Highmark Medicare Advantage Plans 2025

Choosing a Medicare Advantage plan for 2025? Understand the specifics of Highmark Medicare Advantage plans, including key changes, costs, and available benefits.

Without overwhelming detail, this guide previews how to evaluate Highmark Medicare Advantage Plans 2025 against your healthcare needs, ensuring you’re well-informed for the year ahead.

 

Key Takeaways

  • Highmark offers diverse Medicare Advantage plans with a strong emphasis on preventive care, network flexibility, and additional benefits like wellness programs. Plan types include HMO, PPO, POS, and SNPs, catering to specific needs and preferences.

 

  • Costs for Highmark Medicare Advantage plans vary depending on the chosen plan, with $0 premium options available. Deductibles must be met before plan coverage kicks in, and plans have out-of-pocket maximums to cap member expenses.

 

  • Highmark is competitive in terms of cost, coverage, and member satisfaction compared to other providers, with a comprehensive approach to healthcare that includes wellness programs, preventive screenings, and innovative health services.

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Exploring Highmark’s 2025 Medicare Advantage Offerings

 

Highmark Medicare Advantage Plans 2025 Exploring Highmark's 2025 Medicare Advantage Offerings

 

In 2025, Highmark offers a range of Medicare Advantage plans tailored to the diverse needs of Medicare consumers.

Highmark places a strong emphasis on network flexibility with their Freedom Blue PPO, allowing comprehensive coverage for health and prescription drugs.

 

Types of Highmark Medicare Advantage Plans

Highmark offers a variety of Medicare Advantage plans including:

  • HMO: provides comprehensive coverage with a strong emphasis on preventive care

 

  • PPO: offers broader network access without the need for specialist referrals

 

  • POS: balances structured coverage with provider flexibility

 

  • SNP: caters to individuals with specific needs

 

 

Coverage and Benefits

Highmark Medicare Advantage plans provide comprehensive coverage, including preventive services and wellness programs. These plans ensure access to mental health services through a diverse national network of providers and expedited access to therapy and psychiatry for members.

The wellness programs offered include the Highmark Wellness Rewards Program, which encourages health-promoting activities, and SilverSneakers, a program aimed at helping seniors maintain physical activity and fitness.

 

Network Freedom

A key feature of Highmark’s Medicare Advantage plan is network freedom. This gives members the flexibility to select from a diverse pool of participating providers, including any doctor or hospital in the U.S. that accepts Medicare, as demonstrated by Highmark’s Freedom Blue PPO plan.

It’s important to note that while Highmark’s network encompasses providers in Pennsylvania and West Virginia, specific details outlining restrictions for members choosing providers are not readily available.

Understanding Costs of Highmark Medicare Advantage Plans

 

Highmark Medicare Advantage Plans 2025 Understanding Costs of Highmark Medicare Advantage Plans

 

Factors like the choice of plan, location, and services used influence the cost of Highmark Medicare Advantage plans. Additionally, Highmark has set the premium for these plans at $0.

Keep in mind that a deductible is the initial amount you are paying out-of-pocket before the plan starts covering medical expenses.

 

Premium Details

Highmark offers:

  • A consistent, affordable monthly premium for all individuals, regardless of age or health history

 

  • $0 premium Medicare Advantage plans that offer cost-effective coverage without monthly premium expenses

 

  • Reduced copays and extra benefits like dental, vision, and hearing coverage

 

Bear in mind that Highmark’s Medicare Advantage plan premiums, averaging at about $96 per month, are higher than the industry average.

 

Managing Deductibles and Copays

Highmark Medicare Advantage plans typically offer the following benefits:

  • $0 copays for medical care

 

  • $0 copays for Tier 1 prescription drugs

 

  • Inpatient stays cost $425 per day for the first 3 days and then $0 from day 4 to 90

 

  • Outpatient visits have a $40 copay

 

  • Specialist visits have a $25 copay

 

Furthermore, copays may be waived in specific cases, such as when an individual is admitted as an inpatient through a referral.

 

Out-of-Pocket Maximums

Highmark Medicare Advantage plans include an out-of-pocket maximum, which serves to limit the amount a beneficiary has to pay themselves, thereby capping their financial contribution towards healthcare costs.

The out-of-pocket maximum for Highmark Medicare Advantage Plans is the limit on the amount of money you will have to pay for covered services in a plan year, and it can be either $7,550 or $5,900, depending on your specific plan.

Enrollment Insights: Gaining Membership with Highmark

 

Highmark Medicare Advantage Plans 2025 Enrollment Insights: Gaining Membership with Highmark

 

Individuals wishing to join Highmark’s Medicare Advantage plans must meet the following criteria:

  • Medicare eligibility

 

  • Enrolled in both Part A and Part B

 

  • Residing in the service area

 

  • Not have end-stage renal disease.

 

 

Eligibility Criteria

Individuals must be enrolled in Medicare Parts A and B to qualify for Highmark Medicare Advantage Plans. The program is open to U.S. citizens who are 65 years of age or older, as well as individuals with specific disabilities, regardless of age.

To be eligible, applicants must reside in Highmark’s service area, and specifically for Pennsylvania residents, they should have lived in the state for at least 90 days prior to applying.

 

Enrollment Process

The enrollment process for a Highmark Medicare Advantage plan includes understanding the timing, choosing the suitable plan, and filling out the application. After your application is processed and approved, you will receive your Welcome Kit and ID Card.

Highmark also offers the convenience of enrolling in Medicare Advantage Plans and Original Medicare online, making the process more streamlined for potential applicants.

 

Comparing Highmark to Other Providers

 

Highmark Medicare Advantage Plans 2025 Comparing Highmark to Other Providers

 

In terms of cost, coverage, and member satisfaction, Highmark’s Medicare Advantage plans are on par with other providers. In Pennsylvania, the average cost of Highmark Medicare Advantage plans is $108 per month, suggesting lower medical costs compared to other providers.

Highmark also offers distinctive services such as dental, vision, and travel insurance, in addition to The Caring Program. They have a quality rating of 4.5 from the Centers for Medicare & Medicaid Services and provide coverage for a range of needs including preexisting conditions, outpatient and emergency services, prescriptions, and pediatric care.

Highmark has been ranked as number two in the nation for Medicare Advantage plan overall satisfaction, indicating high member approval in comparison to other providers.

 

Cost Comparison

In Pennsylvania, the average cost of Highmark Medicare Advantage plans is $108 per month, which is higher than the average costs offered by companies like Wellcare and AARP/Unitedhealthcare, which are less than $20 per month.

The cost differences between Highmark and other providers are influenced by several factors, including higher utilization rates, drug prices, instances of fraud, waste, and abuse, management of chronic diseases, and market forces.

 

Coverage Comparison

Highmark’s Medicare Advantage plans are highly rated, with a rating of 4.5 out of 5 in Pennsylvania, indicating superior coverage when compared with other providers.

Highmark offers extensive network of community doctors and hospitals, particularly in western Pennsylvania, covering 28 counties.

They offer Complete Blue Cross PPO plans, as well as vision, hearing, dental, and fitness benefits.

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Member Satisfaction

Highmark utilizes a comprehensive strategy that integrates quality, safety, and member experience, supports a concierge care model, and works to increase access to medications in order to enhance member satisfaction.

Highmark’s member satisfaction is influenced by several factors, such as:

  • the provider choice allowed by the plans

 

  • the cost value provided to members

 

  • high standards of customer service

 

  • the role of digital tools in helping members select the right plan for their needs.

Highmark’s Commitment to Quality Health Care

 

Highmark Medicare Advantage Plans 2025 Highmark's Commitment to Quality Health Care

 

Highmark’s dedication to quality healthcare is reflected in their extensive coverage of preventive services and wellness programs.

Highmark’s approach to preventive care is centered on promoting overall wellness and holistic health. They prioritize providing regular preventive screenings to help individuals sustain good health and detect potential health concerns early on.

 

Preventive Services

Highmark Medicare Advantage plans provide coverage for a range of preventive services, such as screenings, at no cost to members. These services encompass routine checkups, tests, and other screenings that play a crucial role in early detection of health issues when treatment can be most effective.

Highmark offers incentives to promote the use of preventive services by enabling employers to provide rewards to employees who make healthy lifestyle decisions and complete preventive screenings.

 

Wellness Programs

Highmark provides the Highmark Wellness Rewards program for its Medicare Advantage members, enabling them to earn rewards for completing health-related activities. Additionally, they offer access to the SilverSneakers® program, which grants eligible members complimentary access to fitness and wellness facilities.

Highmark’s wellness programs aid members in attaining their health goals by providing guidance in crucial areas like:

  • weight management

 

  • nutrition

 

  • physical activity

 

  • smoking cessation

 

  • mental health

 

  • stress management

 

 

Special Features of Highmark Plans

Additional benefits of Highmark Medicare Advantage plans include vision, hearing, dental, and fitness benefits. They also include extra perks like free gym memberships and over-the-counter allowances for health items.

Highmark has incorporated innovative programs in their Medicare Advantage plans, which include lower premiums, copays, and new benefits designed to enhance the member experience.

 

Innovative Health Services

Highmark offers innovative health services by:

  • Integrating technology into healthcare delivery

 

  • Emphasizing behavioral health through their Living Health strategy

 

  • Real-time monitoring of mental health and neurological well-being

 

  • Improving telehealth services

 

  • Collaborating with Google Cloud to develop generative AI solutions.

 

Highmark’s innovative health services contribute to enhancing the member experience by personalizing care to meet individual needs and preferences, such as through on-demand virtual physical care.

 

Extra Perks

Highmark plans do include dental and hearing coverage as extra perks. They provide lower copays for high-quality hearing aids and comprehensive dental benefits. Certain Highmark Medicare Advantage plans provide travel-friendly options at a reduced premium.

Additionally, the Highmark Wholecare program offers assistance with transportation costs.

State-Specific Plan Options

 

Highmark Medicare Advantage Plans 2025 State-Specific Plan Options

 

Highmark provides Medicare Advantage plans in Pennsylvania, West Virginia, and Delaware, catering to individuals in these states. Highmark offers specific Medicare Advantage plans in Pennsylvania, including Freedom Blue PPO Valor (PPO) and Complete Blue PPO Signature (PPO).

These plans also provide benefits for preventive care, hearing aids, vision and dental care, as well as popular fitness memberships.

 

Plans in Pennsylvania

Highmark provides a range of Medicare Advantage plans in Pennsylvania, including HMO, PPO, and Part D options, to accommodate the diverse healthcare requirements of the state’s residents. They offer Complete Blue PPO plans, as well as vision, hearing, dental, and fitness benefits.

Moreover, there are plans with $0 premiums and optional supplemental benefits, providing additional customization to meet the healthcare needs and preferences of Pennsylvania residents.

 

Expansion and Availability

Highmark has expanded its Medicare Advantage plans by introducing new plan designs in 2025 to cater to the needs of Medicare consumers in Pennsylvania and Delaware.

They also launched ACA products in Southeastern Pennsylvania for 2025.

The coverage options and benefits of Highmark’s Medicare plans have seen significant enhancements since 2022.

 

Customer Support Experience

Customers can reach Highmark support through their website, phone or by reaching out to their Member Service Team. Highmark aims to respond to non-urgent requests within 14 days.

According to customer reviews, the quality of customer support provided by Highmark is rated around 3.3 to 3.7 out of 5 stars.

 

Contacting Customer Service

Highmark customer service operates from 8 a.m. to 9 p.m. every day of the week. You can reach customer service by calling 866-459-4418.

However, it’s worth noting that Highmark does not provide online chat support for customer service.

 

Quality of Support

Highmark ensures quality with their customer support through their Quality Program, which is specifically designed to enhance the quality, safety, and equity of the clinical care and services offered to their members.

Highmark’s member satisfaction is influenced by several factors, such as:

  • the provider choice allowed by the plans

 

  • the cost value provided to members

 

  • high standards of customer service

 

  • the role of digital tools in helping members select the right plan for their needs.

 

Prescription Drug Coverage with Highmark

 

Highmark Medicare Advantage Plans 2025 Prescription Drug Coverage with Highmark

 

Most covered Medicare Part D prescription drugs under Highmark’s Medicare Advantage come with a $0 copay.

Highmark offers Blue Rx PDP plans, which are specifically designed to cover a wide range of generic and brand name drugs approved by Medicare.

 

Drug Plan Options

Highmark provides the Blue Rx PDP, which is a stand-alone Medicare Prescription Drug Plan.

Beneficiaries have the option to compare the different drug plans offered by Highmark by either calling 844-593-0265 to speak with a Medicare Advisor or by visiting the Highmark website to understand the coverage provided by the Blue Rx PDP plans.

 

Managing Prescriptions

Highmark offers a range of tools for prescription management, such as the Medication Therapy Management (MTM) program, the Highmark Mobile App for automated refill reminders, and the Site of Care Drug Management Program for certain medically billed infusion drugs.

Highmark’s prescription management tools offer various benefits, including the ability to check coverage for prescription and over the counter drugs, stay informed about recalls, and access a comprehensive therapy management program.

These features can ultimately lead to improved overall out of network benefits and cost savings for members.

 

How to Choose the Right Highmark Plan for You

To choose the right Highmark Medicare Advantage plan, follow these steps:

  1. Perform health risk assessments to identify personal health behaviors and risk factors, such as smoking, physical activity, and nutritional habits.

 

  1. Compare the various plans offered by Highmark by reviewing the coverage of drugs.

 

  1. Determine eligibility for any special programs.

 

By following these steps, you can make an informed decision about which Highmark Medicare Advantage plan is best for you.

 

Summary

Highmark offers a wide array of Medicare Advantage plans, each designed to cater to a diverse range of healthcare needs.

From preventive care and wellness programs to comprehensive prescription drug coverage, Highmark has demonstrated its commitment to providing quality healthcare.

With its focus on member satisfaction, innovative health services, and special features, Highmark stands out as a leading provider of Medicare Advantage plans.

It’s crucial to assess your personal healthcare needs, compare different plans, and make an informed choice that best suits your requirements.

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Frequently Asked Questions

 

Is Highmark Medicare a good insurance?

Yes, Highmark Medicare is a good insurance option, with an overall rating of 4.5 stars for quality and performance from the Centers for Medicare & Medicaid Services. You can generally expect good quality service and care that leads to customer satisfaction.

 

Is Highmark Freedom Blue PPO a Medicare Advantage plan?

Yes, Highmark Freedom Blue PPO is a Medicare Advantage plan offered by Highmark Blue Shield with comprehensive benefits and the freedom to choose providers.

 

What is the future of Medicare Advantage plans?

The future of Medicare Advantage plans looks promising, with the Congressional Budget Office projecting that the share of Medicare beneficiaries enrolled in these plans will rise to 62 percent by 2033.

 

Does Highmark have a Medicare Supplement plan?

Yes, Highmark offers Medicare supplement plans, including a variety of Medigap plans like Plan A, B, C, D, F, high-deductible F, G, and N in certain states.

 

What types of Medicare Advantage plans does Highmark offer?

Highmark offers a variety of Medicare Advantage plans, including HMO, PPO, POS, and SNP plans, each tailored to specific needs.

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1-844-350-0776
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Mon-Fri : 8am-9pm ET