The bottom line: Highmark Medicare Advantage earns strong government quality ratings and member experience scores, but it has fewer $0-premium options and is only available in four states. Jump to: Full Review
Highmark Medicare Advantage pros and cons
Pros
- Happy members: Highmark members file half as many complaints as the average company we reviewed, and it does well on measures of member experience.
- High quality ratings: Highmark gets some of the highest quality ratings from the Centers for Medicare & Medicaid Services (CMS), on average.
Cons
- Higher costs: Highmark has fewer $0-premium plans and higher average monthly premiums than many competitors.
- Service area: Highmark offers Medicare Advantage plans in only four states: Delaware, New York, Pennsylvania and West Virginia.
Compare against other providers
🔍 UnitedHealthcare Medicare Advantage
» More options in our roundup of the best Medicare Advantage plans
Compare against other providers
🔍 UnitedHealthcare Medicare Advantage
» More options in our roundup of the best Medicare Advantage plans
Our full review
45+ Medicare companies and brands analyzed by our team of experts.
30+ years of combined experience covering Medicare and personal finance.
Governed by NerdWallet's strict guidelines for editorial integrity.
NerdWallet’s Medicare content, including articles, reviews and recommendations, is produced by a team of writers and editors who specialize in Medicare. Their work has appeared in The Associated Press, Washington Post, Nasdaq, MSN, MarketWatch, Yahoo! Finance and other national and regional media outlets. They have been cited in publications including Healthline, and appeared on NerdWallet's "Smart Money" podcast.
NerdWallet star rating for Highmark Medicare Advantage
Highmark Medicare Advantage plans earned 4.2 out of 5 stars for overall performance. NerdWallet’s ratings are determined by our editorial team. The scoring formula takes into account premiums, out-of-pocket costs, government quality ratings, customer complaints, disenrollment survey data, third party quality accreditation and more.
NerdWallet star ratings are different from CMS ratings for Medicare plans.
Our data-driven, consumer-first scoring rubric for Medicare Advantage plans includes crucial metrics like cost and a wider range of data sources for quality and customer satisfaction in addition to the information incorporated into CMS ratings.
Government quality ratings for Highmark Medicare Advantage
Average CMS star rating, weighted by enrollment: 4.38
Highmark Medicare Advantage plans are rated well above the industry average, receiving an average quality rating of 4.38 out of 5 from the Centers for Medicare & Medicaid Services (CMS) for 2026, weighted by enrollment. For comparison, the average weighted CMS star rating for all companies is 4.02.
Among Highmark members who are in plans with a CMS quality rating, 96% are in a plan rated 4 stars or higher for 2026.
CMS maintains its own database of star ratings, which rank each plan 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.
You can find a plan’s rating with Medicare's plan finding tool.
How much does Highmark Medicare Advantage cost?
Premiums
About 33% of Highmark Medicare Advantage plans have a $0 premium.
Highmark plans with a premium cost about $49.96 per month, on average, weighted by enrollment. That’s a bit higher than average among the companies NerdWallet reviewed.
With any Medicare Advantage plan, you’ll also be responsible for paying your Medicare Part B premium, which is at least $202.90 per month in 2026.
Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay the income-related monthly adjustment amount (IRMAA). Some Medicare Advantage plans pay some or all of your Part B premium.
Prescription drugs
About 86% of Highmark Medicare Advantage plans include prescription drug coverage.
Here’s what you might pay for prescription drugs at some common price points.
Tier 1 (Preferred generics) 97.7% of Highmark Medicare Advantage plans have $0 copays/coinsurance.
$3.75: Average out-of-pocket cost for a drug with a $15 retail price, among Highmark plans with copays or coinsurance at Tier 1 (after deductible, if any).
Tier 2 (Most generics) 50.2% of Highmark Medicare Advantage plans have $0 copays/coinsurance.
$6.91: Average out-of-pocket cost for a drug with a $50 retail price, among Highmark plans with copays or coinsurance at Tier 2 (after deductible, if any).
Tier 3 (Preferred brands) None of Highmark's Medicare Advantage plans have $0 copays/coinsurance.
$43.07: Average out-of-pocket cost for a drug with a $200 retail price, among Highmark plans with copays or coinsurance at Tier 3 (after deductible, if any).
Other out-of-pocket costs
Highmark Medicare Advantage plans have an average maximum out-of-pocket (MOOP) spending cap of $6,951, weighted by enrollment. That’s a little higher than average among the companies NerdWallet reviews.
Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. 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 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, Medicare.gov and most other Medicare shopping tools can help you compare plans' premiums and out-of-pocket costs for certain services and prescription drugs in your location.
Why do people leave Highmark Medicare Advantage plans?
CMS surveys people who voluntarily leave their Medicare plans about their reasons for leaving. Here’s the breakdown of problems people identified when leaving Highmark plans.
Problems getting covered care: 8% (All-company average: 11%).
Problems with doctor/hospital networks: 10% (All-company average: 17%).
Financial issues: 20% (All-company average: 17%).
Problems with prescription drug benefits: 2% (All-company average: 3%).
Problems getting information from the plan: 8% (All-company average: 9%).
(Members can give more than one reason for leaving on the survey and might leave plans for other reasons, so the categories won’t add up to 100%.)
Highmark Medicare Advantage plan types
Highmark offers Medicare Advantage prescription drug plans and Medicare Advantage plans without prescription drug coverage.
Plan offerings include the following types:
A health maintenance organization (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.
HMO point of service (POS) plans are HMO plans that allow members to get some out-of-network services, but they’ll pay more for those services.
Preferred provider organization (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 (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.
Third-party ratings of Highmark
AM Best Financial Strength Rating: A (Excellent)
AM Best is a credit rating agency that specializes in the insurance industry. In August 2025, 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 Highmark has an excellent ability to meet its ongoing insurance obligations.
JD Power Ranking
JD Power releases an annual study measuring member satisfaction with Medicare Advantage plans. It uses eight factors, such as level of trust, ability to get health services, ease of doing business and resolving problems or complaints.
Here’s how Highmark ranked in the markets where it has enough market share to appear on the survey:
New York: 6th out of 6.
Pennsylvania: 2nd out of 7.
Highmark Medicare Advantage service area
Highmark Medicare Advantage plans are available in four states — Delaware, New York, Pennsylvania and West Virginia. Nearly 425,000 people are enrolled in Highmark plans.
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 travel insurance. The company also offers insurance for businesses.
Highmark Medicare Advantage customer service
Highmark Medicare Advantage members can contact their plan’s customer service 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 on Highmark's website.
Compare Medicare Advantage companies
Get more information below about some of the major Medicare Advantage insurance companies. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
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 preferred medical 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).
- Few member complaints and high member experience ratings.
- Good government ratings for quality.
- Fewer $0-premium plans and higher average premiums compared to competitors.
- Available in only four states: Delaware, New York, Pennsylvania and West Virginia.
NerdWallet writers are subject matter authorities who use primary, trustworthy sources to inform their work, including peer-reviewed studies, government websites, academic research and interviews with industry experts. All content is fact-checked for accuracy, timeliness and relevance. You can learn more about NerdWallet's high standards for journalism by reading our editorial guidelines.
- 1.NerdWallet analysis of CMS data. 2026 Star Ratings Data Tables. Accessed Apr 28, 2026.
- 2.NerdWallet analysis of CMS data. Monthly Enrollment by Plan. Accessed Apr 28, 2026.
- 3.NerdWallet analysis of CMS data. CY2026 Landscape 202603. Accessed Apr 28, 2026.
- 4.Centers for Medicare & Medicaid Services. Understanding Medicare Advantage Plans. Accessed Apr 28, 2026.
- 5.NerdWallet analysis of CMS data. Beneficiary Cost File. Accessed Apr 28, 2026.
- 6.NerdWallet analysis of CMS data. 2026 Star Ratings Data Table - Disenrollment Reasons (Oct 8 2025). Accessed Apr 28, 2026.
- 7.AM Best. AM Best Affirms Credit Ratings of Highmark Inc. and Its Subsidiaries. Accessed Apr 28, 2026.
- 8.JD Power. Medicare Advantage Plan Member Satisfaction Facing Headwinds; Digital Innovation an Emerging New Solution, JD Power Finds. Accessed Apr 28, 2026.
Medicare Advantage review methodology
NerdWallet’s Medicare Advantage ratings are based on premiums, out-of-pocket costs, prescription drug coverage, quality data from the Centers for Medicare & Medicaid Services, consumer experience and more. We calculate each health insurance company’s rating on a curved 5-point scale.
NerdWallet’s editorial team analyzed companies covering about 87% of all Medicare Advantage beneficiaries in the United States. We reviewed 25 Medicare Advantage brands, with some insurance companies having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.)
The Medicare Advantage marketplace is concentrated among just a handful of companies. In many places, one company serves more than half of the market. At the national level, NerdWallet’s reviews include each of the 10 largest brands by enrollment.
At the state level, our research includes at least one major insurer in every state where Medicare Advantage plans are sold, and includes the top two insurers in 40 of those 49 states. (Alaska doesn't offer Medicare Advantage plans.) We also look at online search volume to identify regional and other notable players in the space.
These reviews are a guide, but we encourage you to shop around and compare several plans to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for additional information.
Compare Medicare Advantage plans
Insurance company | CMS star rating | States available | Members in high-rated plans | Member experience | Learn more | |
|---|---|---|---|---|---|---|
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 4.11 | 4.11/5 | 48 states and Washington, D.C. | Medium (50% to 84%) | 3.74 (Average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 3.79 | 3.79/5 | 46 states and Washington, D.C. | Low (49% or less) | 3.82 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on http://askchapter.org on NerdWallet | 4.20 | 4.20/5 | 43 states and Washington, D.C. | Medium (50% to 84%) | 3.89 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on http://askchapter.org on NerdWallet |
(855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet | 3.76 | 3.76/5 | 29 states and Washington, D.C. | Medium (50% to 84%) | 3.96 (Above average) | (855) 432-0512 / TTY 711 M-F 9AM-9PM, Sat 10AM-6PM ETSpeak to a licensed insurance agent on askchapter.orgon NerdWallet |