What Is The Highmark Medicare Advantage of 2023?

What Is The Highmark Medicare Advantage of 2023?

2023 Highmark Medicare Advantage Highmark is part of the Blue Cross Blue Shield family, which includes 34 independent organisations.

Highmark’s plans score well in member satisfaction and plan performance, but they’re only offered in four states.

About Highmark Medicare Advantage.

Highmark Medicare Advantage pros and cons

Highmark has pros and cons.


  • J.D. Power’s 2022 Medicare Advantage Study rates Highmark third out of nine providers (including three Blue Cross Blue Shield businesses). It’s the top Blue.
  • CMS gives Highmark’s Medicare Advantage contracts a 4.76-star grade, weighted by enrollment.
  • Highmark plans include Part B Premium Giveback and 24/7 nursing advice.


  • Only Delaware, New York, Pennsylvania, and West Virginia offer Highmark Medicare Advantage plans.
  • Highmark has the most expensive Medicare Advantage plans of the Blues and the fewest $0-premium options (40%).

Available Highmark Medicare Advantage plans

Structure, pricing, and benefits vary among Highmark Medicare Advantage plans. The company offers HMO, PPO, and drug-only insurance. Valor PPO plans from Highmark are new in 2023.

Plans include:

HMOs require you to use a certain network of doctors and hospitals. Your main doctor may send you to a specialist, and out-of-network benefits are limited.

Read: The Best Medicare Advantage Plans in Maine

PPO plans allow you to see any provider who accepts the insurance. You may not require a primary doctor and specialised referrals. Out-of-network care may cost more than in-network.

SNPs limit participation to those with certain diseases or traits. So, the advantages, network, and prescription formularies are customised. Highmark has one SNP:

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

Available Part D prescription drug plans

Highmark sells stand-alone Part D prescription medication plans in Pennsylvania and West Virginia. These plans pay Medicare Part A and Part B medication costs, but not medical costs.

Highmark sells PDPs in two states: ordinary and “complete” with expanded coverage. Highmark offers two alternatives in Erie, Pennsylvania:

Compare the two plans:

*After meeting any applicable deductible, up to a 31-day supply of a Part D prescription medicine at a selected retail pharmacy.

Plan premiums, deductibles, covered medicines, tier fees, and pharmacy agreements vary. Anthem’s website lets you enter your prescriptions and pharmacy to see which plans cover them.

Highmark Medicare Advantage covers dental, vision, and hearing. Many plans offer additional advantages. Some highlights:

  • Some Highmark plans offer monthly Part B premium refunds.
  • Some Highmark plans offer $0 copays for doctor visits, labs, mail-order prescriptions, and preventative dental treatment.
  • Many plans include SilverSneakers, which allows members access to a network of gyms, fitness facilities, classes, and events.
  • Members can get a free House Call Visit from a licenced health practitioner.
  • Relationships. Some Highmark members can access the Blue Neighbors programme, which offers virtual bingo and trivia games.
  • Blues On Call members can call qualified nurses 24/7 for questions.
  • Medication management: Members with chronic diseases including osteoporosis, rheumatoid arthritis, diabetes, or depression have access to a Medication Therapy Management programme to manage medicines effectively and pay prescriptions.
  • Highmark Medicare Advantage members can contact UnitedHealthcare’s customer service:
  • Call 8 a.m. to 8 p.m. local time seven days a week.

As of October 2022, 375,000 people were enrolled in Highmark Medicare Advantage plans in Delaware, New York, Pennsylvania, and West Virginia.

Highmark is tied for sixth in market share and added the most Medicare Advantage subscribers among Blues plans in 2022, 78,000.

Plan, geography, and health needs affect Medicare Advantage costs. The plan’s premium is a cost. Highmark’s Medicare Advantage plans have $0 premiums in 4/10 cases. Monthly consolidated Highmark premiums (Parts C and D) range from $22 to $285.

Highmark’s monthly SNP premium is $41.10.

Even with Medicare Advantage, you must pay your Medicare Part B premium of $170.10 per month in 2022 ($164.90 in 2023). If your income is above a specific threshold, you’ll pay more.

Also consider:

  • The plan’s Medicare Part B premium coverage.
  • Plan deductibles, including drug deductibles.
  • Each visit or treatment requires copayments or coinsurance. For example, your basic doctor may cost $10 and a specialist $45.
  • Out-of-network and in-network maximums.
  • How often you can see an out-of-network doctor.
  • Extra perks and if the plan costs for them.

Medicare’s website lets you compare costs for local plans. You can select UnitedHealthcare or compare across carriers. UnitedHealthcare’s website lets you compare plans by ZIP code.

Highmark Medicare star ratings

4.76 average enrollment-weighted stars:

CMS rates every Medicare Advantage and Medicare prescription medication plan from best (5 stars) to poorest (1 star) (1 star). The FDA bases these ratings on plans’ quality of care and customer satisfaction, and they may alter annually.

All Medicare Advantage plans are evaluated on health plan and medication plan metrics.

Based on enrollment, Highmark Medicare Advantage plans have a 4.76 average rating.

2023 plans average 4.15 stars.

Two-thirds of 2023 Highmark Medicare Advantage contracts are scored 5 out of 5 stars. No 4-star contracts exist.

Highmark’s strengthsCMS uses 40 plan elements to rate contracts. CMS Star Ratings Technical Notes define each factor. Highmark contracts scored 4.5 or above on these measures:

CRC screening.

  • Blood sugar-controlled diabetes care.
  • Quickly getting care.
  • Plan complaints.
  • Leaving the plan.
  • Plan handles appeals quickly.
  • Reconsidering appeals.
  • Call centre interpreter and TTY available.

Read: AAA Renters Insurance Review 2022: What to Know

  • Call centre has an interpreter and TTY.
  • Pharmaceutical complaints.
  • Leaving the drug plan.
  • Prescription medicines.
  • Accurate Medicare plan prices.
  • Hypertension medications (RAS antagonists).
  • Highmark’s weaknesses
  • Highmark contracts lacked in some aspects. CMS Star Ratings Technical Notes define each factor. Below 3.0 stars:

Watching exercise.

  • Care for special needs.
  • Fall prevention.
  • Improvements to health plans.
  • Quality drug plan.
  • Two companies rate health plans and company strength:

AM Best Financial Strength Rating: A (Excellent)

AM Best rates insurance companies. AM Best affirmed Highmark’s A (Excellent) Financial Strength Rating in August 2022. AM Best believes Anthem can meet its insurance commitments with an A rating.

J.D. Power Ranking: 3rd out of 9

J.D. Power rated member satisfaction with Medicare Advantage plans based on coverage and benefits, provider choice, pricing, customer service, information and communication, and billing and payment. Highmark earned 811 out of 1,000 and ranked third among the top nine Medicare Advantage providers, barely above the industry average.

Compare Medicare Advantage providers

Learn about major Medicare Advantage providers below. These insurers serve most states. ZIP code and county determine available plans.

Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield merged to form Highmark in 1996. Highmark is Blue Cross Blue Shield’s fourth-largest company. Highmark offers health, dental, Medicare Advantage, Part D, Medicare Supplement, fertility treatment, and travel insurance. Company offers business insurance.

Highmark Health, Highmark Inc.’s parent firm, reported $22 billion in 2021.

Find the right Medicare Advantage plan

  • Costs of the scheme Do you know the premium, deductible, copays, and coinsurance? Cost-effective?
  • Your doctor in-network? Make sure your favourite doctors are in the plan’s network.
  • Medications covered? Medications must be covered by the plan. What tier are your prescriptions, and are there coverage rules?
  • Dentist coverage? Vision, dental, and hearing coverage?
  • Extras? Does the plan include fitness memberships, transportation, or meal delivery?


I am Dharmendra Jain, Owner of this website. In point of fact, the author, Dharmendra Jain, writes on Finance Niche, because he enjoys disseminating knowledge to people all over the globe. The author has expressed a desire to maintain communication with all of his or her devoted readers. And in order for me to be connected to the internet in the first place, it compelled me to do so.

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