Highmark Medicare Advantage: Important Update Regarding Buffalo Medical Group

Highmark Medicare Advantage: Important Update Regarding Buffalo Medical Group

After several months of negotiating with its for-profit partner (Agilon), Buffalo Medical Group (BMG) has informed Highmark that their primary care providers will be leaving Highmark Blue Cross Blue Shield’s Medicare Advantage network beginning July 1, 2025. BMG’s specialist providers will remain in-network.

Highmark is disappointed in this decision, after making multiple enhanced offers to Agilon and with several months remaining in the agreement with BMG. BMG’s partner Agilon has requested terms for Medicare Advantage members that would make their requested compensation significantly higher, in comparison to other providers in the network. At a time where members are facing increased costs, especially with their health care, Highmark believes they could not agree to their demands. As a not-for-profit health plan, they must ensure members’ health care remains affordable and within reach.

This decision will not affect Commercial (employer-based), Federal Employee Program, and Affordable Care Act members who are covered under a separate agreement that both Highmark BCBS and BMG have agreed to continue.

While Highmark BCBS remains open to resuming negotiations for Medicare Advantage members, BMG has said their decision is final. Therefore, Highmark will begin assisting members who use BMG and may need to make a change for 2025. Approximately 6,000 MA members would be impacted for those providers with agreements that end on July 1, 2025.

Highmark BCBS maintains contracts with nearly 3,000 physicians across Western New York, representing every other major physician group. Members can find other in-network alternatives by logging into the member portal online or through the MyHighmark app.

Highmark BCBS offers Medicare Advantage plans with out-of-network benefits. However, members should be aware that BMG may not agree to accept out-of-network coverage after July 1, 2025, and visits with them may cost more than with in-network physicians.

Highmark BCBS understands members’ concerns and disappointment with this decision and will be reaching out to impacted members to help them through this transition.

Additional insights will be communicated directly and are also available on Highmark's website.

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