• 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.
  • 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 2020.

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

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

  • 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.
  • 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 following is a list of Medicare Advantage plans offered by Highmark. Each has a different combination of extra services and coverage.

  • Freedom Blue PPO Value Rx
  • Freedom Blue PPO Basic
  • Freedom Blue PPO Standard
  • Freedom Blue PPO Classic
  • Freedom Blue PPO Deluxe
  • Freedom Blue PPO Select
  • Community Blue Medicare PPO Distinct
  • Community Blue Medicare Plus PPO Distinct
  • Community Blue Medicare PPO Signature
  • Community Blue Medicare Plus PPO Signature
  • Community Blue Medicare HMO Signature
  • Community Blue Medicare HMO Prestige
  • Security Blue HMO-POS ValueRx
  • Security Blue HMO-POS Basic
  • Security Blue HMO-POS Standard
  • Security Blue HMO-POS Deluxe

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

  • Basic Blue Rx PDP Value
  • Basic Blue Rx PDP Standard
  • Basic Blue Rx PDP Plus
  • Basic Blue Rx PDP Complete

Monthly premiums for these plans range from $25 per month to more than $160 per month, with the more expensive plans offering greater savings on specialty medications. Each plan includes gap (or “donut hole”) coverage and catastrophic coverage.

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

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

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

Each Highmark Medicare Advantage plan charges a monthly premium, 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.

Sample of costs in Pittsburg, Pennsylvania, and New Castle, Delaware

PlanMonthly PremiumDoctor’s visit copaySpecialist copayHospital copayMaximum out-of-pocket
Community Blue Medicare HMO Signature$0
$0
(in and out of network)
$30
(in and out of network)
$295
per admission (after advance plan approval)
$6,700 (in network)
Community Blue Medicare PPO Distinct (PPO)$35$0
(in and out of network)
$30
(in and out of network)
$275 per stay (in network)

$350 per stay (out of network)

$5,900 (in network)

$10,000 (cata-strophic)
Freedom Blue PPO Classic$292$0
(in and out of network)
$25
(in and out of network)
$210
per admission
$4,500
(in network)

$10,000
(cata-strophic)
Security Blue HMO-POS Basic $55$0
(in network)
$30
(in and out of network)
$340 per admit;
$390 per admit (POS)
$5,900 (in network)

$10,000 (cata-strophic)
Security Blue HMO-POS ValueRx$64$0$40$220 per day (days 1–5); $0 per day (days 6–90)

POS: $270 per day (days 1–5); $0 per day (days 6–90)
$5,500 (in network)

$10,000 (cata-strophic)

Sample of costs in Wheeling, West Virginia*

PlanMonthly PremiumDoctor’s visit copaySpecialist copayHospital copayMaximum out-of-pocket
Freedom Blue PPO Classic$167$5
(in and out of network)
$35
(in and out of network)
in network: $220 per day (days 1–5); $0 per day (days 6–90)

out of network: $270 per day (days 1–5); $0 per day (days 6–90)
$5,900 (in network)

$10,000 (cata-strophic)

*There is one Highmark plan available in Wheeling, West Virginia.

Medicare Part C, or Medicare Advantage, 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.

Which plans and products are available to you depends 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 timeframe 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.
  • 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.
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Medicare Part D is Medicare’s prescription medication program. This optional program is administered by private insurance companies and based on a formulary, or a list of basic drugs that each plan must cover.

The formulary usually includes two medications for each class of drugs, such as two medications for your blood pressure or diabetes. The formulary may include generic or brand-name medications.

If your prescription is not on the formulary, you could ask for an exception, or see if you can try an alternative medication that’s covered. Medicare plans update their formulary lists every year, and you’ll save the most money on your prescription medications by using drugs from your plan’s formulary.

  • 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.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

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