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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

Is Highmark good health insurance? Highmark offers numerous policies to fit most budgets and health needs, but its lack of coverage for out-of-network providers limits flexibility.

Overall rating: 4.1

Highmark is a leading health insurance organization and the fourth-largest independent licensee of the Blue Cross Blue Shield Association, serving more than six million customers in Pennsylvania, Delaware, New York, and West Virginia. It has an extensive provider network of over 90,000 doctors. Highmark backs up its health insurance plans with community initiatives such as Highmark Walk for Healthy Community and the Highmark Caring Place.

Highmark Logo

Highmark Health Insurance Overview
Company founded 1996
Coverage area
  • Delaware
  • New York
  • Pennsylvania
  • West Virginia
A.M. Best rating A
BBB rating A-
NCQA accreditation Yes
NCQA rating 4 to 3.5
Plans available
  • CHIP
  • Dental
  • Individual and family plans
  • Medicare Advantage Plans and Medicare Supplement Insurance
  • Travel
  • Vision
Provider network
  • 92,200 in-network physicians and care professionals

Is Highmark a Good Health Insurance Provider?

What we like about Highmark health insurance plans: The drawbacks of Highmark health insurance plans:
  • You can see specialists without obtaining referrals
  • Some plans provide dental and vision coverage
  • Free preventive care visits
  • Coverage is only available in four states
  • Only EPO options are available
  • No coverage for seeing out-of-network providers

What Do Highmark Health Insurance Plans Cover?

Highmark offers a variety of health insurance plans that may meet your health needs and budget:

  • CHIP
  • Dental
  • Individual and family plans
  • Medicare Advantage Plans and Medicare Supplement Insurance
  • Travel
  • Vision

Highmark Health Insurance Plan Options

Highmark has a range of health insurance plans at varying price points. Monthly premiums range between $383 and $669, but your rate may be lower if you qualify for an income-based subsidy. All of Highmark’s health insurance plans are Exclusive Provider Organizations, so you’re required to obtain care from health care providers within the plan’s network.

Highmark Pricing

Compare some of Highmark’s top health insurance plan options:

Highmark Health Insurance Plan Options
Plan name Monthly premium Annual deductible Office visits Annual maximum out-of-pocket cost
Shared Cost Blue EPO Bronze 3800 – EPO $383 $3,800 Doctor visit: $60

Specialist visit: 50% coinsurance after deductible

$8,500
Health Savings Embedded Blue EPO Bronze 6900 HSA – EPO $387 $6,900 No charge after deductible $6,900
Shared Cost Blue EPO Bronze 3800 + Adult Dental and Vision – EPO $416 $3,800 Doctor visit: $60

Specialist visit: 50% coinsurance after deductible

$8,500
Health Savings Embedded Blue EPO Silver 3450 HSA – EPO $499 $3,450 Doctor visit: $70 after deductible

Specialist visit: $70 after deductible

$6,900
Shared Cost Blue EPO Platinum 0 + Adult Dental and Vision – EPO $669 $0 Doctor visit: $5

Specialist visit: $5

$5,000

*Based on pricing for a nonsmoking 35-year-old female in Dover, Delaware

How is Highmark Rated?

Trusted ratings and reviews can help you understand how an insurer’s plans stack up against the competition. See how we rated Highmark.

Overall rating: 4.1
Financial strength rating: 4.5 Customer satisfaction rating: 4 Value rating: 4 Coverage rating: 4

Highmark’s financial strength rating indicates whether the company has sufficient assets to fulfill its financial obligations to its customers. A.M. Best rates Highmark an A-, which indicates financial stability to pay claims.

Customer Satisfaction: 4/5 stars

Highmark’s customer satisfaction rating is based on customer feedback from the Better Business Bureau, the National Committee for Quality Assurance, and Consumer Affairs.

Highmark is rated A- by the Better Business Bureau. In the past three years, the insurance provider has closed 44 customer complaints. Thirteen of those complaints were closed within the past 12 months.

The NCQA gives Highmark’s plans overall ratings of 3.5 and 4.0. Across the three categories, including consumer satisfaction, prevention, and treatment, most plans have scores of 3.0 and 3.5, indicating average performance.

Consumer Affairs gives Highmark 2.5 out of 5 stars based on 33 ratings.

Value: 4/5 stars

Highmark’s overall value rating is based on the benefits its plans provide compared to benefits available from other health insurance plans at comparable price points. Some costs that are considered include monthly premiums, copays and coinsurance, maximum out-of-pocket limits, and annual deductibles.

Coverage: 4/5 stars

Highmark’s coverage rating indicates the range of options customers have about the types of plans available, in-network providers, and coverage options.

Sources