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Highmark: Critical Roadmap Updates, 2023 Star Rating Sheets, Additional Call Recording Guidance

October 24, 2022

Critical Roadmap Updates

Highmark recently discovered several of their 2023 Medicare Roadmap enrollment guides require urgent updates. These inaccuracies have been corrected and any Roadmap orders currently being processed, as well as future orders, will include these updates. Please pay close attention to the corrected details in the chart below. Please also note that the Summary of Benefits included in 2023 Enrollment Kits is accurate, so any information can be verified using those documents. For any Roadmaps currently in hand, please take note of the following benefit corrections:

Now Available: Highmark's 2023 Medicare Star Rating Sheets  

As was shared a few weeks ago, The Centers for Medicare & Medicaid Services (CMS) released Highmark's 2023 Medicare Star Ratings. Highmark's scores were strong again this year, with most plans achieving a 5-Star Rating – the highest score possible! 2023 Star Rating  sheets are in the process of being uploaded to the portal, and will be  distributed in enrollment kits beginning 10/27.  To download and print the 2023 Star Rating sheets, click the links below.



New York

West Virginia

What about Delaware?  

Star Ratings are not on a typical one-year planning cycle,  where what is done this year impacts next year.  Instead, the annual Star  Ratings reflect performance from two years prior. How plans performed in calendar year 2021 was used by CMS for 2023 star ratings. Highmark Delaware's Medicare Advantage plans were launched in 2022, and therefore have not been rated yet.

5-Star Special  Enrollment Period  

  • If a Medicare Advantage Plan, Medicare drug plan, or Medicare Cost Plan with a 5-star rating becomes available, MA members can use the 5-star Special Enrollment Period to switch from their current Medicare plan to a       Medicare plan with a “5-star” quality rating. Members can use this Special Enrollment Period only once between December 8 and November 30.
  • If an MA member moves from a Medicare Advantage Plan that includes prescription drug coverage to a stand-alone Medicare Prescription Drug Plan, they will be disenrolled from their Medicare Advantage Plan, including the       health benefit. They will be returned to Original Medicare for coverage of their health services. Members can only switch to a 5-star Medicare Prescription Drug Plan if one is available in their area.
  • If an MA Member moves from a Medicare Advantage Plan that has drug coverage to a 5‑star Medicare Advantage Plan that doesn’t, they may lose your prescription drug coverage. They’ll have to wait until their next enrollment       opportunity to get drug coverage, and they may have to pay a Part D late enrollment penalty. 

Additional TPMO Call Recording Guidance

Last month Highmark shared Third Party Marketing Organization(TPMO) call recording requirements relevant to individual agents, including the standard disclaimer and state-specific guidance. Highmark would like to share some additional guidance that has recently come to their attention, regarding face to face virtual interactions and what to do if a prospect or member does not want to be recorded. Please be aware:

  • Face to face virtual interactions on platforms like Zoom MUST be recorded.
  • If the prospect or member does not want to berecorded, you should stop the recording and you MUSTEND the call

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