Highmark Medicare Advantage Plans Review

Fact Checked
Medicare rating: 4.5 stars A.M. Best financial strength rating: A BBB rating: A- NCQA rating: 3 to 4.5 stars Consumer Affairs rating: 2 J.D. Power ranking: 3rd out of 10

Quick Highmark Medicare Advantage Plans review: 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, New York, 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 four states, and not all regions have available Medicare Advantage Plans
  • Limited plan options
  • Only PPOs are available

What Do Highmark Medicare Advantage Plans Cover?

Also called Medicare Part C, Medicare Advantage Plans combine Part A and B benefits with various extra services. Most Highmark Medicare Advantage Plans include:

  • Prescription drug coverage
  • Vision
  • Dental
  • Hearing
  • Wellness benefits, such as free gym memberships
  • Medical transportation (some plans)
  • Wellness over-the-counter medications (some plans).

If you have certain chronic medical conditions, such as cancer or Alzheimer’s, you may qualify for a Medicare Advantage Special Needs Plan that serves a specific population group. With Medicare Advantage, you continue to pay your Original Medicare premiums. In many cases, there’s no additional cost, but 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 $166. Neither plan has an annual deductible, and both provide telehealth coverage that is equivalent to in-person visits.

Here are the Highmark Medicare Advantage Plan options in 2022:

Plan name Monthly premium Annual deductible Office visits Annual maximum out-of-pocket cost
Freedom Blue PPO Valor $0 $0 $0 primary/$10 specialist $6,000 in network, $8,950 in and out of network combined
Freedom Blue PPO Standard $0 $0 $0 primary/$30 specialist $7,550 in network, $10,000 in and out of network combined

*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.

Trusted ratings and reviews can help you understand how an insurer’s plans stack up against the competition. See how Medicare, A.M. Best, the Better Business Bureau and more rate Highmark Medicare Advantage plans.

Medicare rating: 4.5 stars Highmark’s Medicare Advantage Plans have an overall rating of 4.5 for quality and performance from the Centers for Medicare & Medicaid Services.
A.M. Best financial strength rating: A A.M. Best is a credit rating agency specializing in the insurance industry. In September 2021, A.M. Best affirmed its Financial Strength Rating of A (Excellent) to Highmark Inc. (Camp Hill, PA) and its life/health subsidiaries, collectively known as Highmark Inc. Group.

An A rating indicates stability to meet ongoing obligations.

BBB rating: A- Highmark has a rating of A- with the Better Business Bureau. Within the past three years, the company has closed 59 customer complaints.
NCQA rating: 3 to 4.5 stars 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 rating: 2 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.
J.D. Power ranking: 3rd out of 10 In its 2021 Medicare Advantage Study, J.D. Power measured Medicare Advantage Plan satisfaction based on coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. Highmark scored 811 points out of 1,000 and came in third out of the top 10 Medicare Advantage providers.
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Certified Senior Advisor (CSA)®

As a health care professional since 1987, Kelly Blackwell has walked alongside and cared for seniors as they journey through the season of their fourth quarter of life. Blackwell holds a Bachelor of Science in nursing from the University of Northern Colorado, a Master of Science in health care administration from Grand Canyon University, an interprofessional graduate certificate in palliative care from the University of Colorado Anschutz Medical Campus and holds a Certified Senior Advisor® credential from the Society of Certified Senior Advisors.

Blackwell contributes to the University of Colorado-Anschutz blog and has been published in “The Human Touch” distributed by the University of Colorado Center for Bioethics and Humanities. She cowrote “Dying Is” for Pathways Hospice.

A registered nurse, Blackwell understands health insurance choices influence quality of life and are driven by values, goals, and beliefs. She’s passionate about engaging with, educating, and empowering seniors as they navigate the health care system. She’s equipped to lend an experienced, compassionate voice to beneficiaries seeking information about Medicare Advantage Plans.

As a CSA®, Blackwell has access to valuable resources for Medicare beneficiaries. Her work as a bedside nurse and clinical manager has given her the opportunity to see how Medicare rules, regulations, and benefits work when patients need them. With a passion to learn and to make a difference in the lives of seniors, Blackwell supports seniors through Medicare and fourth-quarter life decisions.

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