Highmark Medicare Advantage Plans Pennsylvania 2027

Reviewed by Russell Noga, a Licensed Medicare Insurance Broker in all 50 states — Updated October 8, 2026

Highmark offers Medicare Advantage plans across much of Pennsylvania for 2027, through Highmark Blue Cross Blue Shield in western and northeastern Pennsylvania and Highmark Blue Shield in central and southeastern Pennsylvania.

Pennsylvania has a competitive market with Highmark, UPMC Health Plan, Independence Blue Cross, Capital Blue Cross, Geisinger and national insurers.

See Highmark Medicare Advantage plans.

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Key Highlights

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Highmark serves much of Pennsylvania.

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Freedom Blue PPO and HMOs.

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Hospital network access varies by plan.

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For 2027, the national average Medicare Advantage premium is $12 a month, lower than $14.37 (CMS).

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Annual Enrollment: October 15 through December 7, 2026.

Compare plans and enroll online

Highmark Plans in Pennsylvania

HMO Plans

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Usually lower premiums and copays

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Use in-network doctors except emergencies

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May need referrals for specialists

PPO Plans

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See out-of-network doctors at a higher cost

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Usually no referrals needed

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More flexibility if you travel

Network access to Allegheny Health Network (AHN), UPMC and community hospitals differs by plan, so confirm your hospital before enrolling.

Benefits Highmark Plans May Offer

Highmark Plans May Include

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Covers hospital and medical care just as Original Medicare Part A and B do

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Part D prescription drug coverage on most plans

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Routine dental, vision and hearing benefits

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Fitness programs and over-the-counter allowances

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Telehealth visits and care coordination programs

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A yearly out-of-pocket maximum on every plan

Benefits differ by plan and county, not every plan offers every benefit, and they may change for 2027. Review the Evidence of Coverage for any plan before enrolling.

Understanding Medicare Advantage Plans in Pennsylvania

What to Check for 2027

Key Takeaway

Read your Highmark Annual Notice of Change.

Watch for: a non-renewal letter will arrive if your plan is ending. You stay covered through December 31, 2026. Taking no action sends you back to Original Medicare with no drug coverage.

Find & Compare Plans Online

Speak with a licensed insurance agent

1-877-436-2343TTY 711

Mon-Fri: 8am-9pm ET

Pennsylvania Competitors

Insurer Region
UPMC Health Plan Western and central PA
Independence Blue Cross Southeastern PA
Capital Blue Cross Central PA
Geisinger Central and northeastern PA

Pennsylvania Medicare Help

PA MEDI offers free Medicare counseling in Pennsylvania.

Budget and Cost Considerations for Coverage

How Medicare Advantage Works

Medicare Advantage, or Part C, lets you receive your Medicare benefits from a Medicare-approved private insurer. These plans cover all that Original Medicare Part A and Part B cover, apart from hospice care, which remains with Original Medicare. Part D drug coverage is included in most plans, and many may also offer extras like routine dental, vision and hearing benefits.

The trade-off is that Highmark plans generally rely on doctor and hospital networks and may need referrals or prior authorization for certain services. Unlike Original Medicare, each Medicare Advantage plan caps your yearly out-of-pocket costs for covered medical care. Your Part B premium continues, along with the plan’s own premium if there is one.

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

Pros and Cons of Medicare Advantage

Advantages

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Often a low or $0 premium

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A yearly out-of-pocket maximum

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Drug coverage usually included

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Dental, vision and hearing benefits may be included in many plans

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One card and one plan

Tradeoffs

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Network-based; HMOs require in-network care other than emergencies

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Prior authorization and referrals are common

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Copays add up if you use a lot of care

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Plans and networks can change every year

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Moving to Medigap later on could involve health questions

Highmark Drug Coverage for 2027

Part D drug coverage comes with most Highmark Medicare Advantage plans. Formularies, drug tiers and pharmacy networks differ by plan, and costs are often lower at preferred pharmacies and with mail order. In 2027, the out-of-pocket cap on covered drugs is $2,400, and a plan’s Part D deductible may be as high as $700.

Tier Typical Drugs Typical Cost
Tier 1 Preferred generics Lowest copay
Tier 2 Generics Low copay
Tier 3 Preferred brand-name drugs Moderate copay
Tier 4 Non-preferred drugs Higher copay or coinsurance
Tier 5 Specialty drugs Highest coinsurance

Each plan sets its own tiers. Review every plan’s formulary.

A drug you take might be missing from a plan’s 2027 formulary, or come with a rule such as prior authorization. Options remain:

If Your Drug Is Not Covered

1

Request a transition fill. During the first 90 days of a new plan or new plan year, plans generally have to provide a temporary supply of a drug you already take, giving you time to change drugs or ask for an exception.

2

Talk with your doctor about other options. A covered drug from the same class could work just as well for less.

3

Ask for a formulary or tiering exception. A statement from your doctor explains why you need the drug or a lower copay. The plan has to decide within set time limits.

4

Challenge a denial. When the plan turns you down, an appeal is available, with multiple levels of review.

See steps to appeal a Medicare Part D denial.

If Your Plan Is Ending

A non-renewal notice should have reached you in early October if your Highmark plan won’t be available in your county for 2027. You still have time to decide, because your coverage keeps going through December 31, 2026 rather than ending immediately.

If Your Plan Is Ending

1

Review your non-renewal letter. The letter confirms that your plan is ending and lays out your choices.

2

Write down your doctors and drugs. Comparing replacement plans requires this list.

3

Review your 2027 plan options. Look beyond the premium to the network, drug coverage and out-of-pocket maximum.

4

Decide by December 31 to avoid a gap. If you enroll during Annual Enrollment by December 7, your coverage begins January 1, 2027.

5

Rely on a Special Enrollment Period when needed. If your plan is ending, you can generally still choose new coverage until the end of February 2027.

If you do nothing: on January 1, 2027, you go back to Original Medicare, and you will have no drug coverage unless you pick a Part D plan. Being without drug coverage may result in a late enrollment penalty.

Medigap rights: if your Medicare Advantage plan stops serving your area, you generally get a guaranteed issue right, lasting up to 63 days after your coverage ends, to purchase certain Medicare Supplement plans with no health questions.

How to Compare Highmark Plans for 2027

How to Compare

1

Go through your Annual Notice of Change. It shows each 2027 change to the plan you have now.

2

Review your doctors and hospitals. Make sure every provider is in the 2027 network, not only the 2026 one.

3

Review your prescriptions. Verify each drug, its tier and any step therapy or prior authorization rules.

4

Weigh the full cost for the year. Total the premium, usual copays and drug costs, then check the out-of-pocket maximum.

5

Look at star ratings. Medicare scores plans on quality and service using a 1 to 5 star scale.

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Sign up by December 7. Coverage under your new plan begins January 1, 2027.

2027 Enrollment Dates

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Enroll in, change or leave a Medicare Advantage or Part D plan effective January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 Medicare Advantage members can make one switch to another plan or back to Original Medicare
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Switch plans when something happens, such as a move, a loss of other coverage or your plan exiting your area

Annual Enrollment is when most people make their changes. If your current plan suits you, no action is needed, since it renews on its own. Even so, review your Annual Notice of Change, as networks, drug lists, copays and premiums may all change on January 1.

Special Needs Plans

Special Needs Plans (SNPs) are Medicare Advantage plans designed for particular groups. Their benefits, networks and drug lists are shaped around their members, and many provide care coordinators. Even as large insurers cut PPOs for 2027, Special Needs Plans are among the few places they are adding plans.

Type Who Qualifies What Is Different
Dual Special Needs Plan (D-SNP) People with both Medicare and Medicaid Covers both programs together; costs are often very low, with extra benefits
Chronic Condition SNP (C-SNP) People who have qualifying conditions like chronic lung disease, heart failure or diabetes Doctors, drugs and programs designed for the condition
Institutional SNP (I-SNP) Nursing home residents, or people needing that level of care at home Care delivered where the member lives

Turning 65 in 2027

Turning 65 in 2027? Your Initial Enrollment Period runs for seven months: the three months leading up to your birthday month, the birthday month itself and the three months that follow. Enrolling in the first three months starts your coverage on the first day of your birthday month.

Turning 65 Checklist

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Enroll in Part A and Part B, unless you choose to d