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Highmark traces its roots to two Blue Cross Blue Shield (BCBS) licensed insurance companies formed as far back as the 1930s. The merger of Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield in 1996 created Highmark, Inc. The company continued to do business under two separate BCBS names.
In 1999, the company expanded into West Virginia through a partnership with Mountain State Blue Cross Blue Shield. Eventually that company took on the Highmark name as well. Blue Cross Blue Shield of Delaware joined Highmark in 2011, taking the Highmark name officially the following year.
Today, Highmark Blue Cross Blue Shield covers the majority of Pennsylvania as well as parts of West Virginia and Delaware. The company has 4.7 million members in Pennsylvania alone.
The company offers individual and family plans as well as plans for small business. Additional products include dental coverage and Medicare plans. Their headquarters remains in Pittsburgh, but local offices cover each of the partner companies across three states.
Highmark Medicare Plans
Highmark offers all three types of Medicare coverage: Advantage, Part D, and Medicare Supplement. Plans vary from county to county, as do rates. For the purpose of this review, we selected the zip code where the company headquarters are located in Pittsburgh to obtain plan details.
There are nine Medicare Advantage plans to choose from, ranging in cost and coverage. Both HMO and PPO plans are available, as well as plans with or without Part D Prescription Drug coverage. This is an excellent selection of choices that should meet just about any needs.
Community Blue Medicare HMO Signature is the base plan, and is an HMO with a limited network. Primary care visits have a $0 co pay, while specialist visits have a $50 co pay. Emergency room visits have the standard $75 co pay, and inpatient hospital stays have a $300 per day co pay for the first five days. Basic benefits for vision, dental, and hearing are provided. This plan includes Part D coverage with Tier 1 co pays start at $0, Tier 2 at $13, and Tier 3 at $42. Tier 4 is covered at 40% and Tier 5 at 33%.
There is a second Community Blue plan that comes at a higher cost with lower co pays and coinsurance. Primary care is covered with no co pay, while specialist visits have a $10 co pay. Inpatient hospital has a low one-time co pay of $100 per admission. Part D coverage is much the same as is dental, hearing, and vision.
The Security Blue HMO plans are available in four forms: Basic, Value Rx, Standard, and Deluxe. The Basic plan does not include Part D coverage, but has a lower premium and lower co pays than the Value Rx plan.
Co pays on the Basic plan are $5 for primary care visits and $30 for specialist visits. Inpatient hospital stays have a one-time $350 co pay per admission, rather than a per day co pay. The same basic hearing, dental, and vision coverage is included in this plan as with all of the other Highmark plans. There is no prescription coverage, however, so Part D would have to be purchased separately.
The Value Rx plan has a $10 co pay for primary care visits and a $35 co pay for specialists. The inpatient hospital co pay is $200 per day for the first seven days. Prescription drug coverage is included with co pays matching those on the Signature plan, and this plan also includes the same dental, vision, and hearing benefits that is found on the other plans. Co pays overall are a little higher on this plan than with the Basic, but the premium isn’t much higher – this strikes a balance to allow the inclusion of Part D.
The next two plans take a fairly big jump in premium, and have a less limited network although they are still HMOs. The Standard plan has a $10 primary care co pay and a $30 specialist co pay. Inpatient hospital has a one-time $350 co pay. The dental, vision, and hearing benefits are the same as with the Value plan, as are the prescription co-pays.
The Deluxe plan has lower co pays than the other two Rx-inclusive plans. Primary care is a $5 co pay and specialist visits $25. Hospital stays have a one-time co pay of $225 per admission. While the prescription benefits are generally the same, as are the vision benefits, dental care and hearing aids have lower co pays.
The Freedom Blue plans come in three different types, and all three are PPO plans, allowing for a wider network of providers. As PPO plans, they carry higher premiums overall than do HMOs. Coverage is more affordable in network than out of network, as with most PPO plans.
The first option is the Value Rx, which is the lowest priced of the PPO choices. This plan has a $15 co pay and $40 co pay for primary care and specialist respectively if the provider is in-network. Out of network is covered with a 30% coinsurance or 10% for inpatient hospital. Inpatient hospital stays in-network have a $300 per day co pay for the first five days. This plan includes prescription coverage with slightly higher co pays than the HMO plans. Tier 1 starts at $3, Tier 2 at $20, and Tier 3 at $47. Tiers 4 and 5 have coinsurance of 45% and 33% respectively.
The PPO Select option has somewhat lower co pays at $10 for primary care and $30 for a specialist in network, but the difference is not enough to explain the doubled monthly premium. Inpatient hospital stays are $250 per day for the first five days, and prescription coverage is the same as the other plan, as are dental, vision, and hearing benefits. In this case, the much higher premium may be due to an extended network of providers as well as lower co pays, although this is not made clear.
Finally, the third option, The Freedom Blue PPO Classic, takes another big jump in premium. Again co pays are lower overall for this plan, at $5 for a primary care visit and $25 for a specialist. Inpatient hospital stays are covered with a $125 per day co pay for the first five days. Coverage for prescription drugs, dental, hearing, and vision is the same as that offered with the other Freedom Blue plans, although the co pays are somewhat lower for dental care. None of these numbers explains the high cost of this plan – which is the most expensive Highmark offers.
Part D – Prescription Drug Plans
Highmark offers two Part D Prescription Drug plans, Blue Rx PDP Plus and PDP Complete. The first plan has a lower monthly premium but a $400 deductible. Preferred Generic drugs – Tier 1 have no co pay. Tier 2 has a $2 co pay, and the rest of the Tiers are a coinsurance amount. Tier 3 is 15%, Tier 4 is 40% and Tier 5 is 25%. Co pays are higher at non-preferred pharmacies.
The second plan has not deductible but a higher monthly cost. Again, Tier 1 starts at $0 for preferred pharmacies. Tier 2 has a $4 co pay and Tier 3 a $40 co pay. Tiers 4 and 5 have a 35% and 33% coinsurance respectively.
Highmark offers several of the standardized Medicare Supplement plans using the lettered system common to most states. They offer plans A, B, C, F, and N, as well as the high deductible Plan F, which offers the same coverage at a lower premium due to the deductible.
Plan A is the basic plan that all Medicare Supplement providers offer, and covers coinsurance and co pays for hospital, medical, and hospice, as well as three pints of blood annually. From there, the plans offer varying coverage for different out of pocket costs, up to Plan F which is the most comprehensive plan available, covering nearly all out of pocket costs. As a result, Plan F is the most expensive, so the high deductible option is available to mitigate that cost.
Highmark offers the most popular plan choices as well as a few other options, which should ensure that there is a plan to meet the needs of most people.
Highmark only covers a limited region, so a national rate comparison nor our standard sample comparisons are available. However, the website does offer easy access to rate information, and a good range of plans at various price points. The prices we sampled are again from the same zip code where Highmark’s headquarters is located, in Pittsburgh, PA.
Medicare Supplement plans start at $0 premium (although you will still have to pay the regular Original Medicare premium amount, as with all Advantage plans. Rates then climb steadily through the plan list to the most expensive plan, the Freedom Blue PPO Classic, which has a $297 per month premium. Not surprisingly, the HMO plans are more affordable than the PPO plans, with the most expensive HMO plan, (Community Blue Prestige) at $199 per month.
Part D plans cost $95.10 for the Plus option and $170.60 for the Complete option.
For Medicare Supplement plans, the most basic, Plan A, has a premium of $141.25. Plan F, which has the most coverage, is the most expensive at $199.10, although the high deductible option brings it down to $96.55. Although we can’t really compare these rates due to local differences, they do seem to be on the high side from what we have seen elsewhere for the same plans.
Ratings and Reviews
Highmark has an A+ rating with the Better Business Bureau for the main office in Pennsylvania. There were 88 complaints filed in the past three years, and 21 of those were closed in the past 12 months. For a company of this size, those numbers are not high.
The National Committee for Quality Assurance has multiple records on file for Highmark under different names. The ratings range from 3.5 to 4.5 depending on the branch of the company. These overall scores are determined from a multi-factor rating system.
The Medicare star rating for Highmark overall, as ranked by the Centers for Medicare and Medicaid Service, was a 4.0 for 2016.
Consumer Affairs shows 16 reviews for Highmark, and while a few are negative, there are multiple three star and up reviews – in fact, more positive than negative reviews. This is highly unusual for a health insurance company of this size. Even for companies with a good reputation, there are usually more negative than positive reviews available due to the nature of review sites, which are used for complaints more often than kudos.
Overall, the ratings and reviews give a very positive view of Highmark. There are far fewer complaints than we would expect for such a large insurer, and more positive reviews than even larger companies see.
The Bottom Line
Highmark is a solid choice for Medicare coverage. They have a wide range of products, can meet most any budget, and enjoy a good reputation among members and from official channels. Although they appear a little expensive in some areas, the balance of service, product offerings, and price comes out in their favor. For residents of the Highmark coverage area, they are a good option.
For a list of companies that we recommend, visit our Best Insurance Companies page.