How To Buy Health Insurance

Prepare for 2020 with a health insurance plan that fits your needs.

Below, you’ll find a list of common questions that you may need answered before you enroll

WHEN CAN I ENROLL?

Open Enrollment for 2020 runs from November 1 – December 15. This is the period of time when anyone can enroll in an individual health insurance plan for the 2020 plan-year.

Special Enrollment Period (SEP) allows people to enroll in a plan outside of the Open Enrollment Period. To be eligible for an SEP, you must have undergone a qualifying life event like: Getting married, having a child or losing employer coverage. If you’re eligible, you have 60 days from the qualifying life event to enroll in a plan.

ARE MY DOCTORS IN NETWORK?

Find a Doctor to see if your physician is in the network.

If you don’t have a doctor, My Care Navigator can help you find one. Call 888-258-3428.

IS MY HOSPITAL IN-NETWORK?

Highmark networks of hospitals and health care providers give you plenty of options to choose from that are close to home.  You can use our Find a Doctor tool to see which hospitals are in-network.

ARE MY PRESCRIPTIONS COVERED?

To check your prescriptions, visit the RX Formulary or drug benefit tool. It lists all prescription drugs that are covered by Highmark plans.

CAN I GET FINANCIAL ASSISTANCE?

Many people who are eligible for ACA plans qualify for financial help. A health insurance subsidy or tax credit could reduce your insurance costs. A subsidy or tax credit might also enable you to enroll in a more robust plan that better suits your needs. You can learn more and apply at healthcare.gov.

HOW DO I ENROLL?

Starting November 1, we can help you enroll online. You must be enrolled by December 15 for coverage beginning January 1, 2020.

WHAT DO THE NEW STARS RATINGS MEAN?

Starting in 2019, the star ratings system began to appear alongside health plans as part of the Quality Rating System (QRS) required by the Affordable Care Act. The stars, which rate eligible health plans on a 1-5 scale (5 being the best), are designed to provide consumers with information about the quality of health care services and enrollee experience for on-Exchange health plans.

The 3 categories that make up a plan’s overall rating are:

Medical Care – How well the plan’s in-network doctors provide care, like helping patients stay healthy, monitoring and treating their conditions, and providing them with regular screenings and vaccines.

Member experience – Based on how customers answer surveys about how easy it is for them to get appointments and medical tests, their satisfaction with doctors and other healthcare providers, and their overall happiness with their health coverage.

Plan efficiency –Based on how customers answer surveys about their level of satisfaction with aspects of their health plan including customer service, access to information, and affordability.

You can see these three categories under the “Plan Details” section on the Exchange.

Some plans may be designated as "Not Rated" however this does not mean that they are low quality. The reasons why a plan may be listed as "Not Rated" are:

  • The plan hasn’t been on the market for 3 full consecutive years.
  • Its enrollment is too low.
  • It did not have enough data to support a rating for the “Medical Care” category.
  • It did not have enough data to support ratings for 2 of the 3 categories (even if the plan does have a “Medical Care” rating)

CAN I TALK TO A REAL PERSON?

Have questions? Give us a call at

  • Central PA: (855) 741-9956
  • Western PA: (877) 733-2123
  • Northeastern PA: (866) 836-3630
  • Delaware: (855) 408-6856
  • West Virginia: (844) 632-6156

RETURNING MEMBERS: LEARN ABOUT CHANGES FOR 2020

We want to help you make the right decision for you and your family. See how the plans, doctors and hospitals available in your area will change for 2020.

See 2020 Plan Changes