Highmark Insurance: Is It a Good Insurance To Have?

Updated: November 9, 2022
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With more than 6 million clients in Pennsylvania, Delaware, New York, and West Virginia, Highmark insurance is a preeminent provider of health insurance and the fourth-largest independent licensee of the Blue Cross Blue Shield Association. More than 90,000 clinicians make up its vast provider network. Community programs like the Highmark Walk for Healthy Community and the Highmark Caring Place are supported by Highmark to support its health insurance policies.

Does Highmark insurance offer quality health insurance?

We enjoy the following aspects of Highmark’s health insurance plans:

  • You don’t need recommendations to see specialists.
  • Some plans include coverage for vision and dental work.
  • Visits for free preventative care

Those Highmark’s health insurance programs include:

  • Only four states have coverage available.
  • There are only possibilities for exclusive provider organizations (EPOs).
  • There is no coverage for seeing out-of-network doctors.

What is covered by highmark insurance plans?

The following health insurance options from Highmark may fit both your demands and your budget:

  • CHIP
  • Dental
  • Plans for individuals and families
  • Medicare Supplement Insurance and Medicare Advantage Plans
  • Travel
  • Vision

Options for Highmark’s health insurance plans

Health insurance plans from Highmark come in a variety of price ranges. The monthly rates range is $383 to $669, but your cost might be lower if you are eligible for an income-based subsidy. You must seek treatment from medical professionals who are part of the plan’s network because all of Highmark’s health insurance plans are EPOs.

Highmark Medicare Advantage Cost

With average monthly charges of $96, Highmark is one of the more expensive Medicare Advantage providers overall.

The low-cost Highmark plans, however, are widely accessible, and the company offers $0 Medicare Advantage plans in 88% of the counties where it conducts business.

The exorbitant prices charged by Highmark are evident at the state level. In Pennsylvania, the average cost of a Highmark Medicare Advantage plan is $108 per month, compared to less expensive plans from Wellcare and AARP/UnitedHealthcare.

In Delaware, the cost of a plan averages $18 per month, demonstrating Highmark’s focus on providing cheap coverage in the state.

Are the Medicare Advantage plans offered by Highmark insurance a good value?

For those who anticipate needing routine or moderate levels of medical treatment, a low-cost Medicare Advantage plan from Highmark is an excellent option.

Many Highmark plans feature $0 deductibles for medical services and prescription medications. As a result, members can save any upfront payments, and the plan’s benefits start to kick in immediately, making routine treatment more affordable.

Additionally, medical care costs are typically affordable, with copayments of $20 for an X-ray, $30 for a specialist visit, and $50 for urgent care.

Highmark plans are not a good deal for people requiring pricey medical procedures like surgery.

The out-of-pocket maximum is a significant plan provision that limits how much you would have to pay for approved medical services over the year if you require pricey medical treatment. So, regardless of whether you require a $20,000 operation or a $200,000 cancer treatment, the amount specified by your plan is the most you would have to spend out-of-pocket.

Highmark’s coverage is short in this area. The high out-of-pocket maximum of the plan means that before it begins to pay 100% of the costs, your medical expenditures could total thousands of dollars.

Out-of-pocket maximums for the five cheapest Medicare Advantage plans from Highmark in Pittsburgh range from $5,500 to $10,000.

Those with expensive medical requirements can lower their overall costs by paying more for a plan since it has a higher out-of-pocket maximum.

For instance, if a person who required surgery opted for the Highmark plan, which costs $25 per month ($300 annually), as opposed to the free plan, their in-network medical expenses would be reduced by $1,000 as a result of the plan’s lower spending cap. After deducting the plan’s cost, there would be a net savings of $700.

A greater value might be had by upgrading to the $62 per month plan, which has an even lower out-of-pocket maximum. After paying for the plan, a person who had surgery would save $1,256 annually compared to the free plan.

Even the $5,550 out-of-pocket cap is excessive, though. Those who require pricey medical care may save even more money by selecting a different provider with a lower spending cap. A Humana plan that costs $19 per month and has an out-of-pocket maximum of $4,130 would result in a considerable net savings of $3,192 for the year after the plan’s cost when compared to Highmark’s free plan.

What’s the Process for Highmark Insurance Medicare Advantage Plans?

One of the top-rated Blue Cross Blue Shield association affiliates is Highmark.

The Highmark Inc. division provides Highmark plans in Delaware, Pennsylvania, and West Virginia. In addition to Buffalo and Albany, Highmark Blue Cross Blue Shield of Western New York offers insurance in 18 New York counties.

The business offers a variety of insurance products, such as Medicare Advantage plans, which combine Parts A and B of Original Medicare coverage into a single plan. Prescription drug coverage, dental insurance, vision care, and fitness benefits are all typically included in Medicare Advantage plans.

Plan advantages

If you reside in one of the counties the company serves, you will typically have a choice of six Highmark Medicare Advantage plans.

This consists of a combination of PPO plans, which cover both in-network and out-of-network medical care; HMO-POS plans, which give the option to go outside the network for some services; and HMO plans, which restrict coverage to in-network medical providers alone. Benefits could consist of:

  • Prescription drugs: Highmark plans typically offer reasonable copays and good coverage for prescription medications, and discounts are available if you use a preferred pharmacy. However, the more affordable plans in New York have a few hundred dollar prescription medicine deductible. This implies that you could have to pay for some drugs out of cash before receiving benefits.
  • Broad provider network: Blue Cross Blue Shield, a subsidiary of Highmark, has the broadest network of medical facilities. There are options like the $0 Freedom Basic (PPO), which can provide in-network coverage even when you are not close to home, even though the list of doctors differs for each plan.
  • Emergency coverage for all countries: Many plans will pay for emergency or urgent care while you’re traveling abroad.
  • Companionship and non-medical support: A few schemes include the PALS program, which offers at-home chore assistance, loneliness prevention through companionship, and non-medical care, including assistance with grocery shopping. Remember that persons taking part in these programs might be urged to undergo health checkups.
  • Dental: Preventive dental care and other non-routine dental care procedures are typically covered by plans. However, the cost of your advanced dental care may be considerable (up to 50% of the total bill), and a plan approval in advance is frequently needed.
  • Hearing: Most policies offer free hearing tests and coverage for hearing aids. Highmark is one of the best Medicare Advantage suppliers for hearing aids, with prices ranging from $699 to 999 per hearing aid.
  • Vision: Most insurance policies include eye tests, lenses, contacts, and eyeglasses.
  • Fitness: The SilverSneakers fitness program is included in the plans.
  • Wellness debit card: Members who complete tasks like cancer or diabetes testing can earn prizes.
  • Over-the-counter (OTC) allowance: A few plans give members a credit of $100 to $140 annually to spend at the Highmark OTC store on pharmacy items.
  • Telehealth: Depending on your plan, you’ll have access to virtual appointments via the Blues On Call program, the Doctor On Demand app, or a virtual appointment with your neighborhood physicians.

Customer feedback and reviews about Highmark insurance

Medicare Advantage plans from Highmark are known for having some of the greatest customer satisfaction ratings in the nation.

Highmark’s Medicare Advantage plans ranked second nationally for customer satisfaction in the J.D. Power poll. Kaiser Permanente only outperformed Highmark.

This star rating is not an accident. According to the CMS rating information, many of Highmark’s plans have received five stars. This top performance takes 40 criteria into account, including the frequency with which appeals are upheld, the rate at which the plan is evolving annually, and healthcare metrics related to healthy aging.

Highmark enrollees are extremely satisfied with their coverage, customer service, and the caliber of their medical care, according to the star ratings where policyholders provide their input.

Notably, the Highmark Inc. division that conducts business in Delaware, Pennsylvania, and West Virginia has received higher ratings overall than the Highmark Blue Cross Blue Shield division in Western New York.

Although Highmark has positive reviews and a customer service rating of 4.5 to 5, other aspects of the customer experience can differ by location.

Particularly, New York policyholders gave their prescription medicine coverage 3.5 stars out of 5. The lower score is probably because many of, the more affordable plans available in New York have high prescription medication deductibles.

How do customers review Highmark?

You can learn how well-regarded ratings and reviews compare an insurer’s plans to those of the competitors. View our assessment of Highmark.

Financial stability: 4.5/5

Highmark’s financial strength rating indicates the company’s ability to meet its financial obligations to consumers. Highmark receives an A- rating from A.M. Best, indicating financial soundness to cover claims.

Customer satisfaction: 4/5

Highmark’s customer satisfaction rating is determined using feedback from the Better Business Bureau (BBB), the National Committee for Quality Assurance (NCQA), and Consumer Affairs.

Highmark has a BBB rating of A-. The insurance company has resolved 44 consumer complaints in the last three years.

Highmark’s plans receive overall NCQA ratings of 3.5 and 4.0. Most plans have scores between 3.0 and 3.5 in each category—consumer satisfaction, prevention, and treatment—which indicates average performance.

Based on 33 reviews, Consumer Affairs rates Highmark 2.5 out of 5 stars.

Value: 4.5/ 5

Highmark’s plans offer advantages compared to those offered by other health insurance plans at comparable price points to determine their overall value. Monthly premiums, copays, coinsurance, maximum out-of-pocket amounts, and annual deductibles are a few expenses taken into account.

Coverage: 4.5/5

The breadth of choices clients have regarding the different plan types, in-network providers, and coverage options are shown by Highmark’s coverage rating.

Frequently asked questions

Does Highmark resemble Blue Cross Blue Shield in any way?

A separate business, Highmark, is a Blue Cross Blue Shield Association member. Consequently, the business is locally owned and run even if Blue Cross Blue Shield is a partner in the programs.

What distinguishes Highmark and Anthem from one another?

Highmark and Anthem are peer insurance providers because they are a part of the Blue Cross Blue Shield Association. On average, Anthem’s Medicare Advantage plans are 80% less expensive than Highmark’s. However, Highmark’s high rating of 4.5 to 5 stars outperforms Anthem’s rating of 3.9 stars.

Do Highmark Medicare plan offer value?

Highmark provides reliable Medicare Advantage plans with high customer satisfaction percentages and first-rate customer service. The coverage is best for consumers who require routine or moderate quantities of medical treatment, and its $0 plans are commonly available.

Can I use my Highmark insurance at UPMC?

UPMC is regarded as in-network and will accept your insurance under most Highmark plans. Details vary per plan, so you might not have complete access to some Highmark narrow-network plans.

Where can I find Highmark?

Medicare plans and conventional health insurance are sold by Highmark in Delaware, New York, Pennsylvania, and West Virginia, where it also conducts business.

Is Aetna superior to Highmark insurance?

Highmark’s Medicare Advantage plans are generally rated higher, while Aetna’s coverage is cheaper.

How much did Highmark insurance spend to rename the stadium Highmark?

The estimated $4 million yearly fee for the naming rights to the Buffalo, New York, area’s Bills stadium is paid by Highmark Blue Cross Blue Shield. According to the business, there won’t be an increase in insurance costs. This comes after investing in the naming rights to a stadium in Pittsburgh in 2012.

Sources and approach

The data is mostly gathered from Centers for Medicare & Medicaid Services or CMS data on Medicare Advantage. Only Medicare Advantage plans with prescription drug coverage were considered in our cost analysis; PACE plans, special needs plans, Part B-only plans, employer-sponsored plans, Medicare Medicaid plans, and sanctioned plans were not included. When a plan contains distinct monthly expenditures or coverages, each instance of the plan is considered separately. Based on each contract, an average star rating is calculated.

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