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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. More than 5 million persons are covered throughout Pennsylvania, West Virginia, and Delaware.

They also offer coverage to same-sex couples, since they received permission with the Center for Medicare and Medicaid Services. Delaware and other surrounding states already offer this benefit, and Highmark also offers LGBT-friendly plans. Prices are identical to similar plans for other couples. Lehigh Valley Health network facilities may be utilized by all members, along with with services from the Allegheny Health Network (AHN).

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. Local seminars are routinely provided to help Seniors, and free tools designed to estimate your drug and medical costs are also available. A "high-deductible" Plan F Supplement plan offers low premiums.

There are about 15 different policies offered for persons under age 65 for 2019 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.


Highmark Pa Health Insurance - Low cost medical coverage for individuals. Pre-existing conditions covered.

 

Catastrophic Plans

my Direct Blue Major Events Blue EPO 7900 - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. Three primary care physician (pcp) office visits provided at no cost. Deductible is $7,900 with maximum out-of-pocket expenses of $7,900 and 0% coinsurance. NOTE: Policy is only available to applicants under age 30. For lower income households, selecting a Bronze-tier plan may provide more benefits and a lower rate.

my Direct Blue Lehigh Valley  Major Events Blue EPO 7900 - Available in Lehigh, Schuylkill, and Northampton Counties. Three primary care physician (pcp) office visits provided at no cost. Deductible is $7,900 with maximum out-of-pocket expenses of $7,900 and 0% coinsurance. NOTE: Policy is only available to applicants under age 30. For lower income households, selecting a Bronze-tier plan may provide more benefits and a lower rate.

 

Bronze Plans

my Direct Blue EPO 7900 - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. $7,900 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance. 

my Direct Blue Lehigh Valley EPO 7900 - Available in Lehigh, Schuylkill, and Northampton Counties. $7,900 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance. 

my Direct Blue EPO 4000 - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. $4,000 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance.  $60 pcp office visit copay, but specialist visits must meet deductible.

my Direct Blue Lehigh Valley EPO 4000 - Available in Lehigh, Schuylkill, and Northampton Counties. $4,000 deductible with $7,900 maximum out-of-pocket expenses and 0% coinsurance.  $60 pcp office visit copay, but specialist visits must meet deductible. 


Silver Plans

my Direct Blue EPO 4450 HSA - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. $4,450 deductible with $6,650 maximum out-of-pocket expenses and 10% coinsurance. HSA-eligible plan.

my Direct Blue Lehigh Valley EPO 4450 HSA - Available in Lehigh, Schuylkill, and Northampton Counties. $4,450 deductible with $6,650 maximum out-of-pocket expenses and 10% coinsurance. HSA-eligible plan. 

my Direct Blue EPO Silver 2400 - 2 Free PCP Visits - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. $2,400 deductible with $7,800 maximum out-of-pocket expenses and 30% coinsurance. $40 and $90 office visit copays (first two pcp visits are free) and $90 Urgent Care copay. $20 copay for telemedicine service. Tier 1 and Tier 2 drug copays are $5 and $30 ($10 and $60 mail order).

my Direct Blue Lehigh Valley EPO Silver 2400 - 2 Free PCP Visits - Available in Lehigh, Schuylkill, and Northampton Counties. $2,400 deductible with $7,800 maximum out-of-pocket expenses and 30% coinsurance. $40 and $90 office visit copays (first two pcp visits are free) and $90 Urgent Care copay. $20 copay for telemedicine service. Tier 1 and Tier 2 drug copays are $5 and $30 ($10 and $60 mail order). 

my Direct Blue EPO Silver 0 - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. $0 deductible with $7,800 maximum out-of-pocket expenses and 40% coinsurance. $40 and $90 office visit copays (first two outpatient mental health visits are free) and $90 Urgent Care copay. $20 copay for telemedicine service. Tier 1 and Tier 2 drug copays are $5 and $30 ($10 and $60 mail order). 

my Direct Blue Lehigh Valley EPO Silver 0 - Available in Lehigh, Schuylkill, and Northampton Counties. $0 deductible with $7,800 maximum out-of-pocket expenses and 40% coinsurance. $40 and $90 office visit copays  (first two outpatient mental health visits are free) and $90 Urgent Care copay. $20 copay for telemedicine service. Tier 1 and Tier 2 drug copays are $5 and $30 ($10 and $60 mail order).  

 

Compare Highmark health insurance policies in Pennsylvania. Review private plans and Senior options.

 

Gold Plans

my Direct Blue EPO 1000G - Available in Berks, Cumberland, Dauphin, Franklin, Lancaster, and Perry Counties. $1,0000 deductible with maximum out-of-pocket expenses of $5,000 and 20% coinsurance. $20 and $20 office visit copays  and $75 copay for Urgent Care visits and and $10 copay for telemedicine service. Lab tests subject to $25 copay, and basic diagnostic services subject to $45 copay. Advanced imaging must meet a coinsurance and deductible. Tier 1, 2, 3, and 4 drugs are subject to 15%, 25%, 35%, and 50% payment.


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 accepted when they apply for a policy, it is most important to review all of the available 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 current federal subsidy is based on household income eligibility. For example, a family of four with income under $95,400 will probably 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. When "Trumpcare" becomes fully effective in 2018 or 2019, income requirements will change.

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. Previously, Medicaid eligibility requirements were expanded. Thus, many affordable Central Pa medical plans are offered, especially, if you qualify for Medicaid.

The FOL Guidelines help Pennsylvania consumers determine if they are Medicare-eligible.


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 need help, call or contact us and we will show you 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, Lebanon, Berks, Lehigh, And Lancaster 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, Lebanon, Berks, Lehigh, And Lancaster Counties

$88 - Plan F (High Deductible)

$127 - Plan A

$128 - Plan N

$151 - Plan B

$177 - Plan C

$178 - Plan F

 

75 Year-Old Dauphin, Lebanon, Berks, Lehigh, And Lancaster Counties

$103 - Plan F (High Deductible)

$149 - Plan A

$150 - Plan N

$178 - Plan B

$209 - Plan C

$209 - Plan F

 

65 Year-Old Luzerne County

$91 - Plan F (High Deductible)

$82 - Plan A

$128 - Plan N

$106 - Plan B

$134 - Plan C

$161 - Plan F

 

70 Year-Old Luzerne County

$98 - Plan F (High Deductible)

$96 - Plan A

$138 - Plan N

$124 - Plan B

$158 - Plan C

$178 - Plan F

 

75 Year-Old Luzerne County

$115 - Plan F (High Deductible)

$112 - Plan A

$162 - Plan N

$148 - Plan B

$190 - Plan C

$210 - Plan F

 

65 Year-Old Butler County

$74 - Plan F (High Deductible)

$107 - Plan A

$110 - Plan N

$127 - Plan B

$149 - Plan C

$149 - Plan F

 

70 Year-Old Butler County

$88 - Plan F (High Deductible)

$129 - Plan A

$132 - Plan N

$154 - Plan B

$181 - Plan C

$181 - Plan F

 

75 Year-Old Butler County

$102 - Plan F (High Deductible)

$151 - Plan A

$156 - Plan N

$181 - Plan B

$214 - Plan C

$214 - Plan F

 

Sample Highmark Blue Medicare Advantage Monthly Rates (Part C)

 

65 Year-Old Dauphin, Cumberland, Perry, Lebanon, Adams, York, Northumberland, and Juniata Counties

$0 - Community Blue HMO Signature

$27 - Community Blue PPO Signature

$71 - Freedom Blue PPO ValueRx

$93 - Freedom Blue PPO Basic

$187 - Freedom Blue PPO Standard

$190 - Freedom Blue PPO Deluxe

 

65 Year-Old Erie County

$0 - Community Blue HMO Signature

$62 - Security Blue HMO Basic

$65 - Security Blue HMO ValueRx

$79 - Freedom Blue PPO ValueRx

$138 - Freedom Blue PPO Select

$192 - Security Blue HMO Standard

$199 - Community Blue Medicare HMO Prestige

$232 - Security Blue HMO Deluxe

$284 - Freedom Blue PPO Classic

 

65 Year-Old Lancaster County

$16 - Community Blue HMO Signature

$75 - Freedom Blue PPO ValueRx

$93 - Freedom Blue PPO Basic

$191 - Freedom Blue PPO Standard

$294 - Freedom Blue PPO Deluxe

 

65 Year-Old Northampton County

$26 - Community Blue HMO Signature

$75 - Freedom Blue PPO ValueRx

$93 - Freedom Blue PPO Basic

$191 - Freedom Blue PPO Standard

$294 - Freedom Blue PPO Deluxe

 

Senior Prescription Drug Coverage (Stand-Alone)

The "preferred" and "standard" pharmacy networks are available. The "preferred" option offers lower out-of-pocket costs. Part B premiums must still continue to be paid. A "Gap Discount" may also be available to the lower the cost of brand name drugs. The discount may be as much as 50%, if other assistance is not being received.

Blue RX PDP Plus - $415 deductible. Preferred network offers $0 copay for preferred generic drugs and $7 copay for generic drugs. 20%, 40%, and 25% coinsurance applies to preferred brand, non-preferred brand, and specialty drugs respectively. Standard network offers $5 copay for preferred generic drugs and $12 copay for generic drugs. 25%, 50%, and 25% coinsurance applies to preferred brand, non-preferred brand, and specialty drugs respectively. Primary coverage is $3,700 of drug expenses. For coverage gap ($5,100 out-of-pocket expenses vs. $3,820), coinsurance is 51% for generic and 40% for brand. After the $5,100 out-of-pocket expense limit has been met, generic and multi-source drugs are subject to higher of 5% coinsurance or $3.40 copay. Others are subject to $8.50 copay.

Blue  RX PDP Complete - $0 deductible. Preferred network offers $0 copay for preferred generic drugs and $5 copay for generic drugs. The preferred brand drug copay is $40.  35%, and 33% coinsurance applies to  non-preferred brand, and specialty drugs respectively. Standard network offers $5 copay for preferred generic drugs and $10 copay for generic drugs. The preferred brand drug copay is $45. 50%, and 33% coinsurance applies to  non-preferred brand, and specialty drugs respectively. Primary coverage is $3,750 of drug expenses. For coverage gap ($5,100 out-of-pocket expenses vs. $3,820), coinsurance is 26% for generic tiers 1 and 2 and 51% for generic tiers 3, 4, and 5.  Brand coinsurance is 40%. After the $5,100 out-of-pocket expense limit has been met, generic and multi-source drugs are subject to higher of 5% coinsurance or $3.40 copay. Others are subject to $8.50 copay.

 

 Affordable dental insurance from Highmark Blue Shield in Pennsylvania is available. Compare the best plans for your teeth and get coverage.

 

Highmark BC Blue Edge Dental Plans

Affordable dental benefits are offered to individuals, families, and small groups, at any time throughout the year. Current enrollment in a healthcare plan is not required, and applying for coverage is simple and quick. An online application is available. Once an application is completed and submitted, the policy effective date will be the first day of the following month. The United Concordia network is utilized, which provides more than 90,000 dentists countrywide. Four plan options are available, which are described below:

Premier - Provides the most comprehensive benefits with the lowest out-of-pocket expenses. $50 annual deductible with $1,250 maximum benefits per person. 100% coverage is provided for  for oral evaluations, radiograph, cleanings, fluoride treatment, emergency palliative treatment, sealant, and space maintainers. 80% coverage is provided for  for crown, inlay, outlay, and denture repair, anterior and posterior resin-based white fillings, repair and adjustment of prosthetics, amalgam restorations, and simple extractions. 50% coverage is provided for surgical extractions, complex oral surgery, root canals, general anesthesia, nitrous oxide, IV sedation, periodontics, crowns, inlays, onlays, and prosthetics.

High -  Provides the second-most comprehensive benefits. $100 annual deductible with $1,000 maximum benefits per person. 100% coverage is provided for  for oral evaluations, radiograph, cleanings, fluoride treatment, emergency palliative treatment, sealant, and space maintainers. 50% coverage is provided for  for crown, inlay, outlay, and denture repair, anterior and posterior resin-based white fillings, repair and adjustment of prosthetics, amalgam restorations, and simple extractions. 30% coverage is provided for surgical extractions, complex oral surgery, root canals, general anesthesia, nitrous oxide, IV sedation, periodontics, crowns, inlays, onlays, and prosthetics.

Value -  For applicants that rarely use comprehensive benefits. $25 annual deductible with $1,000 maximum benefits per person. 100% coverage is provided for  for oral evaluations, radiograph, cleanings, fluoride treatment, emergency palliative treatment, sealant, and space maintainers. 50% coverage is provided for  for crown, inlay, outlay, and denture repair, general anesthesia, nitrous oxide, IV sedation, anterior and posterior resin-based white fillings, repair and adjustment of prosthetics, amalgam restorations, and simple extractions. No coverage is provided for surgical extractions, complex oral surgery, root canals, periodontics, crowns, inlays, onlays, and prosthetics.

Basic -  The least expensive option. $0 annual deductible with $1,000 maximum benefits per person. 100% coverage is provided for  for oral evaluations, consultations, radiograph, cleanings, fluoride treatment, emergency palliative treatment, sealant, and space maintainers. 

 

The PALS Program For Seniors

PALS (People Able To Lend Support) is a free program offered to all Highmark members. Free help is available to persons that may need physical or mental assistance with common and uncommon daily activities.  Providers include existing customers, their relatives, and other volunteers in the area. There is no cost or obligation to utilize the free help. Comprehensive training is required for all volunteers. Several  helpful services that are provided include:

Companionship provided in-person or via telephone.

Assistance with pets and animals, including feeding, walking, and checking general health.

Help with minor house repairs (inside and outside).

Shop for food and other essential items.

Assist with work in and outside of the home.


Travel Insurance

When you travel outside of the United States, your current plan may not cover specific expenses. However, GeoBlue provides preventative benefits, along with coverage for pre-existing conditions, and unexpected accidents and illnesses. Physicians, specialists, and other healthcare providers that speak English can be utilized. Urgent-Care, ER, evacuation, and in-hospital and outpatient hospital expenses can be covered. Worldwide Insurance Services LL Operates GeoBlue, which is licensed by BCBS. 24/7 access to live help and coverage verification are also provided.

Several popular plans are listed below:

VOYAGER -  Used mostly for business or missionary trips since duration must not exceed six months and coverage is for a single trip.  Voyager Essential and Voyager Choice are two plan options. "Essential" does not require a primary plan and the maximum covered age is 74. "Choice" covers pre-existing conditions, and requires a primary plan. The maximum covered age is 84.

TREKKER - Unlimited trips over a 12-month period are allowed. Pre-existing conditions are covered, and a primary health plan is required. Essential plan provides up to $50,000 of international coverage while Choice option provides up to $250,000 of international coverage. Choice plan also includes up to $25,000 of accidental, death and dismemberment coverage.

EXPLORER - International coverage that can also provide benefits in the US. There are no annual or lifetime maximum limits, and preventative care for babies, children, and adults is covered at 100%. Pcp office visits are subject to only a $10 copay. Deductible options are $0, $1,000, $2,500, and $5,000. Coinsurance maximum options are $2,000, $8,000, and $10,000. Additional benefits include hospice, skilled nursing facility, and home health care. 100% coverage after deductible is included for many expenses, including surgery, anesthesia, diagnostic x-rays, lab work, in-patient drugs, ambulance service, durable medical equipment, and basic prescriptions ($1,000 maximum).

 

Fertility Coverage

Fertility treatment programs help young couples have a baby. WINFertility provides up to a 40% discount on the cost of drugs, and IVF treatment. A coach/nurse is available to provide support during the entire process, and there are no enrollment fees. A free prenatal program designed to reduce the risk of birth defects is also included. After meeting with a specialist, a price quote is provided for the medical services and drug therapies. Treatment packages are designed to provide comprehensive coverage throughout the entire process. A prenatal program helps reduce the risk of birth defects.

Free information and counseling is also provided for the following topics: Conditions For Assisted Hatching, Getting Pregnant, Donor Eggs, Egg Freezing, Embryo Adoption,  Endometriosis, Female Infertility, Infertility Medications And Treatment, IVF, Male Infertility, INVOcell, Oncofertlity, PGD, Same Sec Couples Wanting Children, Secondary Infertility, Surrogacy, Transgender Issues, and Methods To Conceive. The local facility is the AHN Center for Reproductive Medicine located on McKnight Road. Fertility financing is offered, with 60-month terms available to pay for expenses. NOTE: WINFertility is not a subsidiary of Highmark BS.

 

Updates From The Past:

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.

Open Enrollment, which began on October 1st, continues through the end of March. 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.

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.

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.

Three new policy designs will be available for 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.

Shared Cost Blue PPO 6000 is one of the most popular Highmark plans for Central Pennsylvania. Although copays are high for primary-care physician and specialist visits, the deductible does not have to be met.

Fewer consumer choices are available in many Central Pa counties, since Aetna and UnitedHealthcare have exited the market. For instance, in the Harrisburg area, only Geisinger, Capital BC, and Highmark offer plans.

Open Enrollments  for persons under age 65 declined. Higher rates and the temporary decision to eliminate broker assistance contributed to the reduction in new policies issued.