Highmark Medicare Advantage 2024-2025 Review: Pros, Cons, Costs

Highmark Medicare Advantage plans are highly rated but available in only four states.

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The bottom line: Highmark Medicare Advantage earns strong star ratings and member experience scores, but it has fewer $0-premium options and is only available in four states. Jump to: Full Review

Highmark Medicare Advantage

Highmark

4.52

CMS Star Rating

(855) 432-0512

TTY 711

Speak to a licensed insurance agent on askchapter.org
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We will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed below.

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Speak to a licensed insurance agent on askchapter.org
(855) 432-0512

TTY 711

Highmark Medicare Advantage pros and cons

Pros

Member experience: Highmark member experience ratings, including care coordination and customer service, beat those of major providers.

Higher-than-average star rating: Weighted by enrollment, Highmark’s Medicare Advantage plans get an average Medicare star rating of 4.52 stars out of 5 from CMS.

Extra perks: Highmark plans offer a number of benefits, from Part B Premium Giveback perks to 24/7 support.

Cons

Service area: Highmark offers Medicare Advantage plans in only four states: Delaware, New York, Pennsylvania and West Virginia.

Few $0-premium options: Highmark has the smallest percentage of $0-premium plans (33%) of the bigger providers.

Compare against other providers

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UnitedHealthcare Medicare Advantage - UHC (product card)

UnitedHealthcare

3.82

CMS Star Rating

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Aetna Medicare Advantage

Aetna

4.27

CMS Star Rating

(855) 432-0512

TTY 711

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We will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed below.

M-F 8am-10pm EST, Sa-Su 9am-9pm EST

Speak to a licensed insurance agent on askchapter.org
(855) 432-0512

TTY 711

Humana Medicare Advantage

Humana

3.63

CMS Star Rating

(866) 215-2655

TTY 711

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5am - 8pm, daily PST

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Cigna Medicare Advantage

Cigna

3.93

CMS Star Rating

(855) 432-0512

TTY 711

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on NerdWallet

We will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed below.

M-F 8am-10pm EST, Sa-Su 9am-9pm EST

Speak to a licensed insurance agent on askchapter.org
(855) 432-0512

TTY 711

» More options in our roundup of the best Medicare Advantage plans

Compare against other providers

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UnitedHealthcare Medicare Advantage - UHC

UnitedHealthcare

3.82

CMS Star Rating

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GET A QUOTE

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Humana Medicare Advantage

Humana

3.63

CMS Star Rating

(866) 215-2655

TTY 711

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5am - 8pm, daily PST

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(866) 215-2655

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» More options in our roundup of the best Medicare Advantage plans

Our full review

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Highmark Medicare Advantage star ratings

Average star rating, weighted by enrollment: 4.52

Highmark Medicare Advantage plans are rated well above the industry average, receiving an average rating of 4.52 stars out of 5 from the Centers for Medicare & Medicaid Services (CMS) for 2025, weighted by enrollment. For comparison, the average weighted star rating for plans from all providers is 3.92

Centers for Medicare & Medicaid Services. Fact Sheet - 2025 Medicare Advantage and Part D Star Ratings. Accessed Oct 23, 2024.
.

Of Highmark Medicare Advantage plans with star ratings in 2025, all are rated 4 stars or higher. Hence, all of Highmark’s members are in highly rated plans

Centers for Medicare & Medicaid Services. 2025 Star Ratings Data Tables (ZIP). Accessed Oct 23, 2024.
.

CMS maintains its own database of star ratings on every Medicare Advantage and Medicare prescription drug plan, ranging from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

You can find a plan’s rating with the Medicare plan finding tool.

What does Highmark Medicare Advantage cost?

In 2025, about a third of Highmark’s Medicare Advantage plans offer $0 premiums. You'll also be responsible for paying your Medicare Part B premium, which is $174.70 per month in 2024

Centers for Medicare & Medicaid Services. Costs. Accessed Oct 23, 2024.
.

(Most people pay this standard Part B amount, but if your income is above a certain threshold, you’ll pay the income-related monthly adjustment amount (IRMAA). Some Medicare Advantage plans cover part or all of your Part B premium.)

Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network or how often you may go out of network for care.

  • Whether you require extra benefits and whether the plan charges for them.

Here are examples of Highmark Medicare Advantage costs for the most popular plans in a mid-range city:

Highmark Medicare Advantage plan

Pricing

Complete Blue PPO Distinct (PPO)

Monthly premium: $12.

Deductible: None.

Out-of-pocket max: $5,500 in-network.

Copays:

  • Primary care: $0.

  • Specialist: $10.

  • Emergency care: $125.

  • Inpatient hospital: $275.*

Dental allowance: $3,000.

Community Blue Medicare HMO Signature (HMO)

Monthly premium: $0.

Deductible: None.

Out-of-pocket max: $6,200.

Copays:

  • Primary care: $0.

  • Specialist: $25.

  • Emergency care: $125.

  • Inpatient hospital: $295.*

Dental allowance: $3,000.

Security Blue HMO-POS ValueRx (HMO-POS)

Monthly premium: $30.

Deductible: None.

Out-of-pocket max: $5,500 in-network.

Copays:

  • Primary care: $0.

  • Specialist: $35.

  • Emergency care: $125.

  • Inpatient hospital: $220.**

Dental allowance: Preventive services only.

Selected plans are available in ZIP code 15106. *Inpatient hospital copay is per admit in-network. **Inpatient hospital copay is per day for days 1-5.

To get a sense of costs, use Medicare’s website to compare information among available plans in your area. You can select by insurance carrier to see only Highmark plans or compare across carriers.

Available Highmark Medicare Advantage plans

Highmark offers HMO and PPO plans as well as stand-alone Medicare Part D prescription drug plans. Highmark also has a plan designed for veterans.

Plan offerings include the following types:

A health maintenance organization (HMO) generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor to see a specialist, and out-of-network benefits are usually limited.

HMO point of service (POS) plans are HMO plans that allow members to get some out-of-network services, but they’ll pay more for those services.

Preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

Special needs plans (SNPs) restrict membership to people with certain diseases or characteristics. Hence, the benefits, network and drug formularies are tailored to the needs of those members. Highmark offers one type of SNP:

  • Dual-Eligible SNP: For people who are entitled to Medicare and who also qualify for assistance from a state Medicaid program.

Third-party ratings

AM Best Financial Strength Rating: A (Excellent)

AM Best is a credit rating agency that specializes in the insurance industry. In September 2023, AM Best affirmed its Financial Strength Rating of A (Excellent) for Highmark and its life/health subsidiaries

.

An A rating in this category indicates that AM Best believes Highmark has an excellent ability to meet its ongoing insurance obligations.

J.D. Power Ranking

In its 2024 U.S. Medicare Advantage Study — the 10th it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on eight factors ranging from level of trust to how well a provider resolves problems or complaints. The study was fielded in the 10 biggest state Medicare markets. On these measures, Highmark placed second of all major providers in Pennsylvania (the only state in which Highmark had enough market share to be considered)

.

Highmark Medicare Advantage service area

Highmark Medicare Advantage plans are available in four states — Delaware, New York, Pennsylvania and West Virginia — and more than 420,000 people are enrolled in Highmark plans. The company added 27,000 members for the 2024 plan year, according to a report from health care analytics firm The Chartis Group

.

About Highmark

Highmark, headquartered in Pittsburgh, Pennsylvania, was created in 1996 when Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield consolidated operations. Highmark is the fourth-largest company in the Blue Cross Blue Shield family. Highmark offers health insurance for individuals and families, dental insurance, Medicare Advantage and Part D plans, Medicare Supplement Insurance, and other insurance coverage such as travel insurance. The company also offers insurance for businesses.

Highmark Medicare Advantage customer service

Highmark Medicare Advantage members can contact their plan’s customer service in the following ways:

  • Call the number on their member ID card from 8 a.m. to 8 p.m. local time seven days a week.

  • Request a call from a Highmark Medicare Advisor.

Compare Medicare Advantage providers

Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.

Find the right Medicare Advantage plan

It’s important to do your research before selecting a Medicare Advantage plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
Highmark Medicare Advantage

Highmark

4.52

CMS Star Rating

Highmark is a member of the Blue Cross Blue Shield family. Highmark plans are highly rated and score well for member satisfaction, but plans are available in only four states.

(855) 432-0512 / TTY 711

M-F 8am-10pm EST, Sa-Su 9am-9pm EST

Speak to a licensed insurance agent on askchapter.org

GET A QUOTE

on NerdWallet

We will connect you with Medicare companies based on the information you provide. They will help you find a plan that suits your needs. If you prefer to speak to a licensed insurance agent right away, please call the number listed below.

States available

4 states


Members in high-rated plans

High (85% to 100%)


Member experience

3.98 (Above average)


States available

4 states


Members in high-rated plans

High (85% to 100%)


Member experience

3.98 (Above average)


Pros

  • Higher-than-average overall star rating from CMS.
  • Member experience ratings are well above average.

Cons

  • Available in only four states: Delaware, New York, Pennsylvania and West Virginia.
  • Has the smallest percentage of $0-premium plans of the major providers.

Medicare Advantage review methodology

The Medicare Advantage marketplace is concentrated among just a handful of companies; in many places, one insurer serves more than half of the market. NerdWallet reviewed 26 Medicare Advantage brands, with some insurers having more than one brand under their umbrella. (For example, Blue Cross Blue Shield includes the brands Anthem and Highmark.) At the national level, these reviews include nine of the 10 largest brands by enrollment. At the state level, our research includes at least one major insurer in 47 of the 49 states that offer Medicare Advantage plans, and includes the top two insurers in 35 of those states. (Alaska doesn't offer Medicare Advantage plans.) We also look at online search volume to identify regional and other notable players in the space.

NerdWallet’s Medicare Advantage reviews are based on ratings data from the Centers for Medicare & Medicaid Services, as well as pricing, plan availability by state, plan types available, consumer experience, extra benefits offered and more. These reviews are a guide, but we encourage you to shop around and compare several plans to find the best coverage and rate for you. NerdWallet does not receive compensation for any reviews. Read our editorial guidelines for additional information.

Medicare will have big changes in 2025. Compare Medicare Advantage plans