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HighMark Blue Cross Northeast Region

Highmark Blue Cross Blue Shield serves Medicare recipients in Pennsylvania with Medicare Advantage plans such as HMO’s and PPO’s. Highmark is the fourth-largest Blue Cross Blue Shield company in the United States.

Highmark Blue Cross is based out of Erie Pennsylvania and serves 21 counties throughout central PA and the Lehigh Valley. Highmark Blue Shield also provides services in conjunction with Independence Blue Cross in southeastern Pennsylvania.

In Pennsylvania, Highmark Blue Cross sells individual Medicare Advantage insurance plans to all Medicare recipients regardless of their medical history.

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Medicare Advantage Plans are required to cover all the services that Original Medicare covers. Original Medicare covers hospitalization, medical such as doctor and specialist visits, emergency room visits, ambulance services, and even hospice care. If you are out of your network and you require emergency care or urgent care, your Medicare Advantage Plan will always cover your needs.

There are some Medicare Advantage Plans that also offer additional benefits such as dental, vision, hearing, and wellness programs such as “Silver Sneakers.”

Just like recipients who have Medigap plans, you pay a monthly Part B premium in addition to a monthly premium for your Medicare Advantage plan. In 2018, the standard Part B premium amount is $134 and could be higher depending on your income.

Highmark Blue Cross Blue Shield offers a variety of Medicare Advantage plans in the northeast region counties of Pennsylvania. The following plans are offered in the counties of Clinton, Tioga, Lycoming, Bradford, Sullivan, Susquehanna, Wyoming, Luzerne, Indiana, Pike, Monroe, Carbon, and Lackawanna.

Community Blue

This plan usually has a very low monthly premium. Community Blue has a copay for your doctor and specialist visits and once you’ve met the deductible, this plan is traditionally covers 80 percent of your major medical services, hospitalization and includes emergency care throughout the United States. It even includes coverage for maternity care and an annual eye exam.

Advance Blue

The big advantage of choosing an Advance Blue plan is that non-network coverage is accepted by the plan for up to 70%.

Covering 90 percent of most hospital services after deductible, members of these plans are covered for doctor visits, convenient care clinics, prescriptions, urgent care, lab service and many more benefits for a copay. After your deductible is met you can be covered up to 90 percent for most hospital services. The Advance Blue plan usually has a higher monthly premium than the other HMO’s that Highmark offers.

PPO Blue

This plan provides you with all of your care covered for a low monthly premium after you meet the medical deductible. This plan also does not require the member to get a referral for specialist visits.  Preventive care is available at no cost to you with in-network providers, and out-of-network benefits are covered as well.

Direct Blue

This Direct Blue plan provides an abundance of comprehensive benefits with free preventive care, and many services for a copay so you don’t have to worry about what you’ll end up paying for care. The plan has low deductibles, low copays and reduced out-of-pocket expenses. You can select from a variety of cost combinations that will fit your budget and medical needs.

Simply Blue

If you need coverage but not many services, Simply Blue plans provide low premiums, a number of deductibles, and minimal coverage on preventive care and hospital services. Known as a catastrophic plan, these are often not the most ideal option for everyone as it is hard to predict getting injured or ill, and you pay out-of-pocket for most services until the deductible is met.

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