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Highmark Medicare Advantage 2024 Review
Highmark Medicare Advantage plans are highly rated but available in only four states.
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Kate Ashford, CSA® Lead Writer | Medicare, retirement, personal finance
Kate Ashford is a writer and NerdWallet authority on Medicare. She is a certified senior advisor (CSA)® and has more than 20 years of experience writing about personal finance. Previously, she was a freelance writer for both consumer and business publications, and her work has been published by the BBC, Forbes, Money, AARP, LearnVest and Parents, among others. She has a degree from the University of Virginia and a master’s degree in journalism from Northwestern’s Medill School of Journalism. Kate has appeared as a Medicare expert on the PennyWise podcast by Lee Enterprises, and she's been quoted in national publications including Healthline, Real Simple and SingleCare. She is based in New York.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Highmark is a member of the Blue Cross Blue Shield family, which includes 33 independent companies. Highmark plans are highly rated and score well for member satisfaction, but plans are available in only four states.
We will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed above.
States available
4 states
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
High (90% or more)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
3.99 (Above average)
Pros
Higher-than-average overall star rating from CMS.
Member experience ratings are well above average.
Cons
Available in only four states: Delaware, New York, Pennsylvania and West Virginia.
Has the smallest percentage of $0-premium plans of the major providers.
States available
4 states
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
High (90% or more)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
3.99 (Above average)
Pros
Higher-than-average overall star rating from CMS.
Member experience ratings are well above average.
Cons
Available in only four states: Delaware, New York, Pennsylvania and West Virginia.
Has the smallest percentage of $0-premium plans of the major providers.
Highmark is a member of the Blue Cross Blue Shield family, which includes 33 independent companies that together form the third-largest provider of Medicare Advantage plans
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.
Highmark Medicare Advantage pros and cons
Highmark’s offerings have advantages and disadvantages.
Pros
Member experience: Highmark member experience ratings, including care coordination and customer service, beat those of major providers.
Higher-than-average star rating: Weighted by enrollment, Highmark’s Medicare Advantage contracts get an average Medicare star rating of 4.42 stars out of 5 from the CMS.
Extra perks: Highmark plans offer a number of benefits, from Part B Premium Giveback perks to 24/7 support.
Cons
Service area: Highmark offers Medicare Advantage plans in only four states: Delaware, New York, Pennsylvania and West Virginia.
Few $0-premium options: Highmark has the smallest percentage of $0-premium plans (38%) of the bigger providers.
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 4.42
Of the Highmark Medicare Advantage contracts with star ratings in 2024, all are rated 4 stars or higher. Hence, all of Highmark’s members are in highly rated contracts.
. (Most people pay this standard amount, but if your income is above a certain threshold, you’ll pay more.)
Copays, coinsurance and deductibles
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 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.
Here are examples of Highmark Medicare Advantage costs for the most popular plans in a mid-range city:
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 Highmark plans or compare across carriers.
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. Highmark also has a plan designed for veterans.
Plan offerings include the following types:
HMO plans
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-POS plans
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.
PPO plans
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.
SNPs
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.
Available Highmark 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
$108.80.
$195.10.
Annual deductible.
$545.
None.
Drug copay, Tier 1*
$0.
$0.
Drug copay, Tier 2*
$7.
$5.
Drug copay, Tier 3*
20% (Tier 3 insulin $35).
$40 (Tier 3 insulin $35).
*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 Highmark’s website to check how each available plan would cover your medications.
Highmark
4.42
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
We will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed below.
M-F 9am-9pm ET, Sa 10am-9pm ET
Speak to a licensed insurance agent on askchapter.org
M-F 9am-9pm ET, Sa 10am-9pm ET
Speak to a licensed insurance agent on askchapter.org
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 September 2023, 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.
J.D. Power Ranking
In its 2023 U.S. Medicare Advantage Study — the ninth it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on eight factors ranging from level of trust to how well a provider resolves problems or complaints. The study was fielded in the five biggest Medicare markets: California, Florida, New York, Pennsylvania and Texas. On these measures, Highmark placed second of all major providers in Pennsylvania (one of the two markets from the study in which Highmark has plans)
Highmark Medicare Advantage plans are available in four states — Delaware, New York, Pennsylvania and West Virginia — and more than 415,000 people are enrolled in Highmark plans. The company added 27,000 members for the 2024 plan year, according to a report from health care analytics firm The Chartis Group
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.
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.
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.
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).
Medicare Advantage review methodology
The Medicare Advantage marketplace is concentrated among just a handful of companies; in many places, one insurer serves more than half of the market. NerdWallet reviewed 26 Medicare Advantage brands, with some insurers having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.) At the national level, these reviews include nine of the 10 largest brands by enrollment. At the state level, our research includes at least one major insurer in 47 of the 49 states that offer Medicare Advantage plans, and includes the top two insurers in 35 of those 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.
NerdWallet’s Medicare Advantage reviews are based on ratings data from the Centers for Medicare & Medicaid Services, as well as pricing, plan availability by state, plan types available, consumer experience, extra benefits offered and more. 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.
