Highmark Medicare Advantage Plans Review

Fact Checked
Expert reviewed by: Tammy Burns, insurance and healthcare consultant
Published: 4/23/2021


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Tammy Burns
Medicare advisor and nursing consultant
Tammy Burns
Medicare advisor and nursing consultant

Tammy Burns is an experienced health insurance advisor specializing in Medicare and senior health issues, including Medicare Advantage Plans and prescription drug plans, as well as ACA certified for health insurance and other ancillary, life and annuity products.

Highmark administers Medicare Advantage Plans with quality coverage for preventative care, but reviews are mixed on its treatment coverage.

Highmark is a regional health insurance company and independent licensee of the Blue Cross Blue Shield Association, offering policies to approximately 5.6 million members in Pennsylvania, West Virginia, and Delaware. It was established in the 1930s in response to the Great Depression and has since grown to be the fourth-largest overall Blue Cross Blue Shield-affiliated organization. In general, Highmark Medicare Advantage plans provide reliable coverage for preventative services but receive consistently low ratings for its coverage for hospital stays, physical therapy, and home health care. Understanding this insurer’s strengths can help you determine whether it’s a good fit for your needs.

Pros and Cons of Highmark Medicare Advantage Plans

What we like about Highmark Medicare Advantage Plans: The drawbacks of Highmark Medicare Advantage Plans:
  • No annual deductibles
  • No copay to see a primary care doctor
  • Covers a broad range of telehealth services
  • Only available in three states, and not all regions have available Medicare Advantage Plans
  • Limited plan options
  • Only PPOs are available

What Do Highmark Medicare Advantage Plans Cover?

Medicare Advantage Plans, including those by Highmark, provide an alternative way to receive Original Medicare benefits. These plans are offered by private insurance companies that comply with federal regulations and have the same medical and hospital coverage as Original Medicare. However, many plans have additional benefits such as vision, dental, hearing, and fitness coverage, prescription drug coverage, or home-based personal care services. With a Medicare Advantage Plan, you generally pay a premium equal to Original Medicare’s Part B premium. Some plans have additional monthly premiums depending on their scope of coverage.

Highmark Medicare Advantage Plan Options

There are two main Highmark Medicare Advantage plans, both of which are PPOs. These plans are flexible and cover in-network and out-of-network care, but they may have higher premiums than other Medicare Advantage Plan types. Both plans have monthly premiums beyond the standard Part B premium, one with a $25 premium and the other with a premium of $167. Neither plan has an annual deductible, and both provide telehealth coverage that is equivalent to in-person visits. The primary difference between these two plans is their annual maximum out-of-pocket costs. If you have the Distinct plan, you may pay up to $7,550 out-of-pocket per year for health care services. With the Standard plan, the maximum is a little lower at $6,500.

Here are the Highmark Medicare Advantage Plan options:

Plan Name Monthly premium Annual deductible Office visits Telehealth Emergency room Annual maximum out-of-pocket cost
Freedom Blue PPO Distinct

 

$25 $0 $0 primary/$35 specialist $0 primary/$0 home health/$35 specialist/$35 mental health/$35 physical therapy/$35 substance abuse counseling $90 $7,550
Freedom Blue PPO Standard

 

$167 $0 $0 primary/$35 specialist $0 primary/$0 home health/$35 specialist/$35 mental health/$35 physical therapy/$35 substance abuse counseling

 

$90 $6,500

*Based on pricing in Charleston, West Virginia

Highmark Medicare Advantage Plans Reviews and Ratings

Reviews for Highmark are mixed, with some members noting prompt, friendly service while others comment on high out-of-pocket costs and limited coverage options. In general, the plans rate well for their coverage of preventative services but have lower ratings for coverage of acute or chronic conditions.

Highmark has a rating of A- on the Better Business Bureau. Within the past three years, the company has closed 44 customer complaints.

The National Committee for Quality Insurance has ratings for three Highmark Medicare Advantage plans. Two plans have a rating of 3.5 and the other is rated 3. In the consumer satisfaction metric, the plans rate between 3.5 and 4.5. In the prevention metric, which measures how well the plans cover preventative services, all plans are rated 4.0. The plans consistently score lowest in the treatment metric, with ratings between 2.5 and 3.5.

Consumer Affairs discloses a rating of 2.5 out of 5 stars for Highmark based on 33 reviews. Many customers commend the company’s integrity and friendly service, while others note the high premiums and limited coverage.

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