Highmark Blue Shield health insurance plans are available through our website at the lowest available rates for residents in the 21 counties of Central Pennsylvania and the Lehigh Valley. We make it easy to compare affordable individual and family policies and buy quality Marketplace coverage. All policies can be purchased on a monthly basis and we help you understand your subsidy calculation and how it impacts your Exchange enrollment.
Highmark BS is well-known for its trust, integrity and innovation. Through a large network of doctors, specialists and hospitals, you'll always have a wide selection of providers. Most plans also allow you to use "out-of-network" facilities, although there is a higher out of pocket cost. Areas around Dauphin, Lancaster, Lebanon and Perry counties have especially high numbers of available medical facilities.
They also offer coverage to same-sex couples, since they received permission with the Center for Medicare and Medicaid Services. Since Delaware and other surrounding states already offer this benefit, Highmark decided to file papers so they can also offer LGBT-friendly plans.
Senior Medicare Supplement and Advantage coverage is offered to persons that have reached age 65 and signed up for Parts A and B. Separate Part D prescription drug plans are also offered, and sometimes included in Advantage contracts. Although Medigap plans are standardized, you can often reduce your out-of-pocket costs, including deductibles and copays.
There are about 15 different policies offered for persons under age 65 for 2017 and beyond. Determining which policy is best for you and your family depends on multiple factors. Some of the most prominent factors include your age, county of residence, smoking status and family income (for federal subsidy calculation). Of course, you will not be asked any medical questions. For a personalized confidential quote, simply contact us with this information.
Major Events Blue PPO 7150 - Available in Dauphin, Lebanon, and Perry counties. Three primary care physician (pcp) office visits provided at no cost. Deductible is $7,150 with maximum out-of-pocket expenses of $7,150 and 0% coinsurance. NOTE: Policy is only available to applicants under age 30.
my Premier Blue Flex PPO 6000BQE - Available in Lancaster and Franklin counties. $6,000 deductible with $6,450 maximum out-of-pocket expenses and 40% coinsurance. All non-preventative expenses must meet deductible and coinsurance. Enhanced and Standard networks available.
Shared Cost Blue PPO 6800 - Available in Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northumberland, Northampton, Perry, Schuylkill, Snyder, Union, and York counties. $100 and $135 pcp office visit copays with $150 Urgent Care visit copay. Deductible is $6,800, with $7,150 maximum out-of-pocket expenses and 30% coinsurance. Tier 1, 2, 3,and 4 drugs are covered at 15%, 25%, 35%, and 50% of the cost.
Alliance Flex Blue PPO 6800 - Available in Dauphin, Lebanon, and Perry counties. "Enhanced" and "Standard" benefits provide two different options. For example, pcp, specialist, and Urgent Care copay options are $95, $130, $150, or $130, $160, and $190. Deductible is $6,850, and maximum out-of-pocket expenses are $7,150.
Alliance Flex Blue PPO 2300 - Available in Perry, Lebanon, Dauphin, Berks, and Cumberland counties. $2,300 deductible with $7,100 maximum out-of-pocket expenses and 30% coinsurance. $50 and $80 office visit copays (primary-care physician and specialist) and $90 copay for Urgent Care visits. Diagnostic lab and basic imaging treatment are also subject to $80 copay. Tier 1, 2, 3, and 4 drugs are subject to 15%, 25%, 35%, and 50% payment for the cost of the drug.
my Lehigh Valley Flex Blue PPO 2900S - Available in Schuylkill, Lehigh, and Northampton counties. $2,900 deductible with maximum out-of-pocket expenses of $7,150 and 30% coinsurance. $50 and $80 office visit copays (primary-care physician and specialist) and $100 copay for Urgent Care visits. Diagnostic lab and basic imaging treatment are also subject to $50 copay. Advanced imaging must meet $250 copay. Tier 1, 2, 3, and 4 drugs are subject to 15%, 25%, 35%, and 50% payment for the cost of the drug (similar to previous plan).
my Premier Blue Flex PPO 2700SQE - Available in Lancaster and Franklin counties. $2,700 deductible with maximum out-of-pocket expenses of $6,000 and 20% coinsurance. All non-preventative expenses (including prescription drugs) must meet deductible and are then covered with 20% coinsurance.
my Premier Blue Flex PPO 3200S - Available in Lancaster and Franklin counties. $3,200 deductible with $6,850 maximum out-of-pocket expenses and 20% coinsurance. $30 and $80 office visit copays (primary-care physician and specialist) and $110 copay for Urgent Care visits. Diagnostic lab (non-hospital) and basic imaging treatment are also subject to $35 and $70 copays. Advanced imaging must meet 20% coinsurance and deductible. Tier 1, 2, 3, and 4 drugs are subject to 15%, 25%, 35%, and 50% payment for the cost of the drug.
Alliance Flex Blue PPO 1000 - Available in Berks, Cumberland, Dauphin, Lebanon, and Perry counties. "Enhanced" and "Standard" benefits provide two levels of coverage. Enhanced coverage included $1,000 deductible with $5,250 maximum out-of-pocket expenses and 20% coinsurance. Office visit copays are $20 and $30 with $60 Urgent Care copay. Diagnostic lab and basic imaging is subject to only a $30 copay. Tier 1, 2, 3, and 4 drugs are subject to 15%, 25%, 35%, and 50% payment for the cost of the drug.
my Lehigh Valley Flex Blue PPO 1000G - Available in Schuylkill, Lehigh, and Northampton counties. $1,000 deductible (Enhanced) with maximum out-of-pocket expenses of $6,800 and 20% coinsurance. $10 and $20 office visit copays and $40 copay for Urgent Care visits. Diagnostic lab and basic imaging treatment are also subject to $20 copay. Advanced imaging must meet $150 copay. Tier 1, 2, 3, and 4 drugs are subject to 15%, 25%, 35%, and 50% payment for the cost of the drug.
my Premier Blue Flex PPO 1700GQ - Available in Lancaster and Franklin counties. $1,700 deductible with $3,250 maximum out-of-pocket expenses and 10% coinsurance. Once deductible and coinsurance have been met, 100% of all covered expenses are paid.
Pa Health Exchange Plans
We continue to be a point of reference for you so you can quickly view and compare plans and if you wish, speak to an experienced professional. This could save time and aggravation of having to deal directly with a new government-run website and inexperienced newly-hired workers.
Since every applicant is now accepted when they apply for a policy, it will be most important to review all of the choices. Four metal options (Platinum, Gold, Silver and Bronze) are offered along with special "SHOP" policies for small business owners and their employees. Each year, prices are reset, and new plans can be offered by carriers to meet the changing needs of consumers. Highmark Group coverage information is available for employers and workers.
Also, since all submitted applications are approved with medical questions no longer asked, Highmark no longer offers many of the older Guaranteed-issue (GI) policies from 2013 and earlier. However, when policies are purchased outside Open Enrollment periods (other than approved exceptions, such as divorce, loss of job, baby or dependent reaching age 26), medical questions may be asked on short-term or limited-benefit policies.
The new federal subsidy is based on household income eligibility. For example, a family of four with income under $95,400 will be able to qualify for rate reductions. Likewise, a couple with no children with income under $62,920 will also qualify for the Obamacare subsidy. The larger the household, the bigger the potential aid becomes.
The official Federal Poverty Guidelines (FPL) levels are listed below. (Credit to Impact CA for providing the graph) These guidelines will be used for 2017 effective dates. The earnings amounts increased about 1.5% due to inflation. If your total household income is below 138% of the FPL, Medicaid and/or CHIP may be available, and you would not be able to apply for a Pa Health Exchange plan. In 2015, Medicaid eligibility requirements were expanded. Thus, many affordable Central Pa medical plans are offered, especially, if you qualify for Medicaid.
So…which Highmark Under-65 contract is best for you? Of course, there is no right answer, but generally, if you like copays, the Silver plans may be your best choice. If you like Health Savings Accounts, the PPO HDHP options are the best choices. If you’re not sure…call or contact us and we’ll help you decide which policy fits your needs the best. If you need help finding a provider in your area, we can help verify if your doctor or hospital is "in-network."
Highmark BC Medicare Coverage
For Seniors in Pennsylvania, there are three types of policies available for purchase. They are Medicare Advantage (Part C), prescription drug coverage (Part D) and Medicare Supplement (Medigap). Policies are generally medically underwritten although during Open Enrollment periods, acceptance is often guaranteed. Open Enrollment dates for persons age 65 and over, differ than the dates for persons under age 65.
Medicare Advantage - The Community Blue Medicare HMO Signature is the least expensive option. Although the network is limited, office visit copays are only $5 and $50, and lab/diagnostic tests are subject to copays of $0-$25. The out-of-pocket maximum is $6,700. Outpatient surgery and ER copays are $300 and $75. Additional plan options include Freedom Blue PPO ValueRx, Freedom Blue PPO Basic, Freedom Blue PPO Standard, and Freedom Blue PPO Deluxe.
Prescription Drug - It's important to remember that the original and basic Medicare does not provide drug coverage. The two available options are Blue RX PDP Plus (The cheaper policy with a $310 deductible) and Blue RX PDP Complete, which has no deductible.The Plus plan pays specified percentages of non-generic prescriptions. The Complete plan has copays ($40 Preferred Brand and $70 Non-Preferred Brand).
Medicare Supplement (Medigap) - The six available plans are F, A, N, B, C and F (HD). Plans C and F are the most expensive because most out-of-office expenses are paid in full. The other plans will save money, unless their is high usage.
Highmark Medigap Blue Medicare Supplement Rates (Monthly)
65 Year-Old Dauphin And Lebanon Counties
$75 - Plan F (High Deductible)
$106 - Plan A
$106 - Plan N
$125 - Plan B
$146 - Plan C
$146 - Plan F
70 Year-Old Dauphin And Lebanon Counties
$88 - Plan F (High Deductible)
$127 - Plan A
$128 - Plan N
$151 - Plan B
$177 - Plan C$178 - Plan F
Updates From The Past:
October 2013 - As a direct result of the Affordable Care Act legislation, Highmark will be terminating about 175,000 personal policies in Western Pa. Unfortunately, for many of these policyholders, rates will increase because of forced mandates under the new law. However some customers will see price reductions, especially if they qualify for the federal Obamacare subsidy.
January 2014 - Open Enrollment, which began on October 1st, continues through the end of March (2014). During this time, you can not be turned down for medical conditions and government subsidies will instantly reduce premiums, if your income is below 400% of the Federal Poverty Level.
February 2014 - Through the end of 2013, Highmark has enrolled more than 40,000 persons in Exchange plans. And yes, our website has been a big part of the process. This number far outpaces both Geisinger and Capital Blue Cross. However, both of those carriers are regional companies that don't extend coverage in as many counties.
The Community Blue Silver policies are extremely popular because of the competitive pricing, and the cost-sharing features that lower deductibles and copays for many qualified applicants. A nationwide policy would be an alternative selection for persons that spend much of the year outside of Pennsylvania.
April 2014 - Highmark signed up approximately 150,000 new customers during Open Enrollment, which ended on March 31st. Exchange plans are still available to applicants that qualify for one of several approved exceptions. Not all of the persons that signed up have paid premiums and about half were previously uninsured or had coverage with a different carrier.
October 2014 - Three new policy designs will be available for 2015 effective dates. Specific details may not be available until November when Open Enrollment begins. Policy changes and prices have been submitted to the Pa Department of Insurance, but have not been approved yet. Also, non-grandfathered plans that are being terminated will end on December 31st.
December 2015 - Shared Cost Blue PPO 6000 is one of the most popular 2016 Highmark plans for Central Pennsylvania. Although copays are high for primary-care physician and specialist visits, the deductible does not have to be met.
November 2016 - Fewer consumer choices are available in many Central Pa counties, since etna and UnitedHealthcare have exited the market. For instance, in the Harrisburg area, only Geisinger, Capital BC, and Highmark offer plans.