Highmark Health Options

What Highmark Health Options does

Highmark Health Options, legally known as Highmark BCBSD Health Options Inc., is a private Delaware-domiciled health insurance company and independent licensee of the Blue Cross Blue Shield Association. It operates as a subsidiary of Highmark Inc. and is headquartered at 800 Delaware Avenue, Wilmington. The company provides two core products exclusively to Delaware residents: a Medicaid managed care plan serving low-income adults, children, pregnant women, elderly adults, and individuals with disabilities, and a Medicare Dual-Eligible Special Needs Plan (D-SNP) for individuals eligible for both Medicare and Medicaid. Revenue is generated through capitation contracts with the Delaware state Medicaid program and CMS, with no commercial or individual market products.

The company operates a healthcare management platform supporting both products, complemented by member-facing tools (HealthTrio Connect member portal, HHO on the Go telehealth, Community Support resource finder, and Healthy Rewards incentive program) and provider-facing infrastructure (Provider Resource Center, HealthSparq-powered provider directory, and Availity-authenticated prior authorization tools). Supplemental benefits include prescription drug coverage, dental, vision, behavioral health, long-term services and supports, fitness benefits for D-SNP members, and a Flex Card allowance. The go-to-market is sales-led and government-relationship-driven: enrollment flows through the Delaware state Medicaid eligibility system and provider referrals, with member retention supported by community outreach partnerships (Food Bank of Delaware, YMCA Delaware, Kingswood Community Center) and direct member communications.

The business is fully government-funded with no commercial revenue diversification. All operations are confined to Delaware, creating concentrated exposure to a single state's Medicaid procurement and rate-setting environment. The company maintains compliance with HIPAA, CMS Interoperability, mental health parity, and ACA Section 1557 nondiscrimination requirements. No AI capabilities, M&A activity, funding rounds, or management team disclosures are present in the available data, limiting visibility into growth trajectory and operational scale.

Name

Highmark Health Options

Legal name

Highmark BCBSD Health Options Inc.

Website

https://highmarkhealthoptions.com

Company type

Private

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Highmark Health Options is a private Delaware health insurer providing Medicaid managed care and Medicare D-SNP plans to low-income and dual-eligible residents through government contracts with the state and CMS.

Ownership category

akta.pro rank

Product category

Government Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro primary industry

TANF/CHIP Managed Care Plans (HLAEAEAA)

akta.pro secondary industries

D-SNP Plan Sponsorship & Benefit Design (HLAEAFAA), D-SNP Quality, Stars, HEDIS & Compliance (HLAEAFAJ), Medicaid/CHIP Dental & Vision Benefits Administration (FSAIAHAK)

Keywords

• Medicaid managed care
• Medicare D-SNP plans
• Dual-eligible coverage
• Government health insurance
• Community health support

Headquarters

HQ city

Wilmington

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales

Revenue model

1. Medicaid Managed Care: Government-funded Medicaid managed care program providing health coverage for eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities in Delaware. Revenue derived from per-member-per-month capitated payments from state Medicaid programs.
2. Medicare D-SNP (Dual Eligible Special Needs Plan): Medicare Advantage Special Needs Plan for individuals eligible for both Medicare and Medicaid. Provides coordinated Medicare and Medicaid benefits with additional supplemental coverages including prescription drugs, vision, and dental. Revenue from CMS Medicare contracts and state Medicaid programs.

Go-to-market motion1 record

Distribution channels4 records

Marketing channels4 records

Core offering

Highmark Health Options is a Delaware-based health insurance company that administers government-funded Medicaid and Medicare Dual-Eligible Special Needs Plan (D-SNP) coverage. It provides integrated medical, prescription drug, dental, vision, behavioral health, and long-term services and supports to low-income individuals, children, pregnant women, the elderly, and people with disabilities. The company operates under a Blue Cross Blue Shield license and serves members through contracted provider networks, a member portal, and community-based support programs.

Product overview

Highmark Health Options is a health insurance company offering two integrated core products: Medicaid coverage for adults and children, and Medicare D-SNP (Dual Special Needs Plan) for individuals eligible for both Medicare and Medicaid. These products provide comprehensive healthcare benefits including medical services, prescription drugs, dental, vision, behavioral health, and long-term services and supports. The company operates through a Provider Resource Center for healthcare providers, a Member Portal (HealthTrio Connect) for member account management, and supplementary services including Community Support for social determinants of health, Healthy Rewards incentives, a Flex Card for D-SNP members, and Telehealth services. All offerings are designed to serve Delaware residents eligible for Medicaid and Medicare programs.

Differentiator

Problem solved

Functional benefit

Products and services

• Delaware Medicaid Government-funded Medicaid health insurance for adults and children eligible in Delaware, providing medical services, prescription coverage, dental and vision care, behavioral health benefits, pregnancy and newborn care, and long-term services and supports.
• Medicare D-SNP (Highmark Health Options Duals HMO SNP) A Medicare Advantage Dual-Eligible Special Needs Plan for individuals eligible for both Medicare and Medicaid, offering coordinated Medicare and Medicaid benefits plus supplemental coverage including prescription drugs, vision, dental, fitness benefits, and flex card allowances.
• Provider Resource Center Online portal for contracted healthcare providers serving Medicaid and Medicare D-SNP members in Delaware, providing access to provider manuals, prior authorization code lookup, training materials, claims information, and policy updates via Availity authentication.
• Member Portal (HealthTrio Connect) Self-serve online portal where Medicaid and D-SNP members can log in to access their health insurance accounts, review benefits, check claims status, and manage their Highmark Health Options coverage.
• Community Support A resource connection service that links members with local community resources for food security, housing, education, legal matters, financial assistance, and employment support to address social determinants of health.
• Telehealth (HHO on the Go) Telehealth service that allows Medicaid and D-SNP members to access medical care remotely through virtual visits with healthcare providers.
• Long-Term Services and Supports (LTSS) Comprehensive support services for Medicaid members requiring long-term care, including home-based and community-based care options for individuals with chronic conditions or disabilities.

Segments2 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

Partnerships

Five partnerships are on record, tiered core and minor.

• Food Bank of DelawarecoreStrategic or Co-development PartnerMonthly food distribution partnerships connecting Highmark Health Options members with food security resources. Community support initiative addressing social determinants of health for Medicaid and D-SNP members.
• YMCA (Delaware)coreStrategic or Co-development PartnerDiabetes prevention and healthy weight classes offered to Highmark Health Options members. Health and wellness programming supporting chronic disease management and prevention for community members.
• Kingswood Community CentercoreStrategic or Co-development PartnerCommunity events and health outreach programs at Kingswood Community Center serving Highmark Health Options members and Delaware community residents.
• Healthwise, IncorporatedminorOthersHealth information content provider. Copyrighted material adapted with permission from Healthwise, Incorporated for member health education resources.
• HealthsparqcoreTechnology or IntegrationProvider directory platform integration enabling members to search for approved doctors, hospitals, and pharmacies within the Highmark Health Options provider network.

Scale indicators1 record

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Humana: Major Medicare Advantage insurer with growing D-SNP focus. Overlaps with Highmark Health Options on the dual-eligible segment and supplemental benefits design.
• Elevance Health (Anthem): BCBS-licensed parent of multiple state Blue plans offering Medicaid and Medicare Advantage D-SNP products. Comparable regulatory moat via BCBSA licensing and government-program portfolio.
• Aetna (CVS Health): Operates Medicaid managed care plans in multiple states and Medicare Advantage D-SNPs. Broad incumbent with government-program capabilities similar to Highmark Health Options.
• Centene Corporation: Largest U.S. Medicaid managed care insurer with presence across most states including Delaware. Operates as broad incumbent with extensive government-program portfolio overlapping Highmark Health Options' offerings.
• UnitedHealthcare Community & State: UnitedHealth Group's Medicaid and D-SNP division. Largest U.S. health insurer with broad Medicaid presence; competes with Highmark Health Options in government-sponsored managed care.

Direct peers

• Molina Healthcare: Pure-play government-sponsored healthcare insurer focused on Medicaid, Medicare D-SNP, and Marketplace plans. Comparable in product mix and dual-eligible focus, though operating across multiple states.
• AmeriHealth Caritas Delaware: Medicaid managed care plan serving Delaware Medicaid beneficiaries. Direct competitor in the same Delaware Medicaid MCO market, offering similar capitated coverage for TANF and CHIP populations.
• Delaware First Health (Centene): Centene-owned Medicaid managed care plan operating in Delaware. Directly competes for Medicaid contracts and dual-eligible members in the same state footprint.

Others

• HealthSparq: Provider directory and transparency platform integrated with Highmark Health Options. Adjacent ecosystem participant supplying the plan's provider search and navigation tooling.
• Highmark Inc. Parent organization of Highmark Health Options. Operates BCBS-licensed health plans across Pennsylvania, West Virginia, Delaware, and New York; provides enterprise context and shared infrastructure.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat4 records

Key risks4 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/highmark-health-options

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Highmark Health Options