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Pennsylvania Highmark Blue Cross Blue Shield Health insurance policies are available at extremely affordable rates. Instantly get the lowest rates for individual and family under-65 Highmark plans. On and off-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. Senior Medicare Supplement, Advantage, and Part D prescription drug plans are also available. 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 December 15th.

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. Dental benefits are provided by United Concordia, and vision benefits are provided by Visionworks of America. The HM Insurance Group provides stop loss coverage and managed care reinsurance.

Any child under age 19 may receive CHIP benefits. If you qualify for free CHIP coverage, there are no copays for primary care physician (pcp) or specialist office visits, the ER, or generic and brand drugs. Low-cost and full-cost out-of-pocket expense plans are also very affordable. A wide range of preventative and symptomatic benefits are included.

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, but more providers will also be available.  Out-of-network coverage is also provided with the highest out-of-pocket costs.

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. Physicians and specialists are often located within several areas of members. Allegheny Health Network doctors, surgeons, and other providers, are members of the Preferred tier. No out-of-network coverage is provided unless there is an emergency. Employers in the following counties can also utilize this network: Allegheny, Butler, Beaver, Erie, Washington, and Westmoreland. Mercer County companies with more than 50 employees are also eligible.

my Direct Blue Western Pa Network Hospitals - Advanced Surgical Hospital, Allegheny General Hospital, Allegheny Valley Hospital, Bradford Regional Medical Center, Butler Memorial Hospital, Canonsburg General Hospital, Children's Hospital Of Pittsburgh, Corry Memorial Hospital, Dlp Conemaugh Memorial Medical Center, Dlp Conemaugh Myersdale Medical Center, Dlp Conemaugh Miners Medical Center, Excela Frick Hospital, Excela Latrobe Hospital, Excela Westmoreland Hospital, Forbes Regional Hospital, Heritage Valley Beaver, Heritage Valley Sewickley, Jefferson Regional Medical Center, Meadville Medical Center, Millcreek Community Hospital, Monongahela Valley Hospital, Nason Hospital, Saint Vincent Health Center, Western Pennsylvania Hospital, and Titusville Area Hospital.

 

Get affordable Highmark healthcare coverge in Western Pa. Individual and family plans are eligible for federal subsidies that lower premiums.

 

2018 Pa Highmark BCBS Plans

 

Catastrophic Tier

Major Events Blue PPO 7350 (Community Blue Plan) - Available On-Exchange in Beaver, Blair, Butler, Cambria, and Somerset Counties. Available Off-Exchange in Allegheny, Armstrong, Bedford, Cameron, Centre, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, and Westmoreland Counties. $7,350 deductible with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. Three pcp office visits available at no cost.

 

Bronze Tier

my Direct Blue HMO 6950B - Available On-Exchange in Allegheny, Crawford, Erie, Washington, and Westmoreland Counties. $6,950 deductible with maximum out-of-pocket expenses of $7,350. Pcp office visit copay is $50.

my Direct Blue HMO 700B - Available On-Exchange in Allegheny, Crawford, Erie, Washington, and Westmoreland Counties. $7,000 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Office visit copays are $60 and $100, and the Urgent Care copay is $120. The telemedicine service copay is $20. Lab tests are subject to a $20 copay (non-hospital) or $80 (hospital). Basic diagnostic services are subject to a $100 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

my Direct Blue EPO 6950B - Available On-Exchange in Beaver and Butler Counties. $6,950 deductible with maximum out-of-pocket expenses of $7,350 and 0% coinsurance.  Pcp office visit copay is $50.

my Direct Blue EPO 700B - Available On-Exchange in Beaver and Butler Counties. $7,000 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Office visit copays are $60 and $100, and the Urgent Care copay is $120. The telemedicine service copay is $20. Lab tests are subject to a $60 copay. Basic diagnostic services are subject to a $100 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

my Direct Blue Conemaugh EPO 6950B - Available On-Exchange in Blair, Cambria, and Somerset Counties. $6,950 deductible with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. Pcp office visit copay is $50.

my Direct Blue Conemaugh EPO 700B - Available On-Exchange in Blair, Cambria, and Somerset Counties. $7,000 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Office visit copays are $60 and $100, and the Urgent Care copay is $120. The telemedicine service copay is $20. Lab tests are subject to a $60 copay. Basic diagnostic services are subject to a $100 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

 

Silver Tier

my Direct Blue HMO 7150S - Available On-Exchange in Allegheny, Crawford, Erie, Washington, and Westmoreland Counties. $7,150 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Office visit copays are $70 and $90, and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $30 copay (non-hospital) and $120 (hospital). Basic diagnostic services are subject to a $110 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

my Direct Blue EPO 7150S - Available On-Exchange in Beaver and Butler Counties. $7,150 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Office visit copays are $70 and $90, and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $90 copay and basic diagnostic services are subject to a $110 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

my Direct Blue Conemaugh EPO 7150S - Available On-Exchange in Blair, Cambria, and Somerset Counties. $7,150 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. Office visit copays are $70 and $90, and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $90 copay and basic diagnostic services are subject to a $110 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4). 

my Direct Blue HMO 2850SQE - Available Off-Exchange in Allegheny, Crawford, Erie, Washington, and Westmoreland Counties. $2,850 deductible with maximum out-of-pocket expenses of $6,550 and 20% coinsurance. Office visits, Urgent Care visits, prescription drugs, and other non-preventative coverage must meet deductible and coinsurance.

my Direct Blue HMO 3750S - Available Off-Exchange in Allegheny, Crawford, Erie, Washington, and Westmoreland Counties. $3,750 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. PCP visits have a $0 copay for the first two visits, and $40 thereafter. Specialist and Virtual visits have a $90 copay and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $20 copay and basic diagnostic services are subject to a $90 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).  

my Direct Blue EPO 2850SQE - Available Off-Exchange in Beaver and Butler Counties. $2,850 deductible with maximum out-of-pocket expenses of $5,700 and 20% coinsurance. Office visits, Urgent Care visits, prescription drugs, and other non-preventative coverage must meet deductible and coinsurance.

my Direct Blue EPO 3750S - Available Off-Exchange in Beaver and Butler Counties. $3,750 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. PCP visits have a $0 copay for the first two visits, and $40 thereafter. Specialist and Virtual visits have a $90 copay and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $60 copay and basic diagnostic services are subject to a $90 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).  

my Direct Blue Conemaugh EPO 2850SQE - Available Off-Exchange in Blair, Cambria, and Somerset Counties. $2,850 deductible with maximum out-of-pocket expenses of $5,700 and 20% coinsurance. Office visits, Urgent Care visits, prescription drugs, and other non-preventative coverage must meet deductible and coinsurance. 

my Direct Blue Conemaugh EPO 3750S - Available Off-Exchange in Blair, Cambria, and Somerset Counties. $3,750 deductible with maximum out-of-pocket expenses of $7,350 and 30% coinsurance. PCP visits have a $0 copay for the first two visits, and $40 thereafter. Specialist and Virtual visits have a $90 copay and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $60 copay and basic diagnostic services are subject to a $90 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).   

 

Gold Tier

 

my Direct Blue HMO 1000G - Available On-Exchange in Allegheny, Crawford, Erie, Washington, and Westmoreland Counties. $1,000 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Office visit copays are $70 and $90, and the Urgent Care copay is $110. The telemedicine service copay is $20. Lab tests are subject to a $20 copay (non-hospital) and $80 (hospital). Basic diagnostic services are subject to a $100 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

my Direct Blue EPO 1000G - Available On-Exchange in Beaver and Butler Counties. $1,000 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Office visit copays are $0 for the first two pcp visits ($20 thereafter) and $50, and the Urgent Care copay is $75. The telemedicine service copay is $20. Lab tests are subject to a $25 copay.  Basic diagnostic services are subject to a $45 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

my Direct Blue Conemaugh EPO 1000G - Available On-Exchange in Blair, Cambria, and Somerset Counties. $1,000 deductible with maximum out-of-pocket expenses of $6,500 and 20% coinsurance. Office visit copays are $0 for the first two pcp visits ($20 thereafter) and $50, and the Urgent Care copay is $75. The telemedicine service copay is $20. Lab tests are subject to a $25 copay.  Basic diagnostic services are subject to a $45 copay. Prescription drug coinsurance is 15% (Tier 1), 25% (Tier 2), 35% (Tier 3) and 50% (Tier 4).

 

Individual And Family Rates

Since it's not feasible (lack of space) to publish rates and scenarios for all ages and incomes, we're using hypothetical examples. The estimated subsidy (if applicable) has been deducted from the premium. Rates are monthly.

 

35-year-old with household income of $25,000 living in Westmoreland County.

$82  - my Direct Blue HMO 6950B

$110 - my Direct Blue HMO 7000B

$232 - my Direct Blue HMO 1000G

$241 - my Direct Blue HMO 7150S

 

Married couple (both age 45) with household income of $35,000 living in Allegheny County.

$111 - my Direct Blue HMO 6950B

$177 - my Direct Blue HMO 7000B

$465 - my Direct Blue HMO 1000G

$487 - my Direct Blue HMO 7150S

 

Married couple (both age 55) with household income of $35,000 living in Beaver County.

$291 - my Direct Blue HMO 6950B

$394 - my Direct Blue HMO 7000B

$845 - my Direct Blue HMO 1000G

$878 - my Direct Blue HMO 7150S

 

60-year-old with household income of $45,000 living in Butler County.

$245 - my Direct Blue EPO 6950B

$308 - my Direct Blue EPO 7000B

$582 - my Direct Blue EPO 1000G

$602 - my Direct Blue EPO 7150S

 

Senior Highmark BCBS Plans For Persons That Are Medicare-Eligible

 

Get affordable medical coverage if you are a Senior in Western Pa. Highmark offers many low-cost policies.

 

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.

Available Plans:

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 2018 deductible is $2,200. You must meet the entire deductible before benefits are paid. Plans are offered without underwriting during Open Enrollment or when converting from a business group plan that utilized Highmark. Premiums illustrated below are

 

Current Monthly Preferred Rates

 

Allegheny, Fayette, Westmoreland, Indiana, Greene, and Washington Counties (Southwest Region) - Age 65

Plan A - $136

Plan B - $144

Plan C - $190

Plan D - $145

Plan F - $191

Plan F (HD) - $93

Plan G - $145

Plan N - $140

 

Allegheny, Fayette, Westmoreland, Indiana, Greene, and Washington Counties (Southwest Region) - Age 70

Plan A - $164

Plan B - $175

Plan C - $232

Plan D - $175

Plan F - $232

Plan F (HD) - $111

Plan G - $175

Plan N - $169

 

Beaver, Bedford, Armstrong, Jefferson, Centre, Clearfield, Cambria, Elk, Forest, Cameron, Butler, Clarion, Lawrence, Mercer, Potter, Venango, Warren, McKean, Erie, Crawford, Blair, Huntingdon, and Somerset Counties - Age 65

Plan A - $111

Plan B - $118

Plan C - $155

Plan D - $125

Plan F - $155

Plan F (HD) - $77

Plan G - $125

Plan N - $114

 

Beaver, Bedford, Armstrong, Jefferson, Centre, Clearfield, Cambria, Elk, Forest, Cameron, Butler, Clarion, Lawrence, Mercer, Potter, Venango, Warren, McKean, Erie, Crawford, Blair, Huntingdon, and Somerset Counties - Age 70

Plan A - $134

Plan B - $142

Plan C - $188

Plan D - $150

Plan F - $188

Plan F (HD) - $91

Plan G - $150

Plan N - $138

 

Wayne, Pike, Monroe, Carbon, Luzerne, Lackawanna, Wyoming, Susquehanna, Bradford, Sullivan, Lycoming, Clinton, and Tioga Counties - Age 65

Plan A - $86

Plan B - $109

Plan C - $141

Plan D - $117

Plan F - $170

Plan F (HD) - $96

Plan G - $119

Plan N - $105

 

Wayne, Pike, Monroe, Carbon, Luzerne, Lackawanna, Wyoming, Susquehanna, Bradford, Sullivan, Lycoming, Clinton, and Tioga Counties - Age 70

Plan A - $101

Plan B - $127

Plan C - $166

Plan D - $133

Plan F - $187

Plan F (HD) - $103

Plan G - $136

Plan N - $112

 

Dauphin, Franklin, Juniata, Cumberland, Perry, Lebanon, Fulton, York, Adams, Lancaster, and Mifflin Counties - Age 65

Plan A - $108

Plan B - $111

Plan C - $150

Plan D - $121

Plan F - $150

Plan F (HD) - $76

Plan G - $121

Plan N - $109

 

Dauphin, Franklin, Juniata, Cumberland, Perry, Lebanon, Fulton, York, Adams, Lancaster, and Mifflin Counties - Age 70

Plan A - $130

Plan B - $134

Plan C - $181

Plan D - $145

Plan F - $182

Plan F (HD) - $91

Plan G - $145

Plan N - $131


 

Medicare Advantage

 

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.

 

Compare Highmark BCBS Senior Advantage options. Medicare coverage provides comprehensive benefits to PA Seniors.

 

Available Plans

Community Blue Medicare HMO Signature -$0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $40, with copays of $50 for x-rays, and $270 for advanced imaging. The lab and diagnostic test copay is $0-$25. Outpatient surgeries are covered with a $275-$350 copay, and the ambulance copay is $350 per trip. The ER copay is $80, while inpatient hospital stays have a $275 copay for the first five days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $40 for generic, $115 for preferred brand, $270 for non-preferred drugs, and 33% for specialty.

Community Blue Medicare HMO Prestige - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $10, with copays of $10 for x-rays, and $75 for advanced imaging. The lab and diagnostic test copay is $0-$10. Outpatient surgeries are covered with a $50 copay, and the ambulance copay is $150 per trip. The ER copay is $80, while inpatient hospital stays have a $100 copay per admission. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $40 for generic, $115 for preferred brand, $270 for non-preferred drugs, and 33% for specialty.

Community Blue Medicare PPO Signature - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $40, with copays of $50 for x-rays, and $270 for advanced imaging. The lab and diagnostic test copay is $0-$25. Outpatient surgeries are covered with a $275-$350 copay, and the ambulance copay is $350 per trip. The ER copay is $80, while inpatient hospital stays have a $275 copay for the first five days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $40 for generic, $115 for preferred brand, $270 for non-preferred drugs, and 33% for specialty.

Security Blue HMO Basic - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $30, with copays of $45 for x-rays, and $100 for advanced imaging. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $100-$200 copay, and the ambulance copay is $125 per trip. The ER copay is $80, while inpatient hospital stays have a $350 copay per admission. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance. Prescription drug benefits are not included.

Security Blue HMO ValueRx - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $10 and $40, with copays of $30 for x-rays, and $175 for advanced imaging. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $175-$250 copay, and the ambulance copay is $225 per trip. The ER copay is $80, while inpatient hospital stays have a $225 copay for the first five days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $40 for generic, $115 for preferred brand, $270 for non-preferred drugs, and 33% for specialty.

Security Blue HMO Standard - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $10 and $30, with copays of $25 for x-rays, and $100 for diagnostic radiology services. The lab and diagnostic test copay is $10. Outpatient surgeries are covered with a $225 copay, and the ambulance copay is $175 per trip. The ER copay is $80, while inpatient hospital stays have a $325 copay for each visit. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

Security Blue HMO Deluxe - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $25, with copays of $20 for x-rays, and $50 for diagnostic radiology services. The lab and diagnostic test copay is $0-$5. Outpatient surgeries are covered with a $75-$150 copay, and the ambulance copay is $125 per trip. The ER copay is $80, while inpatient hospital stays have a $225 copay for each visit. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance. 

30-day prescription drug copays are $0 for preferred generic, $13 for generic, $42 for preferred brand, $100 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $32.50 for generic, $105 for preferred brand, $250 for non-preferred drugs, and 33% for specialty.

Freedom Blue PPO Classic - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $5 and $10, with copays of $20 for x-rays, and $125 for diagnostic radiology services. The lab and diagnostic test copay is $0-$10. Outpatient surgeries are covered with a $200 copay, and the ambulance copay is $125 per trip. The ER copay is $80, while inpatient hospital stays have a $125 copay for the first 5 days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $45 for generic, $126 for preferred brand, $270 for non-preferred drugs, and n/a for specialty.

Freedom Blue PPO Select - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $10 and $30, with copays of $30 for x-rays, and $175 for diagnostic radiology services. The lab and diagnostic test copay is $0-$15. Outpatient surgeries are covered with a $125-$225 copay, and the ambulance copay is $175 per trip. The ER copay is $80, while inpatient hospital stays have a $125 copay for the first 5 days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $40 for generic, $115 for preferred brand, $270 for non-preferred drugs, and 33% for specialty.

Freedom Blue ValueRx - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $10 and $40, with copays of $40 for x-rays, and $200 for advanced imaging. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $200-$275 copay, and the ambulance copay is $225 per trip. The ER copay is $80, while inpatient hospital stays have a $250 copay for the first 6 days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.

30-day prescription drug copays are $0 for preferred generic, $15 for generic, $42 for preferred brand, $90 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $40 for generic, $115 for preferred brand, $270 for non-preferred drugs, and 33% for specialty.

Freedom Blue PPO Basic - $0 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $15 and $35, with copays of $30 for x-rays, and $150 for advanced imaging. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $100-$200 copay, and the ambulance copay is $125 per trip. The ER copay is $80, while inpatient hospital stays have a $350 copay per admission. Skilled nursing facilities have a $0 copay for the first 20 days, and a $167.50 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance. Drug coverage is not included.

 

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 may not be 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. All contracts listed below provide catastrophic coverage.

 

Available Plans

Basic Blue Rx - $27.20 per month. $405 deductible (except Tiers 1 and 2). Preferred 30-day copays are $4 (Tier 1), $9 (Tier 2), 15% (Tier 3), 30% (Tier 4), and 25% (Tier 5). Preferred 90-day mail order copays are $10 (Tier 1), $23 (Tier 2), 15% (Tier 3), 30% (Tier 4), and 25% (Tier 5).

Blue Rx PDP Plus -  $84.90 per month. $405 deductible. Preferred 30-day copays are $0 (Tier 1), $5 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day mail order copays are $0 (Tier 1), $12.50 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 25% (Tier 5).

Blue Rx PDP Complete - $157.80 per month. $0 deductible. Preferred 30-day copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 35% (Tier 4), and 33% (Tier 5). Preferred 90-day mail order copays are $0 (Tier 1), $12.50 (Tier 2), $100 (Tier 3), 35% (Tier 4), and 33% (Tier 5). 

 

Highmark Blue Edge Dental Insurance Plans

Coverage is offered to individuals and families within required service area. Having existing medical benefits is not required. Plans are issued at any time throughout the year. Policy becomes active on the first day of the month after the application is received. Spouses and dependents may apply on the same application as the primary insured. Non-covered services may be eligible for network reductions through United Concordia.

 

Blue Edge Dental Basic - $0 deductible with $1,000 maximum annual benefits per person. 100% coverage for oral exams, evaluations, radiographs, cleanings, fluoride treatments, sealants, consultations, emergency palliative treatment and space maintainers. Monthly rates are $18.37 (ages 0-25), $20.53 (ages 26-39), $22.15 (ages 40-49), and $22.69 (ages 50 and above).

Blue Edge Dental Value - $25 deductible with $1,000 maximum annual benefits per person. 100% coverage for oral exams, evaluations, radiographs, cleanings, fluoride treatments, sealants, consultations, emergency palliative treatment and space maintainers. 50% coverage for repairs of crowns, inlays, onlays, and dentures.  Resin based composite anterior and posterior white fillings, amalgam restorations, and simple extractions also covered at 50%. Monthly rates are $21.58 (ages 0-25), $22.93 (ages 26-39), $26.98 (ages 40-49), $31.70 (ages 50-63), and $32.38 (ages 64 and above).

Blue Edge Dental High - $100 deductible with $1,000 maximum annual benefits per person. 100% coverage for oral exams, evaluations, radiographs, cleanings, fluoride treatments, sealants, consultations, emergency palliative treatment and space maintainers. 50% coverage for repairs of crowns, inlays, onlays, and dentures.  Resin based composite anterior and posterior white fillings, amalgam restorations, and simple extractions also covered at 50%. Surgical extractions, complex oral surgery, root canals, periodontics, crowns, inlays, onlays, fixed partial dentures, and dentures, are covered at 30%.  Monthly rates are $25.78 (ages 0-25), $27.39 (ages 26-39), $32.22 (ages 40-49), $37.86 (ages 50-63), and $38.66 (ages 64 and above).  

Blue Edge Dental Premier - $50 deductible with $1,250 maximum annual benefits per person. 100% coverage for oral exams, evaluations, radiographs, cleanings, fluoride treatments, sealants, consultations, emergency palliative treatment and space maintainers. 50% coverage for repairs of crowns, inlays, onlays, and dentures.  Resin based composite anterior and posterior white fillings, amalgam restorations, and simple extractions also covered at 80%. Surgical extractions, complex oral surgery, root canals, periodontics, crowns, inlays, onlays, fixed partial dentures, and dentures, are covered at 50%.  Monthly rates are $31.63 (ages 0-25), $33.61 (ages 26-39), $39.54 (ages 40-49), $46.46 (ages 50-63), and $47.45 (ages 64 and above).   

 

Conversion Plans

If your CHIP or Highmark group coverage is terminating, you may qualify for a "Conversion" plan. Both single and family options are offered. Benefits are guaranteed, with pre-existing conditions covered. And the effective date coincides with the termination date of prior coverage. Available plan options are shown below:

Shared Cost Blue PPO 7000

my Direct Blue HMO 700B

my Direct Blue Lehigh Valley EPO 7000B

 

Affiliated Companies That Offer Non-BCBS Products And Services

Allegheny Health Network - Offers wellness services, healthcare education, and research through many locations in the area, including the following hospitals: Allegheny General, Cannonsburg, Forbes, Jefferson, Saint Vincent, and West Penn. Additional outpatient surgery and Urgent Care facilities are also available.

GeoBlue Travel Insurance - Expatriates and international travelers can apply for medical benefits that cover the ER, office visits, wellness exams, evacuation, and hospital stays.  Students, teachers, missionaries, and volunteers can also secure coverage. Short and long-term travel plans are available through Worldwide Insurance Services.