Medicare Advantage Plans offered by Highmark: Varieties, coverage locations, and additional details
Highmark, a private insurance company, offers Medicare Advantage plans to approximately 7 million people in Pennsylvania, Delaware, New York, and West Virginia. These plans are licensed with Blue Cross Blue Shield (BCBS) and are available in specific BCBS service areas, including Delaware, Pennsylvania, West Virginia, Northeastern, and Western New York.
Services and Perks Provided by Highmark
Highmark's Medicare Advantage plans include a range of services designed to enhance the healthcare experience for its members. Some of these services include 24-hour nursing service, home visit program, PALS program, Medication Therapy Management (MTM) Program, Highmark House Call, Silver Sneakers fitness program, and Blues On Call.
Choosing a Medicare Advantage Plan
When looking for a Medicare Advantage plan, Medicare's plan comparison tool can be a useful resource. It allows individuals to compare plans based on factors such as monthly premiums, copayments, coinsurance, deductibles, and provider networks.
State Health Insurance Assistance Programs also offer impartial advice and assistance in selecting an Advantage plan.
Types of Medicare Advantage Plans
Medicare Advantage plans come in five main types: Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS), Special Needs Plans (SNP), and Medicare Medical Savings Accounts (MSAs). Highmark offers plans in the HMO, PPO, and HMO-POS (a combination of HMO and PPO) categories.
Costs and Coverage of Highmark Medicare Advantage Plans
Highmark Medicare Advantage plans differ from Original Medicare primarily in coverage, costs, and additional benefits.
Coverage
Original Medicare (Part A hospital insurance and Part B medical insurance) allows access to any doctor or hospital that accepts Medicare nationwide, with no network restrictions. In contrast, Highmark’s Medicare Advantage plans typically require receiving care within a network of providers and may require prior authorization for some specialist services.
Medicare Advantage plans cover at least the same services as Original Medicare but often include additional coverage, such as routine dental, vision, and hearing care, which Original Medicare generally does not cover.
Costs
Original Medicare involves separate premiums for Parts A and B; it does not have a limit on out-of-pocket costs unless supplemented by Medigap insurance. Highmark Medicare Advantage plans often have $0 or low monthly premiums beyond standard Part B premiums and include an annual cap on out-of-pocket expenses, providing greater financial predictability compared to Original Medicare’s unlimited cost exposure.
Some Medicare Advantage plans might come with copayments or coinsurance depending on the service and plan type.
Additional Benefits
Highmark Medicare Advantage plans offer extra benefits not covered by Original Medicare, such as dental, vision, hearing coverage, gym memberships, virtual doctor visits, and allowances for health products (e.g., vitamins, over-the-counter medicines). They may also offer enhanced mental health services with potentially lower out-of-pocket costs than Original Medicare.
Comparing Highmark Medicare Advantage Plans
When comparing Highmark Medicare Advantage plans, individuals should consider copayments, coinsurance, monthly premiums, provider networks, and deductibles. Out-of-pocket maximum for these plans can reach up to $6,500.
For example, in Lackawanna County, Pennsylvania, the monthly premium for the Freedom Blue PPO basic plan is $61, while the Community Blue Medicare HMO Signature plan has no monthly premium.
It's essential to note that Highmark's specific plan details are not fully detailed in the search results, but Highmark's Medicare Advantage plans follow the typical Medicare Advantage model described above.
In summary, Highmark Medicare Advantage plans bundle hospital and medical coverage with limits on out-of-pocket costs and extra benefits but typically have network limitations and may need prior authorizations, while Original Medicare provides broader access but fewer benefits and no out-of-pocket max unless combined with supplemental plans. Specific plan details, including networks and costs, can vary by location and plan design.
[1] Medicare.gov. (n.d.). Compare Medicare Advantage Plans. Retrieved from https://www.medicare.gov/find-a-plan/questions/home
[2] Medicare.gov. (n.d.). Types of Medicare Health Plans. Retrieved from https://www.medicare.gov/what-medicare-covers/types-of-medicare-health-plans/what-are-the-different-types-of-medicare-health-plans
[3] Medicare.gov. (n.d.). How Medicare Advantage Plans Work. Retrieved from https://www.medicare.gov/what-medicare-covers/types-of-medicare-health-plans/how-do-medicare-advantage-plans-work
[4] Medicare.gov. (n.d.). Mental Health Care. Retrieved from https://www.medicare.gov/coverage/mental-health-care
[5] Medicare.gov. (n.d.). What's covered. Retrieved from https://www.medicare.gov/what-medicare-covers/what-s-covered/medicare-coverage-tools/medicare-coverage-tools-home.html
- Highmark's health insurance plans, including Medicare Advantage, also involve collaboration with various health organizations and providers, providing services such as 24-hour nursing, home visit programs, and fitness programs like Silver Sneakers.
- In the realm of science and medical-conditions, Highmark Medicare Advantage plans offer additional coverage, like routine dental, vision, and hearing care, which are typically not included in Original Medicare.
- For those needing guidance in choosing a Medicare Advantage plan, both Medicare's plan comparison tool and state-based Health Insurance Assistance Programs provide impartial advice and resources to help make an informed decision.
- Finance is an important factor to consider when evaluating Highmark Medicare Advantage plans, as their costs can vary significantly depending on the service, plan type, premiums, copayments, coinsurance, deductibles, and out-of-pocket maximums.
