Highmark: Your Tools for OEP Success are Just a Click Away!

OEP Starts Soon!

For consumers across the Highmark footprint in Pennsylvania, West Virginia, Delaware, and New York, November 1 is the first day of this year's Open Enrollment Period (OEP)!

Below are some useful sales resources and suggestions to make your OEP a successful one.

In the meantime, Highmark is here to support you and want to wish you the best of luck this season - HAVE A GREAT OEP!

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Reminder: 2025 ACA Rate Preview

The information below was sent a few weeks ago but Highmark would like to remind you about average ACA rate changes for agent-sold members, to give you and your clients an idea of the increases they will experience. Here's what you will see across the Highmark footprint:

Unsubsidized Members

For unsubsidized members, expect small increases in West Virginia, slightly above trend increases in Pennsylvania and Delaware, and more significant increases in NY.

• Western Pennsylvania: +8.5%
• Central Pennsylvania: +12%
• Northeast Pennsylvania: +10%
• Southeastern Pennsylvania: +10%
• West Virginia: +3%
• Delaware: +9%
• New York: +26.5% - Reminder that only half of the members in NY will be renewed for the 2025 PY (those who were enrolled in a Standard Non-HSAQ or Destination 65 plan for PY 2024, all others will be discontinued and will need to actively re-enroll)

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Subsidized Members

• In Western Pennsylvania:
  • Most Together Blue EPO and my Direct Blue EPO members will see largely stable premiums, with some variance based on county
  • For members enrolled in my Blue Access, in counties where Centene is absent, members will see an average increase of ~$70 (15%)
  • Subsidized Members in any WPA product in the 10 counties where Centene has entered for 2025 (Blair, Clearfield, Elk, Fayette, Huntingdon, Jefferson, Somerset, Cambria, Clarion, and Westmoreland) will see $100+ PCPM increases due to APTC disruption in those counties
• In general, most members in CPA will see average increases of $25 (8%)
• Northeast Pennsylvania premiums will be increasing by an average of ~$5 (1%)
• In SEPA, members will see an average increase of ~$100 (21%)
• Due to an increase in available APTC in the market, WV members should see an average decrease (~$20) in their premiums across the board
• DE premiums will be increasing by an average of ~$120 (46%)

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Selling Extra Savings Silver

For certain consumers in Pennsylvania, West Virginia, Delaware, and New York- Highmark's Extra Savings Silver plans make a lot of sense. Let's take a look!

Who is Extra Savings Silver for?

• Extra Savings Silver plans have limited availability because they're income-restricted and only available on-exchange. They make the most sense for Pennsylvania/West Virginia/Delaware members at less than 200% Federal Poverty Level (FPL) (approximately $30,000/year for a single person).

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What can eligible members expect?

• Generous benefits! Extra Savings Silver plans are effectively platinum-level plans at Silver prices.
• Among the lowest Out-Of-Pocket Maximums that Highmark offers - as low as $1,200.
• Some of the lowest copays offered - as low as $0.
• In Pennsylvania, Highmark offers a Premier Extra Savings Silver 0 plan to consumers under 200% FPL. This plan offers $0 office visits (including PCP, specialist, mental health, and more)!
• Plans including Adult Dental and Vision are also available!

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What about New York?

• Extra Savings Silver plans are now available to higher income levels in New York! Consumers in New York between 138% and 250% FPL will generally be eligible for the Essential Plan. Incomes between 251% and 350% FPL (approximately $52,500/year for a single person) will be eligible for “Extra Savings Silver B” plans that are cover almost 90% of medical costs; and those between 351% and 400% FPL (approximately $60,000/year for a single person) will be eligible for “Extra Savings Silver A” plans that are cover almost 75% of medical costs.
• In both NY regions, Highmark offers Destination 65 Extra Savings Silver plans. These plans offer $0 deductibles and $0 PCP copays. The Silver B version also includes $0 Specialist, Lab, and X-Ray copays!
• Destination 65 Plans including Adult Dental and Vision are also available!

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Sales Resources Available via Marcom and the Producer Portal

Highmark is working diligently to finalize all 2025 ACA sales resources.

Marcom

The following resources are currently available for order via Marcom:

• Product Catalogs
• Plan Comparison Guides
• Rate Guides
• Off-Exchange Applications

Producer Portal

In the coming days Highmark will upload all of the following 2025 resources to the Producer Portal in the Resources section, and will communicate once they are available:

• Product Catalogs
• Plan Comparison Guides
• Rate Guides
• Off-Exchange Applications
• Blue Edge Dental Applications
• Change Forms
• HSA User Guides
• SEP Forms

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