Pennsylvania Highmark Blue Cross Blue Shield Health insurance policies are available at extremely affordable rates. Instantly get the lowest rates for individual and family Highmark plans. Marketplace policies are designed for different situations, and we research and review your choices to provide you with the best prices and highest-quality policy options. We help you find coverage for the 29 counties of Western Pennsylvania including the Pittsburgh area.
Based in Pittsburgh, Highmark BCBS covers more than 5 million persons in Pennsylvania, West Virginia and Delaware. As one of the largest insurers in the US, plans are offered both "on" and "off" the federal Exchange Marketplace, and during and after Open Enrollment periods. An SEP (Special Enrollment Period) exemption is needed to qualify if the OE deadline is missed. However, plan benefits and rates remain identical to the offers you receive between November 1 and January 31.
Typically the main competitor for BCBS in Allegheny and surrounding counties is UPMC. Both carriers dominate market share and feature the largest list of providers for private and employer-provided plans. Despite frequent disagreements between the two giant insurers, Highmark customers are able to utilize many UPMC facilities, including physicians and specialists. Generally, all emergency-room visits are considered "in-network" for both companies.
Multiple Provider Network Options
my Community Blue Flex PPO - In-network treatment is available as "Enhanced" or "Standard" levels. Utilizing Enhanced physicians, hospitals, and other facilities, will likely result in lower copays and coinsurance. Using Standard physicians for treatment will increase your out-of-pocket expenses.
my Connect Blue EPO - In addition to the "Enhanced" and Standard" levels, a "Preferred" option is also available. This level offers the lowest doctor copays for Highmark individual plans. Allegheny Health Network doctors, surgeons, and other providers, are members of the Preferred tier.
2017 Marketplace Plans
Major Events Blue PPO 7150 (Community Blue) - Available to applicants under age 30, or any person that can prove "financial hardship." $7,150 deductible with maximum out-of-pocket expenses of $7,150. Coinsurance is 0%, so once deductible has been met, covered medical expenses are paid in full. Three primary-care physician (pcp) office visits are provided with no applicable deductible, copay, or coinsurance.
my Connect Blue EPO 6500B (Community Blue Flex Plan) - available in Allegheny, Beaver, Butler, Erie, Washington, and Westmoreland Counties.
Preferred - $6,500 deductible with maximum out-of-pocket expenses of $7,150. 30% coinsurance with $90 and $120 copays on pcp and specialist office visits. Urgent Care copay is $130, and non-hospital diagnostic lab and imaging copay is $40. Chiropractor copay is $120 with a maternity services copay of $1,500. Tier 1 90 days drug cost is$ 6-$20, and Tier 2 drug cost is $40-$150.
Enhanced - $6,800 deductible with maximum out-of-pocket expenses of $7,150. 50% coinsurance with $130 and $180 copays on pcp and specialist office visits. Urgent Care copay is $130, and non-hospital diagnostic lab and imaging copay is also $130. Chiropractor copay is $180 with a maternity services coinsurance of 50% after the deductible has been met. Tier 1 90 days drug cost is$ 6-$20, and Tier 2 drug cost is $40-$150.
Standard - $7,000 deductible with maximum out-of-pocket expenses of $7,150. 60% coinsurance which also applies to pcp and specialist office visits. Urgent Care and non-hospital diagnostic lab and imaging must meet deductible and coinsurance. Chiropractor and maternity services coinsurance is 60% after the deductible has been met. Tier 1 90 days drug cost is$ 6-$20, and Tier 2 drug cost is $40-$150, which is identical to previous two options.
Health Savings Blue PPO 2750 - $2,750 deductible with 20% coinsurance. Uses Community Blue Network.
Shared Cost 3200 - Very popular option because of $30 and $70 copays on pcp and specialist visits. Also $8 and $45 copays on generic/brand drugs.
Comprehensive Care Blue PPO 1500 - Low $1,500 deductible although non-preventive office visits must meet deductible.
Health Savings Blue 2500 - $2,500 deductible but only 10% coinsurance to help reduce out-of-pocket cost.
Shared Cost Blue PPO 1200 - Community Blue option that is the cheapest Gold-tier policy from Highmark. Very low $1,200 deductible with $20 and $30 office visit copays.
Total Health Blue PPO 1200 - Very low $1,200 deductible and $25 copay on office visits.
Balance Blue PPO 500 - And you thought the previous policy had a low deductible! This one features a $500 deductible with low $20 and $40 office visit copays.
Shared Cost Blue PPO 1500 - Also comes in a Multi-State plan. Similar to previous policy, only higher deductible and out-of-pocket maximum.
Health Savings Blue 1300 - $1,300 deductible with 10% coinsurance. Very reasonable out-of-pocket maximum of $2,300.
Comprehensive Care Blue PPO 500 - Very low $500 deductible and $1,650 maximum out-of-pocket maximum. Deductible and 10% coinsurance must be met for non-preventive office visits. However, prescriptions receive a copay (only) of $5, $20, and $45 on generic, brand, and specialty drugs.
Since it's not feasible (lack of space) to publish every rate scenario for every age and income, we're using hypothetical examples.
Scenario one is a couple (both age 45) with household income of $35,000 living in Allegheny County. The estimated subsidy of $181 has been deducted from the premium. The monthly prices you see below are your cost for selected Highmark plans:
$181 - Shared Cost Blue PPO 5500
$225 - Health Savings Blue PPO 2750
$320 - Health Savings Blue PPO 3400
$331 - Shared Cost Blue PPO 1200
$332 - Total Health Blue PPO 1200
$363 - Balance Blue PPO 500
Scenario two is a single 45 year-old with household income of $25,000 living in Westmoreland County. The estimated subsidy of $61 has been deducted from the premium.
$119 - Shared Cost Blue PPO 5500
$142 - Health Savings Blue PPO 2750
$189 - Health Savings Blue PPO 3400
$195 - Shared Cost Blue PPO 1200
$195 - Total Health Blue PPO 1200
$211 - Balance Blue PPO 500
$389 - Comprehensive Care Blue PPO 500
Scenario three is a married couple (Both age 55) with household income of $25,000 living in Westmoreland County. There re two children in the household that are covered under CHIP or separate plans. The estimated subsidy of $350 has been deducted from the premium.
$208 - Shared Cost Blue PPO 5500
$277 - Health Savings Blue PPO 2750
$424 - Health Savings Blue PPO 3400
$441 - Shared Cost Blue PPO 1200
$443 - Total Health Blue PPO 1200
$490 - Balance Blue PPO 500
$597 - Shared Cost 3200
NOTE: "Community Blue Flex PPO" plans offer two "tiers" of benefits. Enhanced value and standard value options provide customers a choice of levels of care. The enhanced value will possibly lower the deductible, coinsurance, or copay.
Senior Plans For Persons That Are Medicare-Eligible
Medicare Supplement (Medigap)
To qualify for a policy, you must already be covered for Parts A and B, and live within the designated Highmark BCBS service area. As an underwritten policy, you may have to meet certain medical guidelines. However, during designated Open Enrollment periods, no underwriting will be required. NOTE: The Open Enrollment period is NOT the same as the ACA OE period for persons under age 65. And of course, if you have another Medigap/Advantage plan in effect, you will have to terminate that contract if you accept the new policy.
Plan F (High Deductible) - Must meet deductible before supplemental benefits begin.
Plan A - Basic coverage including Part B coinsurance.
Plan N - Similar to previous plan, although copays for office visits and ER. Skilled nursing facility and Part A deductible included.
Plan B - Also similar to Plan A with Part A deductible included.
Plan C - Part B deductible included along with 80% of foreign travel exchange expenses.
Plan F - The most expensive plan since Part A and B deductibles are covered along with Part B excess charges.
NOTES: Re the high-deductible plan F option, the 2015 deductible is $2,180. You have to meet the entire deductible before benefits are paid. Also, Plans C, B, and A are offered at any time throughout the year and are medically underwritten. Plans F and N are offered without underwriting during Open Enrollment or converting from a business group plan that utilized Highmark.
These types of plans typically have lower rates than Medigap options since Highmark (and not the federal government) provides your Parts A and B benefits. Costs of your treatment are paid by the insurer and not Medicare. Often, drug coverage (Part D) is also included.
Community Blue Medicare HMO Signature - Cheapest option with premiums often $0. (Yes....That's $0!) Office visit copays are $10 for primary care physicians and $40 for specialists. A $300 copay applies to outpatient surgery and an inpatient hospital stay is subject to a $275 copay for the first five days. Prescriptions, dental and vision are covered (subject to policy provisions) and the maximum yearly out-of-pocket cost is $6,700.
Security Blue HMO ValueRX - Lower copays on specialist visits, x-rays and lab tests than "Signature" plan. Outpatient surgery copay ranges between $150 and $250 while inpatient hospital stay copay is $200 (first seven days). Similar vision, dental and maximum yearly out-of-pocket cost as previous plan.
Security Blue HMO Value - Low $5 copay on pcp visits. $100-$200 copay on outpatient surgery. $350 per hospital admission. Prescription drugs are not covered.
Freedom Blue PPO ValueRX - $15 and $40 office visit copays. $200-$300 copay on outpatient surgery. Only $250 per day for hospital admissions. Prescriptions covered including $4 and $15 copays on preferred and non-preferred generic drugs. $500 hearing aid benefits (every 36 months) along with additional vision and dental.
Freedom Blue PPO Select - Similar to previous plan, but lower copays and coinsurance. For example, office visit pcp/specialist copays are $10 and $35 instead of $15 and $40. X-ry and advanced imaging copayments are also less.
Community Blue HMO Medicare Prestige - Slightly more expensive than previous plan. $0 and $10 copays on office visits and $50 copay on outpatient surgery. Prescription drug copays are also slightly less.
Security Blue HMO Standard - Slightly higher out-of-pocket expenses than the Prestige plan.
Prescription Drug Coverage Part D
Medicare does not offer prescription benefits, so you can easily obtain benefits if you are already enrolled in Parts A and B. Of course, you also must reside in the network area covered by Highmark BCBS. Also, if you have an Advantage plan, you are not eligible for separate Part D benefits. The "coverage gap" of $2,960 in RX expenses to $4,700 out-of-pocket costs offers coinsurance benefits. Both contracts listed below provide catastrophic coverage.
Blue Rx PDP Plus - Cheaper of the two options although there is a $320 deductible to meet. Copays are $2 for Preferred generic, $12 for Non-preferred generic, $25% for Preferred Brand, 50% for Non-preferred Brand, and 25% for Speciality drugs.
Blue Rx PDP Complete - No deductible but more expensive than "Plus" plan. $4 copay for Preferred generic drugs. Also, Brand RX has copays ($40 and $70) instead of coinsurance.
UPDATES FROM THE PAST
Highmark will pay all unpaid UPMC claims since the beginning of the year. Since they will be classified as "inside the network," more than 25,000 claims will now be paid. Highmark will also pay maternity expenses from rival UPMC's Magee Womens Hospital if the pregnancy originated in 2014.
The new "Connect Blue" network from Highmark will be introduced on 2016 Pa Marketplace plans. With a more limited network, rates are expected to be as much as 10% less than Community Blue policies. Copays on non-preventative office visits may also be lower, along with possible deductible reductions for the preferred tier.
The four types of policies available for 2016 are Connect Blue, Community Blue, Comprehensive Blue, and Health Savings Blue, which is an HSA product.