Highmark Medicare Advantage Plans 2024

As you approach the golden years, finding the right health insurance plan can make all the difference in ensuring your well-being. Highmark Medicare Advantage plans offer a diverse range of options to cater to your unique needs. But how do you choose the plan that’s right for you?

This comprehensive guide will provide an overview of Highmark’s Medicare Advantage offerings, costs, ratings, and more, helping you make an informed decision for your healthcare future with Highmark Medicare Advantage plans 2024.

With an ever-growing number of Medicare beneficiaries, Highmark has stepped up to the plate, providing a variety of Medicare Advantage plans that cater to different lifestyles and health needs.

Let’s embark on a journey to explore Highmark’s numerous offerings, compare them to other providers, and ultimately, find the ideal plan for you in the Highmark Medicare Advantage plans 2024 lineup.

Key Takeaways

• Highmark is a leading health insurance provider offering quality healthcare services and Medicare Advantage plans across select states.
• Highmark’s Medicare Advantage offerings include HMO, HMO Point of Service, PPO, and SNP plans with varying premiums, out-of-pocket expenses, and benefits to meet individual needs.
• When selecting a plan it is important to consider costs, network providers, prescription drug coverage & supplemental benefits offered.

Overview of Highmark

Highmark is a health insurance provider that offers a range of insurance coverage options, including Medicare Advantage plans. Medicare is a federal health insurance program for individuals aged 65 and above, certain individuals with disabilities, and those with End-Stage Renal Disease (ESRD).

As one of the leading health insurance providers, Highmark ensures that its customers have access to a wide variety of Medicare Advantage plan options, catering to their unique health needs.

With a commitment to providing quality healthcare services, Highmark offers a diverse array of Medicare Advantage plans across select states. These plans encompass various categories such as:

• HMO
• HMO Point of Service
• PPO
• SNP plans

Each plan has its own set of benefits, costs, and features.

The upcoming sections will provide a more comprehensive look into these offerings and what they signify for you at various centers.

Highmark’s Medicare Advantage Offerings

Highmark is known for its diverse range of Medicare Advantage plan options, which include HMO, HMO Point of Service, PPO, and SNP plans. Each of these plans comes with its own set of advantages, such as Part B Premium Giveback advantages, 24/7 support, and care coordination.

With a variety of offerings, Highmark ensures that there’s a plan suitable for every individual’s needs.

To gain a better understanding of each plan, we’ll examine the various types of Medicare Advantage plans offered by Highmark along with their specific features.

We’ll then delve into the following plans in more detail:

1. HMO
2. HMO Point of Service
3. PPO
4. SNP

HMO Plans

HMO plans, or Health Maintenance Organization plans, typically require the use of a predefined network of physicians and hospitals, with a referral from your primary care provider needed to see a specialist.

Highmark’s HMO Medicare Advantage plans offer a variety of structures, costs, and benefits, featuring $0 premiums, comprehensive medical benefits, and the opportunity to receive a quarterly allowance for non-prescription health and wellness items.

While these plans focus on Medicare, it’s essential to note that Medicaid also plays a crucial role in providing healthcare coverage for many individuals.

Highmark’s HMO plans boast a network of healthcare providers to meet your needs, ensuring that you can locate a doctor, hospital, or other medical provider with ease. These plans also offer out-of-network benefits, providing you with the flexibility you need for your healthcare.

HMO Point of Service Plans

An HMO Point of Service plan, as the name suggests, is an HMO plan that permits members to access certain out-of-network services, albeit at an additional cost.

Highmark’s HMO Point of Service Plans, such as Security Blue HMO-POS, provide:

• Coverage for all Medicare-covered benefits
• Access to a network of providers
• Optional programs for prescription medication and dental coverage
• Certain preventive services covered without cost-sharing
• Different plan options with varying premiums and benefits

These plans offer a combination of features from traditional HMOs and PPOs. Members are required to select a primary care physician (PCP) within the network and obtain referrals for specialist visits.

It also provides limited out-of-network coverage, giving members the flexibility to seek care outside the network, albeit at an extra cost.

PPO Plans

PPO, or Preferred Provider Organization, plans offer the greatest flexibility, permitting you to:

• Visit any provider that accepts the insurance without the need to select a primary doctor or obtain referrals for specialists
• Access a range of health coverage products, such as dental, vision, and travel insurance
• Benefit from The Caring Program

Highmark’s PPO Plans provide all of these options and more.

The cost of Highmark’s PPO plans may vary depending on the specific plan, location, and individual circumstances. Monthly premiums for Highmark PPO plans range between $383 and $669; however, rates may be higher or lower.

Furthermore, Highmark’s PPO plan allows for out-of-network coverage, enabling you to receive healthcare services from providers and facilities that have not signed a contract with the health plan.

SNP Plans

SNP, or Special Needs Plan, is a type of health plan that is limited to individuals with specific diseases or characteristics.

The needs of those members are kept in mind while offering associated benefits, provider network, and drug formularies.

This ensures they get what they need. Highmark’s SNP Plans are designed to provide specialized care and support to individuals with chronic and disabling mental health conditions such as:

• Bipolar disorders
• Major depressive disorders
• Paranoid disorder
• Schizophrenia

Highmark’s SNP plans offer members:

• Access to a wide network of doctors and hospitals
• Additional benefits to support their health and wellbeing
• Financial assistance for healthy foods and products from participating retailers

Moreover, Highmark’s SNP plans create an Individualized Care Plan tailored to the individual member’s needs and preferences, which is based on health risk assessment responses, claims data, and input from the primary care physician.

Analyzing Highmark’s Medicare Advantage Costs

Highmark’s Medicare Advantage costs vary based on factors such as plan type, location, and individual health needs. Understanding the costs associated with Highmark’s Medicare Advantage plans can help you make an informed decision about which plan best suits your budget and healthcare requirements.

The upcoming subsections will further examine the two main cost aspects of Highmark’s Medicare Advantage: premiums and out-of-pocket expenses. This will offer a clearer picture of the financial implications involved in choosing a Highmark Medicare Advantage plan.

Premiums

Premiums for Highmark Medicare Advantage plans in 2024 range from $0 to $174.70 per month. The premium rates for these plans are determined based on factors such as:

• The plan’s overall performance rating
• The level of out-of-pocket costs for medical, prescription, and dental care
• The presence or absence of co-payments, co-insurance, deductibles, and cost-sharing

These factors are taken into account to ensure that the premium rates are fair and reflect the value and benefits provided by the plans.

In 2024, all tiers of Highmark Medicare Advantage plans offer $0 premiums, making Medicare more affordable. This is in line with previous years, where the majority of beneficiaries were able to access a plan without a supplementary monthly premium, similar to 2023.

Out-of-Pocket Expenses

Out-of-pocket expenses typically encompass copays, coinsurance, deductibles, and additional benefits that are contingent on the selected plan. The typical copays for Highmark Medicare Advantage plans may vary depending on the plan and services.

As an example, copays may include $0 for primary care visits, $25 for specialist visits, and $0 for Tier 1 prescription drugs.

Highmark’s Medicare Advantage plans require beneficiaries to pay a percentage of the total cost for covered services, known as coinsurance.

For instance, if the coinsurance rate is 20%, the beneficiary would be responsible for 20% of the cost, while Highmark would cover the remaining 80%. This assists in sharing the cost of healthcare between the beneficiary and the insurance provider.

Highmark’s Medicare Star Ratings

Highmark boasts an impressive average weighted star rating of 4.42 for its Medicare Advantage plans. The Star Ratings system assists Medicare consumers in comparing the quality of Medicare health and drug plans to ensure they are able to make informed decisions about their health care.

Medicare Advantage plans are evaluated based on health plan measures. Plans offering prescription drug coverage are also assessed on drug plan measures.

In 2024, the average star rating of plans provided by all providers is 4.04 stars, highlighting the high quality of Highmark’s Medicare Advantage offerings.

Highmark Part D Prescription Drug Plans

Highmark offers two Part D prescription drug plans in Pennsylvania and West Virginia for individuals enrolled in Medicare Part A and Part B. These plans provide coverage for most generic and brand-name drugs approved by Medicare, as outlined in the Highmark Medicare-Approved Prescription Drug Formulary.

The costs and coverage options for Highmark’s Part D prescription drug plans vary. To be eligible for these plans, you must be enrolled in Medicare Part A and Part B.

Those with limited income or resources may qualify for Extra Help from Medicare to cover their Medicare prescription drug coverage.

Third-Party Evaluations of Highmark

Evaluations from credible third-party sources can offer helpful perspectives on the financial stability and member satisfaction of Highmark Medicare Advantage plans. Highmark has an A (Excellent) financial strength rating from AM Best, a credit rating agency that specializes in the insurance industry.

Highmark’s J.D. Power rating is 706, which is lower than UPMC For Life’s rating of 709 and Kaiser Foundation Health Plan’s rating of 844.

Although this rating is lower than some competitors, it still demonstrates Highmark’s commitment to providing a satisfactory experience for its Medicare Advantage members.

Choosing the Ideal Medicare Advantage Plan

When choosing a Medicare Advantage plan, factors such as costs, in-network providers, prescription drug coverage, dental coverage, and any supplemental benefits need to be considered. Assessing a plan’s network of providers involves ensuring that your preferred medical provider or providers are part of the plan’s network.

It’s also crucial to evaluate a plan’s costs, such as premiums, deductibles, copays, and/or coinsurance, to determine if you can afford them.

If you’re on medication, understanding how a Medicare Advantage plan covers prescription drugs is necessary.

Here are some factors to consider:

• Pay attention to what tier your prescription drugs are listed under.
• Check whether any coverage rules apply to them.
• Consider any additional benefits provided by a plan, such as fitness memberships, transportation allowances, and meal delivery.

By taking these factors into consideration, you can make an informed decision about the ideal Medicare Advantage plan for you, while also considering available Medicaid services.