Choosing the right Medicare coverage is a big decision, and you might be exploring what options are out there. If you live in a state where Highmark offers plans, you might have come across highmark medicare supplement (also called Medigap) as a possibility. This article can help you determine if a highmark medicare supplement plan could be a good fit.
Table of Contents:
- What is a Highmark Medicare Supplement (Medigap) plan?
- Highmark: A Trusted Name in Insurance
- How Do Highmark Medicare Supplement Plans Work?
- Navigating Your Highmark Medicare Advantage Plan Options
- What about Highmark Medicare Supplement (Medigap) plans?
- Key Considerations When Choosing a Highmark Medicare Supplement Plan
- Beyond the Basics: Are There Extra Perks with a Highmark Medicare Supplement Plan?
- Finding a Highmark Medicare Supplement Plan
- Conclusion
- Title: Highmark Medicare Supplement (Medigap) Plans: What You Need to Know
What is a Highmark Medicare Supplement (Medigap) plan?
Let’s start with the basics. Medigap plans, offered by private insurance companies like Highmark, help fill in the gaps in Original Medicare (Parts A and B). These gaps include things like copays, coinsurance, and deductibles.
So, instead of paying these costs out-of-pocket, a Medigap plan helps cover some or all of these expenses, which can mean more predictable healthcare expenses. Highmark offers various Medicare Advantage plans and prescription drug plans. Let’s explore what these plans entail.
While a Medicare Advantage plan (Part C) provides an alternative way to get your Medicare benefits, it is distinct from a Highmark Medigap plan. Medicare Advantage plans are growing in popularity. However, research from KFF found that in 2023, 51% of Medicare beneficiaries opted for Original Medicare, with or without a supplement.
Choosing between Medicare Advantage vs. Original Medicare is often about balancing your need for flexibility with your preference for predictability. Medicare Advantage plans are offered by private insurance companies, such as Highmark. These plans must be approved by Medicare and provide at least the same coverage as Original Medicare (Parts A and B). Many Medicare Advantage Plans offer additional benefits such as prescription drug coverage.
Highmark: A Trusted Name in Insurance
Highmark is a large insurer within the Blue Cross Blue Shield Association. The Blue Cross Blue Shield Association is not one massive company. Instead, think of it more like a federation of independent, locally operated Blue Cross and Blue Shield companies all across the U.S.
Each company contracts with the federal government to provide Medicare coverage to those eligible. So, while they carry the familiar Blue Cross Blue Shield emblem, each operates separately and offers Medicare Advantage plans within their respective areas. You can check Highmark’s service area on their website to see if a plan is offered where you live. You’ll want to make sure there are enough in-network providers where you live, especially doctors and hospitals you frequent.
How Do Highmark Medicare Supplement Plans Work?
Here’s how Highmark’s Medicare Supplement plans work: You continue to pay your Part B premium directly to Medicare. You pay a separate premium for the Highmark Medigap plan, often deducted directly from your Social Security benefits.
Medicare Supplement plans help cover some of the out-of-pocket costs that you would normally have to pay with Original Medicare. These costs can include deductibles, copayments, and coinsurance. It is also important to remember that Medicare Supplement plans do not provide coverage for everything. For example, they typically don’t cover long-term care, dental care, vision care, or hearing aids.
Navigating Your Highmark Medicare Advantage Plan Options
Highmark provides a few main Medicare Advantage plan choices—each with its own pros and cons depending on your needs. The Medicare Advantage Plans available depend on where you live, so verifying what’s offered in your specific location is always best. Here’s a quick look at some key Highmark Medicare Advantage options and what they mean:
Complete Blue PPO: More Flexibility
The Medicare Advantage PPO plan (Preferred Provider Organization), called Complete Blue PPO, offers more provider flexibility. With a PPO, while you’ll likely have lower costs when you stick with doctors and hospitals in Highmark’s network, you generally retain the option to go out of network when you need to.
Be prepared to shell out more if you step outside the network. But, having that option for care without needing referrals first can be a major plus. We have linked the Complete Blue PPO Summary of Benefits here if you’d like a detailed overview of what’s included. You can also compare Medicare Advantage plans to see how Complete Blue PPO measures up against other plans in your region.
Community Blue Medicare HMO: Lower Costs, More Structure
The Community Blue Medicare HMO is what’s known as a Health Maintenance Organization. HMOs tend to be more budget-friendly when it comes to monthly premiums and often come with attractive Medicare plan perks (think: vision, hearing, even fitness memberships.).
That can make these types of plans especially enticing if you’re aiming to manage costs closely. The catch? They’re usually a bit more structured than PPOs.
The HMO network of providers typically becomes your primary source of care, meaning you’ll see your primary care physician before heading to a specialist in most cases. You’ll find more detailed information in the Community Blue Medicare HMO Summary of Benefits. Remember, it is a smart move to check out all of your Medicare Advantage plans to find the ideal match for your circumstances.
Security Blue HMO-POS: Striking a Balance
Finally, we come to the Security Blue HMO-POS (Point-of-Service). If you think of PPOs and HMOs on a spectrum, this one sits comfortably in the middle.
While it generally operates much like an HMO—meaning you’ll choose a primary doctor who guides your care within a network—it sometimes allows for more flexibility in seeing out-of-network specialists. This structure provides an interesting blend of budget management (like HMOs) while offering some flexibility (like PPOs). To gain a complete grasp, it’s always wise to examine the Security Blue HMO-POS Summary of Benefits.
It is always a wise move to compare Medicare Advantage plans and explore the array of choices available in your locality.
What about Highmark Medicare Supplement (Medigap) plans?
Highmark offers different Medigap plans (A to N) to choose from. What’s available depends on your specific locale and whether you qualified for Medicare before 2020. After that, the options to enroll in plans C and F became more limited.
Although Medicare Supplement plans are standardized across insurers, the cost difference between insurance companies can be pretty significant. Premiums vary depending on several things—like your age, location, tobacco use, and even the way premiums are structured. For instance, premiums can go up with age or remain constant over time.
Key Considerations When Choosing a Highmark Medicare Supplement Plan
There’s no single “best” Highmark Medigap plan. Finding the best Medicare Advantage option involves considering several things.
You’re choosing the plan that feels like the right balance of costs and coverage based on YOUR needs and preferences. It is vital to seek the insights of a trusted Medicare Advisor to navigate this procedure successfully.
Let’s break down some key factors to guide you in choosing the best highmark medicare supplement plan:
What Type of Plan Is Best: HMO, PPO, or HMO-POS?
Choosing among Advantage Plan options comes down to weighing the benefits of cost savings with the need for flexibility. Carefully review whether seeing only doctors in Highmark’s network would pose a problem for your healthcare situation, as HMO’s often require you stay in-network.
You should also consider if a referral is needed before seeking specialty care with the plan, as this may not be ideal for some individuals. Ultimately, you want a Medicare plan that aligns with how you envision getting healthcare.
How Much Coverage Do I Really Need?
This is where it’s time for some honest introspection—a look at your financial comfort level, current health, and future healthcare expectations. Are you someone who values predictable costs even if that means potentially higher premiums? Do you prefer a higher deductible but want the reassurance that a larger portion of your bills will be covered IF a major health event happens down the road?
Medigap Plan F, often considered the gold standard of Medigap policies, provided extensive coverage. It’s one reason Medicare Advantage plan f vs g comparisons frequently focus on cost comparisons.
While you may not have the option to enroll in this specific plan if you didn’t qualify for Medicare before 2020, understanding plan designs with various coverage levels will help guide your decision-making process. Don’t overlook plan options like Medicare Plan N vs Plan G, as these have become popular options in the absence of being able to enroll in plan F. Understanding the nuances of the Medicare Advantage plan G pros and cons, for example, is critical when making decisions.
The plan with the lowest premium doesn’t automatically equate to the “best” choice, just like Medicare Plan N benefits need to be weighed against its costs to arrive at an educated judgment call based on your individual preferences and health situation. Consider the factors unique to you. Then, explore and weigh Medicare Advantage plan designs to land on one aligning with your preferences and unique circumstances. Seeking guidance from a seasoned Medicare Advisor during this stage can be immensely beneficial, providing clarity and facilitating sound decisions.
Can I Change Plans Later On?
What happens if your needs evolve (or, let’s face it—you just plain change your mind?). Can you switch plans down the road? Remember, understanding the ins and outs of what’s in your Medicare Advantage plan is essential when considering whether to make a change.
Knowing this will be helpful in the event you later wonder if you can switch from Medicare Advantage to Medigap. It’s important to compare all of the available Medicare Advantage Plans on the market, but switching isn’t always guaranteed.
While certain situations allow it, like moving outside Highmark’s service area or during designated open enrollment periods, changing due to a simple change of heart may come with restrictions. Before deciding, explore the details provided in the Blue Rx PDP Summary of Benefits. By staying well-informed and even perhaps consulting with experienced Medicare Advisors, you can position yourself for well-informed decisions aligned with your individual healthcare circumstances.
Beyond the Basics: Are There Extra Perks with a Highmark Medicare Supplement Plan?
Many people solely focus on premiums and out-of-pocket costs when selecting a plan. But there’s more to consider: Are there additional bells and whistles with a Highmark Medicare Supplement plan?
Does the plan offer any extra benefits, such as fitness memberships, transportation benefits, or meal delivery? Some Highmark Medicare Advantage plans go above and beyond traditional healthcare coverage.
Examples of “Extra Benefits” Might Include:
- Fitness Programs
- Vision and Dental Care
- Hearing Aids
- Over-the-Counter Benefits
- Meal Delivery (often after a hospital stay)
- Transportation Assistance
Remember: Every little bit helps. Consider if those extras offer genuine value given your health needs.
Finding a Highmark Medicare Supplement Plan
When it comes to securing the right Medicare Advantage & Prescription Drug Coverage, you have two main routes:
Option 1: Navigating Medicare’s Website
Medicare.gov allows you to search, compare Medicare Advantage plans, and often enroll in your chosen plan online. This option gives you more autonomy throughout the entire process.
Option 2: Teaming Up with a Licensed Insurance Agent
Partnering with an independent licensed insurance agent—the human touch—can offer invaluable personalized guidance. An agent can help navigate the ins and outs of each plan and provide a tailored recommendation based on your circumstances and preferences. They can also assist with the Medicare Advantage plan application itself.
If you feel more confident having someone guide you, then working directly with an insurance agent specializing in these types of plans can make the entire process feel less overwhelming.
Conclusion
A highmark medicare supplement plan could be an intelligent way to manage healthcare expenses as you navigate your retirement years, but as you can see there’s a lot to keep in mind as you make these important decisions. It’s important to weigh your healthcare needs and consider things from different perspectives.