Have Highmark and see Jefferson doctors? Here's what to know
You know your doctors. They know you. Hearing that your insurance might no longer be in their network can leave you wondering what to do.
Highmark and Jefferson Health are still negotiating. If they do not reach an agreement, some Highmark plans may be out of network at affected Jefferson locations, including former Lehigh Valley Health Network locations, starting January 1, 2027.
It is not final. And it does not affect every Highmark plan the same way. This page walks through each situation so you can understand yours before you make a change.
Is Highmark leaving Jefferson? What it actually means for you
Start with Mike's short overview, then find your situation below.
Start with your plan, not the headline
An HMO, a PPO and a Medicare Supplement can have very different rules. Before you change plans or cancel an appointment, check what you have, which doctors you see and when you need care.
Which one sounds like you
I have a Highmark Medicare Advantage HMO.
If you see Jefferson doctors, review your options before December 7, 2026. Most HMOs generally do not cover routine out-of-network care, with exceptions such as emergency care. A plan change made during Medicare's Annual Enrollment Period by December 7 generally starts January 1.
We can check plans that include your doctors, or help you understand what keeping Highmark and using different in-network providers would mean.
HMO members: review your options before December 7
I have surgery or ongoing treatment scheduled early next year.
Call us before December 7, even if your plan is a PPO. Surgery, cancer treatment and other ongoing care deserve a closer look now.
We'll help you check your plan's network, expected costs and any transition-of-care options with the plan and your providers. A change made in January may not start until February. Do not delay medically necessary care without talking to your care team.
In active treatment at Jefferson? Don't wait on this
I'm under 65 and buy my own Highmark plan.
If you buy your own health insurance through Highmark, an individual Affordable Care Act (ACA) plan, this is not up for negotiation. These plans will be out of network with Jefferson Lehigh Valley Health Network starting January 1, 2027, whether a deal is reached or not. They do not cover out-of-network care except for emergencies.
If you use Jefferson Lehigh Valley Health Network doctors or hospitals, you need to pick a new plan through Pennie. A plan chosen by December 15 starts January 1. Another option is keeping Highmark and moving your care to St. Luke's.
The Medicare dates on this page are not your ACA enrollment deadlines. We can help you compare plans.
Under 65 with a Highmark ACA plan? What to do now
I have a PPO and only see a few Jefferson doctors.
You may have more flexibility, but waiting has a trade-off. PPOs generally cover some out-of-network care at a higher cost, subject to the plan's rules and the provider's willingness to treat you.
People already enrolled in Medicare Advantage can generally make one change during the January 1 through March 31 Medicare Advantage Open Enrollment Period. The new coverage usually begins the first of the next month. If no agreement is reached, January visits could still be out of network.
Review your appointments and costs before deciding whether waiting makes sense.
PPO members: what to know before waiting
My child has CHIP through Highmark.
If your child has CHIP through Highmark and sees Jefferson Lehigh Valley Health Network doctors, this is an easy fix. In Pennsylvania, your child's CHIP insurance company can be changed throughout the year. There's no enrollment period, so you can switch now for peace of mind, or wait and see whether Highmark and Jefferson reach an agreement for 2027.
To switch, call CHIP at 1-800-986-KIDS (5437) and tell them you want to change your child's health insurance company. Before you do, make sure the new carrier is accepted at your child's doctor's office and hospital system.
Child on CHIP through Highmark? An easy fix
I get Highmark through my job.
Group plans are affected too. If there's no deal, Jefferson could be out of network for Highmark group plans starting January 1, 2027. With a group plan, your employer picks the plan, not you.
If you're an employee, talk to your HR department. Ask what's happening with your plan for 2027 and whether other options are available to you. Another option is moving your doctors to St. Luke's.
If you're a business owner or you run HR, we can look at your group's options before renewal, including which plans keep your employees with Jefferson doctors.
Highmark through work? Talk to your employer
Not every Highmark member is affected
I have a Highmark Medicare Supplement.
A Medicare Supplement, also called Medigap, is different from Medicare Advantage. With a standard Medigap policy, Original Medicare is your primary coverage. The supplement helps pay certain costs Medicare leaves to you.
This Highmark Medicare Advantage network issue generally does not change your access to providers who accept Original Medicare. If you are unsure which type of policy you have, call us before making a change.
Have a Highmark Medicare Supplement? Start here
I have Highmark Wholecare.
Highmark Wholecare Medicaid and Wholecare Dual Eligible Special Needs Plan members are not included in the affected groups described in this update. If a letter or conversation has left you unsure, call us so we can confirm your specific plan and provider.
Highmark Wholecare stays in network for 2027
You have choices
Change your plan, keep your doctors.
We'll check whether an available plan includes your Jefferson providers, prescriptions and other care needs. Network participation and benefits must be confirmed for the specific plan.
Keep Highmark, consider other providers.
If you like your plan, you may prefer to move your care to providers who remain in network. We can help you check options, including St. Luke's where available under your plan.
Keep your plan and use out-of-network care, if covered.
This can mean higher costs or no coverage for some services. Confirm the details with the plan and provider before choosing this route.
Before you call that 800 number on the TV ad, watch this
A team to help you sort it out
You do not need to figure this out from a letter or a headline. At Hitcho Insurance, we'll sit down with you in Allentown or Kingston, or talk by phone, to review your doctors, prescriptions and coverage.
Mike Hitcho has helped people with insurance since 2004. His Army National Guard service shaped the same mission he brings to the agency: looking out for his neighbors. Our team helped clients work through the UnitedHealthcare / Jefferson network disruption, and we're here to help you work through this one.
We represent multiple insurance companies, so we can compare the options available through our agency. The goal is a next step that makes sense for your care, not a rushed decision.
If you need to shop, here's what we look at
Questions we're hearing
Is Highmark definitely leaving Jefferson?
No final change has been announced. Negotiations are ongoing. We'll update this page when confirmed information changes.
I received a letter. Should I switch right away?
Call us first. We'll check your exact plan, the providers involved and the date any change would take effect. A letter about one type of coverage may not apply to another.
What if they reach an agreement after I switch?
Call us before making another change. Whether you can switch again depends on your enrollment eligibility, the timing and whether you have already used an available election.
Is there a charge for a review?
There is no cost or obligation for a plan review with Hitcho Insurance.
Stay informed. No sales pitch
We promise never to spam you. We just want to help.
These emails are meant to inform you of Medicare changes, including what happens next with Highmark and Jefferson Health, so you can understand what a change means for you before it arrives.
- Plain-English updates when Medicare rules or networks change
- Key dates, like the Annual Enrollment Period (October 15 to December 7)
If you have any questions, feel free to call our office
Call the office closest to you. We'll start with what you have, what care you need and what matters most to you.
Allentown, PA
(610) 694-94351245 S Cedar Crest Blvd, Suite 200
Allentown, PA 18103
Monday to Friday, 8:00 AM to 5:00 PM