Curated by Claudia Shannon / Research Scientist / ishonest

Highmark Medicare Advantage plan options

Highmark offers two types of Medicare Advantage (Part C) plans, such as Health Maintenance Organization (HMO) plans and Preferred Provider Organization (PPO) plans.

Each Highmark Medicare Advantage plan has a different combination of extra services and coverage.

Highmark HMO plans

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HMO plans typically offer the most cost savings, but they restrict you to receiving care from physicians and hospitals within your plan’s network. These can also come in the form of HMO Point-of-Service (HMO-POS) plans, which may give you the ability to see out-of-network providers.

Highmark PPO plans

PPO plans offer more flexibility. They allow you to go outside your plan’s network for care — but this comes at a higher price. You’ll likely pay higher premiums for these plans, plus higher copayments when you choose an out-of- network provider.

Highmark Part D options

Highmark offers prescription drug coverage under several of its Medicare Advantage plans. It also offers stand-alone prescription drug, or Part D, coverage.

The monthly premiums for these stand-alone Part D plans vary, with the more expensive plans offering greater savings on specialty medications. Each plan includes gap (or “donut hole”) coverage and catastrophic coverage.

What states offer Highmark Medicare Advantage plans?

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Highmark and its Blue Shield components make up one of the country’s largest health insurance organizations.

Based in Pittsburgh, Highmark offers several Medicare Advantage plans to people who live in parts of:

• Pennsylvania
• West Virginia
• Delaware
• New York

What do Highmark Medicare Advantage plans cover?

Each Highmark Medicare Advantage plan will cover several basic services, and plans offer additional services such as prescription drug coverage and dental plans, if you choose to purchase them.

Basic coverage

Services provided under original Medicare, which is made up of Medicare parts A and B include hospital inpatient services, hospice care, limited skilled nursing care, outpatient and physician visits, preventive care, and some therapies.

Extra options

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Additional services may be added based on your needs and budget. Optional services offered as a part of Highmark Medicare Advantage plans include:

• routine annual vision, dental, and hearing screenings
• glasses or contacts
• hearing aids
• dental work
• chiropractic care
• an allowance for over-the-counter purchases
• wellness and fitness programs
• prescription drug coverage

Highmark also offers a number of specialty services with some of its plans, including:

• Highmark Clinical Care Team: a personalized team of medical professionals aimed at health promotion
• Blues on Call: a 24/7 on-call nursing service for general medical questions
• Highmark House Call: a yearly home visit from a healthcare provider to review your medications and medical history and answer any questions
• People Able to Lend Support (PALS): an organization of volunteers who provide additional support to Highmark members in need

How much do Highmark Medicare Advantage plans cost?

Highmark Medicare Advantage plans may charge a monthly premium, while other plans have a $0 premium. All plans have copayments, coinsurances, and deductibles. Costs vary based on the plan and coverage level you choose.

Below are several examples for 2022 from across Highmark’s coverage area.

What is Medicare Advantage (Medicare Part C)?

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Medicare Advantage (Part C) is a healthcare plan that’s offered through private insurance providers.

Part C combines all the elements of original Medicare plans — inpatient care through Medicare Part A and outpatient care through Medicare Part B — plus additional products and services like prescription coverage (Medicare Part D), dental coverage, and more.

The plans and products available to you depend on your location. You can tailor Medicare Advantage plans to fit your specific healthcare needs and budget. Additional coverage and services will cost more, and your plan may set limitations on which providers, services, and products you can choose from.

You can compare Medicare Advantage plans using Medicare’s plan comparison tool.

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