Highmark Health Options
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.
- Company typePrivate
- Founded-
- HeadquartersWilmington, United States
- Headcount501–1,000
- GTM typeB2C
- OfferingServices
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.
Highmark Health Options firmographics
Firmographics- 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
Highmark Health Options industry classification
Industry- 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
Where Highmark Health Options is headquartered
LocationHeadquarters
- HQ city
- Wilmington
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Highmark Health Options business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Infrastructure, Marketing or Sales
Revenue model
- 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.
- 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
Highmark Health Options product offering
Product offeringCore 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.
Companies that use Highmark Health Options
Customer profileSegments2 records
Ideal customer profiles3 records
Highmark Health Options technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration3 records
Highmark Health Options partnerships and signals
Strategic signalPartnerships
Five partnerships are on record, tiered core and minor.
- Food Bank of DelawarecoreMonthly 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)coreDiabetes 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 CentercoreCommunity events and health outreach programs at Kingswood Community Center serving Highmark Health Options members and Delaware community residents.
- Healthwise, IncorporatedminorHealth information content provider. Copyrighted material adapted with permission from Healthwise, Incorporated for member health education resources.
- HealthsparqcoreProvider 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
Highmark Health Options competitors and assessment
Company assessmentBroad 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
Highmark Health Options social profiles
Digital presenceHighmark Health Options compliance and trust
Trust signalCompliance4 records
Highmark Health Options financial estimates
Financial estimateRevenue estimate
Valuation estimate
Highmark Health Options leadership team
Management profileNumber of profiles
Highmark Health Options funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Highmark Health Options M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Highmark Health Options
What does Highmark Health Options do?
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.
Is Highmark Health Options a public or private company?
Highmark Health Options is a private company. It is classified as corporate owned and is currently operating.
When was Highmark Health Options founded?
Highmark Health Options was founded in -1. It employs 501 to 1,000 people.
Where is Highmark Health Options based?
Highmark Health Options is headquartered in Wilmington, United States, in the North America region.
How does Highmark Health Options make money?
Two revenue lines are on record. Medicaid Managed Care is the primary driver. The others are medicare D-SNP (Dual Eligible Special Needs Plan).
Who are Highmark Health Options's main competitors?
Broad incumbents on record are Humana, Elevance Health (Anthem), Aetna (CVS Health), Centene Corporation and UnitedHealthcare Community & State. Direct peers are Molina Healthcare, AmeriHealth Caritas Delaware and Delaware First Health (Centene). Others are HealthSparq and Highmark Inc..
Does Highmark Health Options have an API?
No public API is recorded for Highmark Health Options.
What industry is Highmark Health Options in?
Highmark Health Options's product category is Government Health Insurance. Its primary akta.pro industry code is HLAEAEAA, TANF/CHIP Managed Care Plans, with a secondary code of HLAEAFAA, D-SNP Plan Sponsorship & Benefit Design. Its NAICS code is 524114 and its SIC code is 6321.