Pennsylvania Highmark Blue Cross Blue Shield Health insurance policies are available at extremely affordable rates. Instantly view 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 2025 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 January 15th. The Senior Medicare OE period uses different dates.
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. Telemedicine visits allow customers to speak to physicians at any time. Advance premium tax credits (APTC) help reduce premiums on all non-catastrophic plans.
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. Utilization of the BlueCard provides access to a network of 95% of physicians and medical facilities throughout the US. Emergency, routine, and urgent healthcare is offered and “BLUE365” provides discounts for gym memberships and healthy meal services.
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 and services are available through most providers. Also, more than 150 countries will accept the card.
Note: A new plan option is Meet Together Blue Virtual Choice . This low-cost option features $0 copays for virtual visits (pcp, specialist, urgent care, and behavioral health). A concierge benefit allows you to speak with the same person every visit. TytoHome, Onduo Diabetes Management, and Virtual Physical Care are included.
2025 Rate Change Requests
Together Blue EPO – 13.27% increase and 12.26% increase
Together Blue Major Events EPO – 12.12% rate increase
Together Blue Major Events EPO + Adult Dental And Vision – 11.17% rate increase
Together Blue EPO Premier – 13.87% rate increase
Together Blue EPO Premier + Adult Dental And Vision – 11.79% rate increase
My Direct Blue EPO – 7.65%, 9.84%, and 5.31% increase
My Direct Blue – 7.91%
My Direct Blue Major Events – 5.73% increase
My Direct Blue Lehigh Valley EPO – 9.03% and 7.84% increase
My Direct Blue Lehigh Valley Major Events – 5.74% increase
My Direct Blue Major Events EPO – 5.54% increase
My Direct Blue EPO + Adult Dental And Vision – 7.88% increase
My Direct Blue Lehigh Valley EPO + Adult Dental And Vision – 7.66% increase
My Direct Blue EPO + Adult Dental And Vision WPA – 6.83% increase
My Blue Access PPO – 9.71% increase
My Blue Access PPO + Adult Dental And Vision – 8.80% increase
My Blue Access PPO HSA – 7.11% increase
My Direct Blue EPO Premier- 9.24% increase
my Priority Blue Flex PPO – 13.77% increase
my Priority Blue Flex PPO + Adult Dental And Vision – 12.70% increase
my Priority Blue Flex PPO HSA – 12.23% increase
my Priority Blue Flex PPO Premier – 12.54% increase
my Priority Blue Flex PPO Premier + Adult Dental And Vision – 11.30% increase
my Priority Blue Major Events PPO – 16.60% increase
My Direct Blue Major Events EPO + Adult Dental And Vision – 9.11% increase
Together Blue EPO – Offered to residents of the following counties: Erie, Allegheny, Butler, Westmoreland, and Washington. Contracted hospitals include (but are not limited to) Allegheny General Hospital, Allegheny Valley Hospital, Brentwood Neighborhood Hospital, Forbes Hospital, Jefferson Hospital, UPMC Children’s Hospital, UPMC Bedford, UPMC Altoona, Saint Vincent Hospital, UPMC Jameson, UPMC Kane, Grove City Hospital, UPMC Horizon, UPMC Cole, UPMC Somerset, UPMC Northwest, and Canonsburg Hospital. Allegheny Health Network doctors, surgeons, and other providers provide coordinated care and assist with scheduling appointments and selecting a primary-care physician.
my Direct Blue EPO – Offered to residents of the following counties: Washington, Allegheny, Westmoreland, Beaver, Butler, Armstrong, Clarion, Forest, Warren, Crawford, Erie, and Cambria. Several out-of-state contracted hospitals include Johns Hopkins, University of Maryland Medical Center, AHN Westfield Memorial Hospital, Olean General Hospital, Cleveland Clinic, and WVU Medicine Children’s Hospital.
My Blue Access PPO – Erie, Crawford, Mercer, Lawrence, Beaver, Washington, Greene, Vernango, Butler, Allegheny, Westmoreland, Fayette, Armstrong, Clarion, Forest, Warren, McKean, Elk, Jefferson, Indiana, Somerset, Cambria, Clearfield, Potter, Cameron, Centre, Blair, Huntingdon, and Bedford.
Catastrophic Tier
Together Blue Major Events EPO 9450 – $9,100 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. Three pcp office visits available at no cost. 100% coverage after deductible is met.
my Direct Blue Major Events EPO 9450 – $9,100 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. Three pcp office visits available at no cost. 100% coverage after deductible is met.
my Blue Access Major Events PPO 9450 – $9,100 deductible with maximum out-of-pocket expenses of $9,450 and 0% coinsurance. Three pcp office visits available at no cost. 100% coverage after deductible is met.
Bronze Tier
Together Blue EPO Bronze HSA 7100 – HSA-eligible plan with $7,100 deductible with maximum out-of-pocket expenses of $7,100 and 0% coinsurance.
my Direct Blue EPO Bronze HSA 7100 – HSA-eligible plan with $7,100 deductible with maximum out-of-pocket expenses of $7,100 and 0% coinsurance.
my Blue Access PPO Bronze HSA 7100 – HSA-eligible plan with $7,100 deductible with maximum out-of-pocket expenses of $7,100 and 0% coinsurance.
Together Blue EPO Bronze 8900 – $8,900 deductible with maximum out-of-pocket expenses of $8,900 and 0% coinsurance.
my Direct Blue EPO Bronze 8900 – $8,900 deductible with maximum out-of-pocket expenses of $8,900 and 0% coinsurance.
my Blue Access PPO Bronze 8900 – $8,900 deductible with maximum out-of-pocket expenses of $8,900 and 0% coinsurance.
Together Blue EPO Bronze 3800 – $3,800 deductible with maximum out-of-pocket expenses of $9,200 and 50% coinsurance. Office visit copays are $65. Diagnostic lab services and x-rays subject to $65 and $150 copays. $100 Urgent care copay. Prescriptions subject to 50% coinsurance and deductible.
my Direct Blue EPO Bronze 3800 – $3,800 deductible with maximum out-of-pocket expenses of $9,200 and 50% coinsurance.Office visit copays are $65. Diagnostic lab services and x-rays subject to $65 and $150 copays. $100 Urgent care copay. Prescriptions subject to 50% coinsurance and deductible.
my Blue Access PPO Bronze 3800 – $3,800 deductible with maximum out-of-pocket expenses of $9,200 and 50% coinsurance. Office visit copays are $65. Diagnostic lab services and x-rays subject to $65 and $150 copays. $100 Urgent care copay. Prescriptions subject to 50% coinsurance and deductible.
Silver Tier.
Together Blue EPO Premier Silver 2900 – $2,900 deductible with maximum out-of-pocket expenses of $8,500 and 30% coinsurance. Office visit copays are $75, and the Urgent Care copay is $100. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Imaging copay is $350. ER copay is $750. Prescription drug copays are $0, $30, $150, and 50%.
my Direct Blue EPO Premier Silver 2900 – $2,900 deductible with maximum out-of-pocket expenses of $8,500 and 30% coinsurance. Office visit copays are $75, and the Urgent Care copay is $100. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Imaging copay is $350. ER copay is $750. Prescription drug copays are $0, $30, $150, and 50%.
my Blue Access PPO Premier Silver 2900 – $2,900 deductible with maximum out-of-pocket expenses of $8,500 and 30% coinsurance. Office visit copays are $75, and the Urgent Care copay is $100. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Imaging copay is $350. ER copay is $750. Prescription drug copays are $0, $30, $150, and 50%.
Together Blue EPO Silver 3500 – $3,500 deductible with maximum out-of-pocket expenses of $9,350 and 30% coinsurance. Office visit copays are $45, and the Urgent Care copay is $90. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Prescription drug copays are $0, $30, $150, and 50%.
my Direct Blue EPO Silver 3500 – $3,500 deductible with maximum out-of-pocket expenses of $9,350 and 30% coinsurance. Office visit copays are $45, and the Urgent Care copay is $90. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Prescription drug copays are $0, $30, $150, and 50%.
my Blue Access PPO Silver 3500 – $3,500 deductible with maximum out-of-pocket expenses of $9,350 and 30% coinsurance. Office visit copays are $45, and the Urgent Care copay is $90. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Prescription drug copays are $0, $30, $150, and 50%.
Together Blue EPO Silver 7000 – $7,000 deductible with maximum out-of-pocket expenses of $9,450 and 30% coinsurance. Office visit copays are $55, and the Urgent Care copay is $100. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Prescription drug copays are $0, $30, $150, and 50%.
my Direct Blue EPO Silver 7000 – $7,000 deductible with maximum out-of-pocket expenses of $9,450 and 30% coinsurance. Office visit copays are $55, and the Urgent Care copay is $100. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Prescription drug copays are $0, $30, $150, and 50%.
my Blue Access PPO Silver 7000 – $7,000 deductible with maximum out-of-pocket expenses of $9,450 and 30% coinsurance. Office visit copays are $55, and the Urgent Care copay is $100. Lab tests are subject to a $75 copay and basic diagnostic services are also subject to a $75 copay. Prescription drug copays are $0, $30, $150, and 50%.
Gold Tier
Together Blue EPO Premier Gold 0 – $0 deductible with maximum out-of-pocket expenses of $6,550. Office visit copays are $15, and the Urgent Care copay is $30. Lab tests are subject to a $45 copay and basic diagnostic services are subject to a $45 copay. The physical and occupational therapy copay is $40 (30 visit limit during benefit period). ER visits have a $280 copay. Prescription drug copays are $0, $25, $75, and 50%. The hospital inpatient (including maternity) is $525.
my Direct Blue EPO Premier Gold 0 – $0 deductible with maximum out-of-pocket expenses of $6,550. Office visit copays are $15, and the Urgent Care copay is $30. Lab tests are subject to a $45 copay and basic diagnostic services are subject to a $45 copay. The physical and occupational therapy copay is $40 (30 visit limit during benefit period). ER visits have a $280 copay. Prescription drug copays are $0, $25, $75, and 50%. The hospital inpatient (including maternity) is $525.
my Blue Access PPO Premier Gold 0 – $0 deductible with maximum out-of-pocket expenses of $6,550. Office visit copays are $15, and the Urgent Care copay is $30. Lab tests are subject to a $45 copay and basic diagnostic services are subject to a $45 copay. The physical and occupational therapy copay is $40 (30 visit limit during benefit period). ER visits have a $280 copay. Prescription drug copays are $0, $25, $75, and 50%. The hospital inpatient (including maternity) is $525.
Together Blue EPO Gold 0 – $0 deductible with maximum out-of-pocket expenses of $7,500 and 40% coinsurance. Office visit copays are $20, and the Urgent Care copay is $40. Lab tests are subject to a $35 copay and basic diagnostic services are subject to a $35 copay. The physical and occupational therapy copay is $20 (30 visit limit during benefit period). ER visits have a $300 copay. Prescription drug copays are $0, $30, $150, and 50%. The hospital inpatient (including maternity) is $725.
my Direct Blue EPO Gold 0 – $0 deductible with maximum out-of-pocket expenses of $7,500 and 40% coinsurance. Office visit copays are $20, and the Urgent Care copay is $40. Lab tests are subject to a $35 copay and basic diagnostic services are subject to a $35 copay. The physical and occupational therapy copay is $20 (30 visit limit during benefit period). ER visits have a $300 copay. Prescription drug copays are $0, $30, $150, and 50%. The hospital inpatient (including maternity) is $725.
my Blue Access PPO Gold 0 – $0 deductible with maximum out-of-pocket expenses of $7,500 and 40% coinsurance. Office visit copays are $20, and the Urgent Care copay is $40. Lab tests are subject to a $35 copay and basic diagnostic services are subject to a $35 copay. The physical and occupational therapy copay is $20 (30 visit limit during benefit period). ER visits have a $300 copay. Prescription drug copays are $0, $30, $150, and 50%. The hospital inpatient (including maternity) is $725.
Together Blue EPO Gold HSA 1700 – HSA-eligible plan with $1,700 deductible with maximum out-of-pocket expenses of $5,700 and 20% coinsurance. $20 office visit and $40 Urgent Care copays (after deductible has been met). $175 ER charges after deductible is met.
my Direct Blue EPO Gold HSA 1700 – HSA-eligible plan with $1,700 deductible with maximum out-of-pocket expenses of $5,700 and 20% coinsurance. $20 office visit and $40 Urgent Care copays (after deductible has been met). $175 ER charges after deductible is met.
my Blue Access PPO Gold HSA 1700 – HSA-eligible plan with $1,700 deductible with maximum out-of-pocket expenses of $5,700 and 20% coinsurance. $20 office visit and $40 Urgent Care copays (after deductible has been met). $175 ER charges after deductible is met.
Together Blue Virtual Choice EPO Gold 1500 – $1,500 deductible with maximum out-of-pocket expenses of $8,300. Office visit copays are $35, and the Urgent Care copay is $70. Lab tests are subject to a $40 copay and basic diagnostic services are subject to a $40 copay. The physical and occupational therapy copay is $35 (30 visit limit during benefit period). ER visits have a $350 copay. Prescription drug copays are $0, $30, $150, and 50%. The hospital inpatient (including maternity) is $725.
my Direct Blue EPO Gold 1500 – $1,500 deductible with maximum out-of-pocket expenses of $8,300. Office visit copays are $35, and the Urgent Care copay is $70. Lab tests are subject to a $40 copay and basic diagnostic services are subject to a $40 copay. The physical and occupational therapy copay is $35 (30 visit limit during benefit period). ER visits have a $350 copay. Prescription drug copays are $0, $30, $150, and 50%. The hospital inpatient (including maternity) is $725.
my Blue Access PPO Gold 1500 – $1,500 deductible with maximum out-of-pocket expenses of $8,300. Office visit copays are $35, and the Urgent Care copay is $70. Lab tests are subject to a $40 copay and basic diagnostic services are subject to a $40 copay. The physical and occupational therapy copay is $35 (30 visit limit during benefit period). ER visits have a $350 copay. Prescription drug copays are $0, $30, $150, and 50%. The hospital inpatient (including maternity) is $725.
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 $40,000 living in Westmoreland County.
$52 – Together Blue EPO Bronze 8900
$75 – Together Blue EPO Bronze 3800
$84 – Together Blue EPO Bronze 6900 HSA
$113 – my Direct Blue EPO Bronze 8900
35-year-old married couple with and two children with household income of $95,000 living in Westmoreland County
$94 – Together Blue EPO Bronze 8900
$170 – Together Blue EPO Bronze 3800
$198 – Together Blue EPO Bronze 6900 HSA
$297 – my Direct Blue EPO Bronze 8900
45-year-old with household income of $40,000 living in Allegheny County.
$108 – Together Blue EPO Bronze 3800
$113 – Together Blue EPO Bronze 6900 HSA
$169 – my Direct Blue EPO Bronze 3800
$175 – my Direct Blue EPO Bronze 6900 HSA
45-year-old married couple with household income of $55,000 living in Allegheny County.
$93 – Together Blue EPO Bronze 3800
$101 – Together Blue EPO Bronze 6900 HSA
$215 – my Direct Blue EPO Bronze 3800
$225 – my Direct Blue EPO Bronze 6900 HSA
55-year-old married couple with household income of $62,000 living in Beaver County.
$50 – my Direct Blue EPO Bronze 3800
$66 – my Direct Blue EPO Bronze 6900 HSA
$156 – my Blue Access PPO Bronze 3800
$174 – my blue Access PPO Bronze 6900 HSA
60-year-old with household income of $46,000 living in Butler County.
$82 – my Direct Blue EPO Bronze 3800
$92 – my Direct Blue EPO Bronze 6900 HSA
$146 – my Blue Access PPO Bronze 3800
$157 – my blue Access PPO Bronze 6900 HSA
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.
Plan F (High Deductible) – Must meet deductible before supplemental benefits begin.
Plan G (High Deductible) – Must meet deductible before supplemental benefits begin. Available to applicants new to Medicare beginning in 2021.
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 and plan G options, the 2023 deductible is $2,700. Applicants 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 female rates.
Allegheny, Fayette, Westmoreland, Indiana, Greene, and Washington Counties (Southwest Region) – Age 65
Allegheny, Fayette, Westmoreland, Indiana, Greene, and Washington Counties (Southwest Region) – Age 65 Whole Health Balance
Allegheny, Fayette, Westmoreland, Indiana, Greene, and Washington Counties (Southwest Region) – Age 70
Allegheny, Fayette, Westmoreland, Indiana, Greene, and Washington Counties (Southwest Region) – Age 70 Whole Health Balance
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
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 Whole Health Balance
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
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 Whole Health Balance
Wayne, Pike, Monroe, Carbon, Luzerne, Lackawanna, Wyoming, Susquehanna, Bradford, Sullivan, Lycoming, Clinton, and Tioga Counties – Age 65
Wayne, Pike, Monroe, Carbon, Luzerne, Lackawanna, Wyoming, Susquehanna, Bradford, Sullivan, Lycoming, Clinton, and Tioga Counties – Age 70
These types of plans typically have lower rates than Medigap options since Pa Highmark BCBS plans (and not the federal government) provide 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. Contracts and rates shown below are for Allegheny County. Prices, coverage, and available plans can differ in other counties.
Community Blue Medicare HMO Signature -$0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,200. Office visit copays are $0 and $25, with copays of $20 for x-rays, and $195 for advanced imaging. The lab and diagnostic test copay is $0-$30. Outpatient surgeries are covered with a $245 copay, and the ambulance copay is $275 per trip. The ER copay is $100, while inpatient hospital stays have a $295 copay. Skilled nursing facilities have a $0 copay for the first 20 days, and a $203 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.
30-day prescription drug copays are $0 for preferred generic, $0 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, $0 for generic, $120 for preferred brand, $275 for non-preferred drugs, and 33% for specialty. Plan ID is H3957-047-3.
Community Blue Medicare HMO Prestige – $41 monthly premium with $0 deductible and maximum out-of-pocket expenses of $5,500. Office visit copays are $0, with copays of $20 for x-rays, and $95 for advanced imaging. The lab and diagnostic test copay is $0. Outpatient surgeries are covered with a $150 copay, and the ambulance copay is $175 per trip. The ER copay is $100, while inpatient hospital stays have a $200 copay per admission. Skilled nursing facilities have a $0 copay for the first 20 days, and a $203 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.
30-day prescription drug copays are $0 for preferred generic, $0 for generic, $40 for preferred brand, $95 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $0 for generic, $92.50 for preferred brand, $275 for non-preferred drugs, and n/a for specialty. Plan ID is H3957-039-0.
Community Blue PPO Distinct -$27 monthly premium with $0 deductible and maximum out-of-pocket expenses of $5,500. Office visit copays are $0, with copays of $20 for x-rays, and $175 for advanced imaging. The lab and diagnostic test copay is $0. Outpatient surgeries are covered with a $200 copay, and the ambulance copay is $275 per trip. The ER copay is $100, while inpatient hospital stays have a $225 copay. Skilled nursing facilities have a $0 copay for the first 20 days, and a $203 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.
30-day prescription drug copays are $0 for preferred generic, $0 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, $0 for generic, $120 for preferred brand, $280 for non-preferred drugs, and 33% for specialty. Plan ID is H3916-035-1.
Community Blue PPO Signature -$0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,500. Office visit copays are $0 and $20, with copays of $20 for x-rays, and $195 for advanced imaging. The lab and diagnostic test copay is $0. Outpatient surgeries are covered with a $245 copay, and the ambulance copay is $275 per trip. The ER copay is $100, while inpatient hospital stays have a $150 for 3 days copay. Skilled nursing facilities have a $0 copay for the first 20 days, and a $203 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance.
30-day prescription drug copays are $0 for preferred generic, $0 for generic, $47 for preferred brand, $100 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $0 for generic, $120 for preferred brand, $275 for non-preferred drugs, and 33% for specialty. Plan ID is H3916-041-1.
Security Blue HMO-POS Basic – $55 monthly premium with $0 deductible and maximum out-of-pocket expenses of $5,900. Office visit copays are $0 and $30, with copays of $25 for x-rays, and $100 for advanced imaging. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $200 copay, and the ambulance copay is $125 per trip. The ER copay is $90, while inpatient hospital stays have a $340 copay per admission. Skilled nursing facilities have a $0 copay for the first 20 days, and a $188 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance. Prescription drug benefits are not included. Plan ID is H3957-043-1. Prescription drug benefits not included.
Security Blue HMO-POS ValueRx – $0 deductible and maximum out-of-pocket expenses of $5,500. Office visit copays are $0 and $40, with copays of $20 for x-rays, and $225 for MRIs. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $200 copay, and the ambulance copay is $265 per trip. The ER copay is $90, while inpatient hospital stays have a $220 copay for the first five days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 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, $45 for preferred brand, $95 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $27 for generic, $115 for preferred brand, $275 for non-preferred drugs, and n/a for specialty. Plan ID is H3957-031-0.
Security Blue HMO Standard – $0 deductible and maximum out-of-pocket expenses of $5,000. Office visit copays are $0 and $30, 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 $175 copay, and the ambulance copay is $200 per trip. The ER copay is $95, while inpatient hospital stays have a $335 copay for each visit. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 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, $44 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, $110 for preferred brand, $250 for non-preferred drugs, and n/a for specialty. Plan ID is H3957-045-1.
Security Blue HMO-POS Deluxe – $0 deductible and maximum out-of-pocket expenses of $4,500. Office visit copays are $0 and $25, with copays of $15 for x-rays, and $125 for diagnostic radiology services. The lab and diagnostic test copay is $0-$10. Outpatient surgeries are covered with a $150 copay, and the ambulance copay is $150 per trip. The ER copay is $95, while inpatient hospital stays have a $210 copay for each visit. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 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. Plan ID is H3957-046-1.
Freedom Blue PPO Classic – $0 deductible and maximum out-of-pocket expenses of $4,500. Office visit copays are $0 and $25, with copays of $15 for x-rays, and $100 for diagnostic radiology services. The lab and diagnostic test copay is $0-$10. Outpatient surgeries are covered with a $150 copay, and the ambulance copay is $115 per trip. The ER copay is $95, while inpatient hospital stays have a $210 copay per stay. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 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, $45 for preferred brand, $95 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $27 for generic, $115 for preferred brand, $275 for non-preferred drugs, and n/a for specialty. Plan ID is H3916-001-1.
Freedom Blue PPO Select – $0 deductible and maximum out-of-pocket expenses of $5,000. Office visit copays are $0 and $30, with copays of $20 for x-rays, and $125 for diagnostic radiology services. The lab and diagnostic test copay is $0-$15. Outpatient surgeries are covered with a $175 copay, and the ambulance copay is $215 per trip. The ER copay is $95, while inpatient hospital stays have a $350 copay. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 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, $45 for preferred brand, $95 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $27 for generic, $115 for preferred brand, $275 for non-preferred drugs, and n/a for specialty. Plan ID is H3916-022-0.
Freedom Blue PPO ValueRx – $0 deductible and maximum out-of-pocket expenses of $5,500. Office visit copays are $0 and $40, with copays of $20 for x-rays, and $200 for advanced imaging. The lab and diagnostic test copay is $0-$20. Outpatient surgeries are covered with a $200 copay, and the ambulance copay is $275 per trip. The ER copay is $95, while inpatient hospital stays have a $220 copay for the first 5 days. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 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, $45 for preferred brand, $95 for non-preferred drugs, and 33% for specialty. 90-day mail-order prescription drug copays are $0 for preferred generic, $27 for generic, $115 for preferred brand, $275 for non-preferred drugs, and 33% for specialty. Plan ID is H3916-032-0.
Freedom Blue PPO Valor – $0 deductible and maximum out-of-pocket expenses of $6,000. Office visit copays are $0 and $10, with copays of $20 for x-rays, and $225 for advanced imaging. The lab and diagnostic test copay is $0. Outpatient surgeries are covered with a $245 copay, and the ambulance copay is $250 per trip. The ER copay is $95, while inpatient hospital stays have a $275 copay per admission. Skilled nursing facilities have a $0 copay for the first 20 days, and a $196 copay for days 21-100. Durable medical equipment is subject to 20% coinsurance. Drug coverage is not included. Plan ID is H3916-042-0.
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 $4,660 in RX expenses offers coinsurance benefits. All contracts listed below provide catastrophic coverage.
Blue Rx PDP Plus – $121.10 per month. $505 deductible. Preferred 30-day copays are $0 (Tier 1), $7 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 25% (Tier 5). Preferred 90-day mail order copays are $0 (Tier 1), $17.50 (Tier 2), 20% (Tier 3), 40% (Tier 4), and n/a (Tier 5). 4,163 formulary drugs are available and the Summary Star Rating is 4.0 Stars. 10,341 Pennsylvania residents are enrolled in this plan and nationally, 11,589 persons are enrolled.
Blue Rx PDP Complete – $192.60 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 n/a (Tier 5). 4,163 formulary drugs are available and the Summary Star Rating is 4.0 Stars. 6,167 Pennsylvania residents are enrolled in this plan and nationally, 7,024 persons are enrolled.
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 $21.27 (ages 0-25), $23.77 (ages 26-39), $25.64 (ages 40-49), and $26.26 (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, repairs and adjustments of prosthetics, general anesthesia, nitrous oxide, and simple extractions also covered at 50%. Monthly rates are $24.85 (ages 0-25), $26.41 (ages 26-39), $31.07 (ages 40-49), $36.51 (ages 50-63), and $37.28 (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, repairs and adjustments of prosthetics, amalgam restorations, general anesthesia, nitrous oxide, and simple extractions also covered at 50%. Surgical extractions, complex oral surgery, root canals, periodontics, crowns, inlays, onlays, fixed partial dentures, prosthetics, and dentures, are covered at 30%. Monthly rates are $29.69 (ages 0-25), $31.54 (ages 26-39), $37.11 (ages 40-49), $43.59 (ages 50-63), and $44.52 (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. 80% coverage for repairs of crowns, inlays, onlays, and dentures. Resin based composite anterior and posterior white fillings, general anesthesia, nitrous oxide, 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 $36.41 (ages 0-25), $38.68 (ages 26-39), $45.50 (ages 40-49), $53.48 (ages 50-63), and $54.61 (ages 64 and above).
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
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.
