Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Highmark Health Options Duals, 2027

H6224Contract001Plan

HMO D-SNP · special needs plan, dual-eligible · 40 counties in West Virginia

Run by Highmark Health Options West Virginia Inc. (contract H6224), sold as Highmark Blue Cross Blue Shield, owned by Highmark Health

Renews for 2027

2026 star rating, contract H6224: not rated (too new)

Highmark Health Options Duals (H6224-001) costs $12.80 a month in 2027, down $19.90 from 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Monthly premium	$32.70	$12.80	down $19.90
In-network out-of-pocket limit	$9,250	$9,850	up $600
Drug deductible	$615	$700	up $85
Counties served	18	40	up 22
12 lines do not change
Part B premium reduction, monthly	none	none	no change
Primary care visit	20% of the cost	20% of the cost	no change
Specialist visit	20% of the cost	20% of the cost	no change
Emergency room	$115 copay	$115 copay	no change
Medical deductible, in network	none	none	no change
Hospital stay, in network	not filed	not filed	no change
Skilled nursing facility, in network	not filed	not filed	no change
Ground ambulance, in network	20% of the cost	20% of the cost	no change
Comprehensive dental, yearly limit	not offered	not offered	no change
Eyewear, yearly limit	not offered	not offered	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Over-the-counter items, yearly	not offered	not offered	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	not offered	$0
Tier 2	Generic	not offered	25% of the cost
Tier 3	Preferred Brand	not offered	25% of the cost
Tier 4	Non-Preferred Drug	not offered	25% of the cost
Tier 5	Specialty Tier	not offered	25% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 15 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 3 plans have a lower out-of-pocket limit, 11 the same. On the premium, 11 plans have a lower premium, 3 the same.

Out-of-pocket limits of the 15 dual-eligible special needs plans

$0 to under $2,0000 plans

$2,000 to under $4,0000 plans

$4,000 to under $6,0001 plan

$6,000 to under $8,0001 plan

$8,000 to $10,000 (this plan)13 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 40 counties: $12.80 a month and $9,850.

West Virginia

Boone Braxton Cabell Calhoun Clay Doddridge Fayette Gilmer Grant Greenbrier Hampshire Hardy Jackson Kanawha Lewis Lincoln Logan Marshall Mason McDowell Mingo Monroe Nicholas Ohio Pendleton Pleasants Pocahontas Putnam Raleigh Ritchie Roane Summers Tucker Tyler Wayne Webster Wetzel Wirt Wood Wyoming

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H6224-001
Legal name of the contract: Highmark Health Options West Virginia Inc.
Sold as: Highmark Blue Cross Blue Shield
Parent company: Highmark Health
Plan type: HMO D-SNP
2026 star rating of the contract: not rated (too new) overall; health plan not rated, drug plan not rated
Members, September 2026: 267
Plan website, as filed with CMS: Highmark.com/health-options-wv/duals

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Kanawha, WVWhere most of its members live; premiums and limits side by side
Every Highmark Blue Cross Blue Shield plan for 2027Its contracts, counties and plans that end
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.