language interpreter and TTY availability.

  • Complaints about the drug plan.

  • Drug plan: Members choosing to leave the plan.

  • Getting needed prescription drugs.

  • Medicare plan finder price accuracy.

  • Medication adherence for hypertension (RAS antagonists).

Highmark contracts struggled in a few of the categories measured. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here’s where they averaged a sub-3.0 star score:

  • Monitoring physical activity.

  • Special needs plan care management.

  • Reducing the risk of falling.

  • Health plan quality improvement.

  • Drug plan quality improvement.

You can find a plan’s rating with the Medicare plan finding tool.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included two here:

AM Best Financial Strength Rating: A (Excellent)

AM Best is a credit rating agency that specializes in the insurance industry. In August 2022, AM Best affirmed its Financial Strength Rating of A (Excellent) for Highmark and its life/health subsidiaries

.

An A rating in this category indicates that AM Best believes Anthem has an excellent ability to meet its ongoing insurance obligations.

J.D. Power Ranking: 3rd out of 9

In its 2022 U.S. Medicare Advantage Study — the eighth it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Highmark scored 811 points out of 1,000 and came in third out of the top nine Medicare Advantage providers and just above the industry average

.

Compare Medicare Advantage providers

Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

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About Highmark

Highmark, headquartered in Pittsburgh, Pennsylvania, was created in 1996 when Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield consolidated operations. Highmark is the fourth-largest company in the Blue Cross Blue Shield family. Highmark offers health insurance for individuals and families, dental insurance, Medicare Advantage and Part D plans, Medicare Supplement Insurance, and other insurance coverage such as fertility treatment benefits and travel insurance. The company also offers insurance for businesses.

In 2021, Highmark Health, the parent company of Highmark Inc., reported $22 billion in consolidated revenue.

Find the right Medicare Advantage plan

It’s important to do your research before selecting a Medicare Advantage plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
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