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Highmark Medicare Review

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UPDATED: Nov 30, 2018

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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.

About 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 one a major player in the health insurance market for the region.

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

Highmark Medicare Plans

Highmark’s Medicare plans 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 plans and rates may be different.

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

Medicare Advantage

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 $20 for specialists, with a per-admission copay of $225 for inpatient hospital. This plan also includes routine dental, vision, and hearing, and prescriptions again start at a $0 copay.

Community Blue PPO signature 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 $40 copay. Inpatient hospital stays have a copay of $250 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 $5 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.

Medicare Part D

There are four Part D prescription drug coverage plans offered by Highmark, two Basic Blue, and two Blue plans. Basic Blue plans are offered in partnership with MII Life Insurance, Inc.

Basic Blue Value Has 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.

Blue Rx Plus has a $415 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 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%.

Medicare Supplement

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

The listed plans are A, B, C, D, F, high deductible F, G, and N, for a total of eight of the available eleven.

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.

Rates

Highmark’s rates are clearly listed along with the plan descriptions. 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 Signature at $13 a month.

The most expensive of the Advantage plans is the Freedom Blue PPO Classic at $293 a month. There are a few plans in the under $100 range, but nothing in between $100 and $200 – plans take a leap to over $200 fairly quickly.

Part D plans start at $21.80 a month for the Basic Blue Value plan. The most expensive is the Blue Rx Complete at $156.

The Medicare Supplement Plan A rate is $141.35, with the least expensive option (and the only one under $100) the Plan F high deductible at $96.85 a month.

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.

Claims

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.

Ratings and Consumer Reviews

Highmark 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 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.

The Bottom Line

Highmark has a good selection of plans, 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.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My 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.

1 Comment

  1. What are some of the “higher performing numbers of some other Medicare providers” that you mention as higher-rated than Highmark PPO, and which of those are providers that would offer a plan for me in the 19446 area of SE PA?

    Reply

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