Highmark Blue Cross Blue Shield Review

Highmark Blue Cross Blue Shield

Highmark BCBS is a leading regional insurer with deep roots in Pennsylvania, West Virginia, and Delaware. In 2026, the company expanded Medicare Advantage access into Southeastern PA while continuing to serve all of WV, DE, and parts of NY and OH. With a wide mix of ACA, Medicare, and group plans, Highmark delivers flexibility—but customer complaints and billing issues remain pain points. Learn more at Highmark.

Pros and Cons

Pros

• ACA and Medicare plans in PA, WV, DE, and parts of NY and OH
• Strong Medicare Advantage Star Ratings in WV and DE
• PPO/EPO plans with BlueCard® national and global emergency access
• Expanded provider access in SEPA for group plans
• Telehealth, mental health, and wellness enhancements across multiple products

Cons

• High complaint volume about billing, claims, and customer service
• ACA and employer plans limited to select regions
• Short-term medical not offered
• Persistent transparency and administrative delays
• Lower-than-average BBB rating

Coverage Area (2026)

United States:

Available in PA (statewide), WV (all 55 counties), DE (statewide), 21 counties in NY, and Washington County in OH. Recent Medicare Advantage expansion into Southeastern PA counties, including Philadelphia, Bucks, and Montgomery. See the carrier’s Service Area Map.

International:

Global emergency coverage via the BlueCard® and Blue High Performance Network (HPN) systems for eligible members.

Provider Network:

BlueCard® gives members access to 95% of U.S. doctors and 96% of hospitals; local PPO and EPO networks also widely available in covered states.

Plan Types Offered (2026)

Under-65 (Individual & Family)

• ACA Marketplace Plans:
  Offered in PA, WV, and DE. Includes Bronze, Silver, and Gold tiers with PPO and EPO options.
• Short-Term Medical (STM):
  Not offered.
• Employer-Sponsored Plans:
  Available in PA and DE, including HDHP, PPO, EPO, and wellness-focused group offerings. SEPA expansion includes enhanced provider access.
• Student Health Plans:
  Not publicly listed.
• Medicaid:
  Not available under the Highmark name.

Medicare (65+)

• Medicare Advantage (MA):
  HMO and PPO options in PA, WV, and DE. 2025 expansion brought coverage to SEPA counties. Includes Special Needs Plans (SNPs) and dual-eligible plans.
• Medicare Supplement (Medigap):
  These plans are available across core states and offer broader provider flexibility than Medicare Advantage plans.
• Part D Prescription Drug Plans:
  These plans are integrated in most MA plans; standalone options may vary by region.
• Retiree Group Medicare:
  Available for employer clients via Medicare Advantage and Medigap products.

Recent Changes in Cost and Options (2026)

Premiums and Rate Changes

2026 brought moderate premium increases in ACA and Medicare plans, following national trends. Subsidies (monthly financial aid for premiums) remain available to qualifying ACA plan enrollees.

Out-of-Pocket Costs

Some group plans offer in-network maxes as low as $2,000 individual/$4,000 family. ACA cost caps remain competitive.

Medicare Advantage Updates

MA plan options expanded into SEPA counties with strong Star Ratings (4.5 in WV, 4.0 in DE).

Plan Enhancements

These include $0 telehealth copays, expanded mental health access, and improved in-network options for group plans in PA and DE.

Network Agreements

Offers expanded SEPA network coverage and ongoing BlueCard® access across states and abroad.

Consumer Experience Snapshot

Complaint Index

NAIC and BBB data show elevated complaints around service delays, billing errors, and claim denials. Average BBB score: 1.09/5.

Satisfaction Scores

Medicare Advantage Star Ratings average 4.0+ in DE and WV.

Methodology

Our Health Insurance Rating Methodology scores insurers across five main categories, each rated on a scale of 1 to 10. The overall score is the average of: Coverage, Breadth and Accessibility, Plan Variety and Customization, Affordability and Value, Innovation and Care Quality, and Consumer Experience and Transparency. Categories assess provider reach, plan diversity, cost structure, care delivery, and member service experiences based on public data, filings, and expert analysis.

Bottom Line

Highmark is a strong choice for consumers in PA, WV, and DE seeking ACA or Medicare coverage with broad network access and enhanced plan flexibility. Its 2026 expansion into Southeastern PA improves access for seniors, and value-added services like $0 telehealth and wellness support strengthen appeal. However, customer service issues and claim handling concerns remain persistent and impact its overall standing.

Best for: Residents in Highmark’s core states looking for ACA or Medicare Advantage plans with strong provider access and wellness tools.

Not ideal for: Those needing national ACA coverage, short-term insurance, or top-tier customer service.

Disclaimer

The views and opinions expressed are those of the authors and do not necessarily reflect the official policy or position of HealthCareInsider.com or HealthCare, Inc.