At a glance
- Medicare Advantage (Part C) plans are private insurance plans that combine multiple elements of Medicare coverage.
- Highmark sells its Medicare Advantage plans in Pennsylvania, West Virginia, and Delaware.
- As of 2019, Highmark was serving approximately 5.6 million members in its coverage areas.
- Several plans are available based on your needs and budget.
Medicare Advantage (Part C) plans combine multiple elements of the Medicare program into a tailored package designed to fit individual needs and budgets.
They’re offered by private insurers, like Highmark, that contract with Medicare. These plans feature hospital and physician services, plus optional programs for things like prescription medication and dental coverage.
Keep reading to learn about some of the Medicare Advantage options that Highmark offers for 2021.
Highmark offers two types of Medicare Advantage (Part C) plans: 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
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.
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.
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:
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.
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.
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
- AIS Home Visit Program: extra support at home for those dealing with serious medical conditions
- 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
- SilverSneakers: a national fitness program designed for older adults
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 from across Highmark’s coverage area.
|Location/plan||Monthly Premium||Health deductible, drug deductible||Primary care physician visit copay||Specialist visit copay||Out-of-pocket max|
|Pittsburg, PA: Community Blue Medicare HMO Signature (HMO)||$0||$0, $0||$0||$30||$7,550 in network|
|Harrisburg, PA: Freedom Blue PPO Standard (PPO)||$175||$0, $0||$0||$35||$5,000 in network, $10,000 in and out of network|
|Morgantown, WV: Freedom Blue PPO Standard (PPO)||$167||$0, $0||$0||$35||$6,500 in network, $10,000 in and out of network|
|Wheeling, WV: Freedom Blue PPO Distinct (PPO)||$35||$0, $0||$0||$35||$7,550 in network, $10,000 in and out of network|
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.
When to enroll in Medicare Advantage
You can sign up for a Medicare Advantage plan during specific enrollment periods. You first need to enroll in Medicare parts A and B. Then, you can enroll in Medicare Advantage during open enrollment periods.
- Initial enrollment. This is a 7-month window around your 65th birthday. You become eligible for Medicare and may enroll 3 months before and after your 65th birth month.
- January 1 through March 31. This is the Medicare Advantage open enrollment period.
- October 15 through December 7. This time frame is open enrollment for all Medicare parts and plans.
- April 1 through June 30. During this period, you may add a Medicare Part D plan if you don’t have prescription drug coverage through your Part C plan.
- Special enrollment period. This is a period that lasts for 8 months after a you have a specific life change, like a move or loss of coverage.
- Highmark offers a variety of Medicare Advantage plans throughout Pennsylvania, West Virginia, and Delaware.
- Not all plans are offered in every coverage area.
- Prices vary based on your location, level of care, and services chosen.