Highmark
4.52
CMS Star Rating
on NerdWallet
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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
4.52
CMS Star Rating
on NerdWallet
M-F 8am-10pm EST, Sa-Su 9am-9pm EST
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.
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.
3.82
CMS Star Rating
from UnitedHealthcare
4.27
CMS Star Rating
on NerdWallet
M-F 8am-10pm EST, Sa-Su 9am-9pm EST
3.63
CMS Star Rating
from Humana
3.93
CMS Star Rating
on NerdWallet
M-F 8am-10pm EST, Sa-Su 9am-9pm EST
» More options in our roundup of the best Medicare Advantage plans
3.82
CMS Star Rating
from UnitedHealthcare
3.63
CMS Star Rating
from Humana
» More options in our roundup of the best Medicare Advantage plans
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.
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.
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.
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.
(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:
Dental allowance: $3,000. |
Community Blue Medicare HMO Signature (HMO) | Monthly premium: $0. Deductible: None. Out-of-pocket max: $6,200. Copays:
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:
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. | |
Sources: |
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.
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:
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.
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 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.
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 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.
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.
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?
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.
M-F 8am-10pm EST, Sa-Su 9am-9pm EST
Speak to a licensed insurance agent on askchapter.org
on NerdWallet
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
Cons
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.