Highmark Medicare Insurance Review & Complaints: Health Insurance

Highmark Medicare rates vary based on the coverage plan you chose, and both HMO and PPO plans are available. The Community Blue HMO Signature plan is the only $0 premium option, with rates increasing from there. Highmark Medicare Supplement plans are available at several levels, with rates starting at $138.85 a month. There are also two levels of Highmark Medicare Part D coverage to choose from.

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Nov 8, 2021

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Financial Strength

Highmark is a Pittsburgh-based Blue Cross Blue Shield (BCBS) licensee offering health insurance plans in Pennsylvania and surrounding states. The company operates as a not-for-profit health plan that is among the largest in the country.

In this Highmark Medicare review, we’ll cover the company’s Medicare plan options including Advantage and Supplement. We’ll also look at some Highmark Medicare quotes and see how they stack up in terms of ratings.

Before you make the decision to buy Highmark Medicare insurance, compare your options. For fast, free Medicare quotes all you have to do is enter your ZIP code.

What is Highmark?

Highmark was created in 1996 from the merger of two much older BCBS companies, both of which reach back to the 1930s. Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield operated as part of Highmark but under their original names for several years before the Highmark name came into official use.

Expansion into other states began with a partnership with Mountain State Blue Cross Blue Shield in Georgia and the addition of Blue Cross Blue Shield of Delaware in 2011. All of the original companies now operate under the Highmark name.

Highmark today has more than 4.7 million members in Pennsylvania and also serves parts of Georgia and Delaware, making them a major player in the health insurance market for the region.

The company’s headquarters remain in Pittsburgh, and they sell individual plans, family plans as well as group plans across the service area. They also offer Medicare Advantage, Supplement, and Part D drug coverage.

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What Types of Health Plans Are Available?

Highmark’s Medicare Advantage plans for 2021 differ depending on location. For the purpose of this review, we selected the company’s home zip code in Pittsburgh to review policy options; if you live in a different area, your insurance plans and rates may be different.

Highmark writes all three types of Medicare coverage in our sample area: Advantage, Supplement, and Part D.

What are Highmark Medicare Advantage Plans?

Our search returned a total of 10 Medicare Advantage plans, with a mix of HMO, HMO-POS, and PPO plans to choose from.

Community Blue HMO Signature is the only $0 premium (beyond your regular Medicare premium) plan from Highmark. This plan has no copay for primary care visits and a $30 copay for specialist visits. Inpatient hospital stays have a flat rate copay of $300 rather than a per-day charge. This plan includes routine dental, vision, and hearing coverage, and prescription coverage starts at a $0 copay for Tier 1.

Community Blue HMO Prestige has copays of $0 for primary care and $25 for specialists, with a per-admission copay of $225 for inpatient hospitals. This plan also includes routine dental, vision, and hearing, and prescriptions again start at a $0 copay.

Complete Blue PPO Distinct provides access to the PPO network and also provides coverage for out of network care. In-network primary care visits have no copay and specialist visits have a $30 copay. Inpatient hospital stays have a copay of $325 per day for the first five days. Out of network copays are higher. This plan again includes routine vision, hearing, and dental coverage and has prescription copays starting at $0 for Tier 1.

Freedom Blue PPO Value Rx is an unusual PPO in that the in-network and out of network copays are the same for many basic services. Primary care visits have no copay, specialists a $40 copay, and inpatient hospital stays $225 for the first five days. Again, prescriptions start at $0 for Tier 1, and dental, vision, and hearing basics are covered.

Like the Value Rx plan, Freedom Blue PPO Select has the same copays in and out of network for office visits and hospital stays. There is no charge for primary care and a $30 copay for specialist visits. Inpatient hospital stays have a copay of $175 for the first five days. Like the other plans, dental, vision, and hearing are included and prescriptions start at $0.

The third Freedom Blue plan is the PPO Classic, which is similar to the others but with a lower specialist copay of $25 ($0 again for primary care) and a flat per-admission inpatient hospital copay of $225. Dental, vision, hearing, and prescription coverage are much the same.

There are four Security Blue HMO-POS plans to choose from. The Basic version has copays of $0 for primary care and $30 for specialists, with a per-admission hospital copay of $350. This plan includes routine vision, dental, and hearing coverage, but does not have any prescription drug coverage.

The Security Blue Value Rx plan has no copay for primary care visits and a $40 copay for specialists. Inpatient hospital stays have a copay of $225 a day for the first five days. This plan does include prescription coverage, with Tier 1 starting at $0. Vision, hearing, and dental are also included.

The Security Blue Standard plan again has no copay for primary care, and it has a $30 copay for specialists. Inpatient hospital stays have a per-admission copay of $350. Again, Tier 1 drugs have a $0 copay and dental, vision, and hearing are included.

Finally, the Security Blue Deluxe plan has no copay for primary care and a $25 copay for specialists. Hospital stays have a per-admission copay of $225. Prescription coverage is similar to the other plans, with $0 copays for Tier 1, and dental, vision, and hearing are included.

What Medicare Part D Plans Are Available?

There are two Part D prescription drug coverage plans offered by Highmark, a change from previous years. Basic Blue plans are no longer offered based on our sample area but previously were available in partnership with MII Life Insurance, Inc.

These are the plans that were previously available, and may still be offered in some areas:

Basic Blue Value does not have a copay for Tier 1 and has a $1 copay for Tier 2, with no deductible. A $415 deductible applies to Tier 3, 4, and 5, which have coinsurance amounts of 15%, 35%, and 25% respectively.

Basic Blue Standard has a $415 deductible that applies to all tiers. After that is paid, Tier 1 has a $2 copay, Tier 2 a $6 copay, and Tiers 3, 4, and 5 have coinsurance amounts of 15%, 32%, and 25% respectively.

Currently available, based on our sample area, are these two options:

Blue Rx PDP Plus has a $445 copay for all tiers. Tier 1 has a $0 copay and Tier 2 a $7 copay. Copays are 20%, 40%, and 25% for Tiers 3, 4, and 5 respectively.

Blue Rx PDP Complete has no deductible at all, and copays are $0 for Tier 1, $5 for Tier 2, and $40 for Tier 3. Tier 4 has a 35% coinsurance and Tier 5 33%.

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What Does Highmark Medicare Supplement Cover?

For our sample area, Highmark offers a good selection of the standardized letter-coded Medicare Supplement plans.

The listed plans are A, B, D, G, and N, for a total of eight of the available eleven. Plan F is only available to those that were eligible for Medicare before January 1, 2020.

Plan A is the base plan offered by all Medicare Supplement insurers and covers Part A and B coinsurance as well as the first three pints of blood each year. The other plans expand on this coverage, with Plan F being the highest level of coverage; F pays for all out of pocket expenses not covered by Medicare. Because this makes it pricey, the high deductible option is offered to provide a lower monthly premium with a set out-of-pocket amount in the form of the deductible.

Does the Company Offer Competitive Rates?

Highmark’s rates are clearly listed along with the descriptions of the products offered. The Community Blue HMO Signature plan is the only $0 premium option, with rates increasing from there. The next cheapest plan is the Community Blue PPO Distinct at $35 a month.

The most expensive of the Advantage plans is the Freedom Blue PPO Classic at $282 a month. There are quite a few plans in the under $100 range and two that land in between $100 and $200 – plans take a leap to over from there $200 fairly quickly.

Part D plans start at $94.80 a month for the Blue Rx PDP Plus. The other plan, the Blue Rx PDP Complete at $164.40

We ran a quote for Medicare Supplement for a 65-year-old female. The Medicare Supplement Plan A rate is $143.95, with the least expensive option being Plan D at $138.85. There is not much difference in rates between the available plans.

These rates are specific to the area in which they were quoted and cannot be easily compared to other regions. That said, we found them to be high overall based on what we have seen nationwide, although there are also some good budget choices here.

How Are Claims Handled?

Like all health insurance companies, Highmark handles claims directly with the providers, so in most cases there should be no need for customers to be involved in the process. As a result, there is not much information to be found regarding claims on the Highmark site.

There is a Highmark Medicare phone number you can call with any questions; this is the same as the Highmark customer service number. you can also find a Highmark prior auth form online if you require one for a treatment or procedure.

The Highmark Medicare provider login can only be used by providers, although customers can use their own login to follow up on claims.

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Are Ratings and Consumer Reviews Positive?

The health insurance company has an A+ rating with the Better Business Bureau (BBB), with a total of 50 complaints in the past three years. 13 of those complaints were closed in the past 12 months. That is a low complaint volume for such a big company. There are 17 negative reviews on the page, citing mainly billing issues and denied coverage.

Consumer Affairs has 17 reviews of the health insurance company with an overall three-star rating – which is good for a site people generally use to file complaints. The reviews are scattered across the spectrum, with the majority being three-star and higher.

The National Committee for Quality Assurance ranks all of Highmark’s Medicare branches at a 3.5 overall out of 5. That is a little above average but not into the higher-performing numbers of some other Medicare insurers. That said, for the two PA branches (HMO and PPO), consumer satisfaction is where they earned their highest marks, with 4.0 rankings for both.

Medicare’s 2019 ratings for the Highmark plans are a solid 4.5 stars with the exception of the Freedom Blue plans – which are also the most expensive – that earned only a 3.5-star rating.

Highmark Medicare: What’s the Bottom Line?

Highmark has a good selection of insurance products, with some budget options as well as some much pricier choices. There are no red flags in our look at their reputation, with low complaint volume and generally good ratings. They are well worth a look for your Medicare needs if you live in their service area.

Now that you have read this health insurance company review, you may have chosen an affordable Highmark Medicare plan that looks like it will work for you. But before you enroll, take the time to compare rates from other companies. We can help. Just enter your ZIP code to get started.

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