Update on Buffalo Medical Group Medicare Advantage agreement

Buffalo, N.Y.  (November 25, 2024) — After several months of negotiating with its for-profit partner (Agilon), Buffalo Medical Group informed us that their primary care providers will be leaving Highmark Blue Cross Blue Shield’s Medicare Advantage network beginning July 1, 2025. This does not affect BMG’s specialist providers. 

We’re disappointed in this decision, after making multiple enhanced offers to Agilon and with the considerable time remaining on our existing agreement. 

Their decision will not affect our 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 we remain open to further negotiations, BMG has shared that their decision is final. In the midst of Medicare Annual Enrollment period for 2025, we will move swiftly to support our affected members in understanding their options. 

While the December 7 open enrollment deadline is approaching, January 1 – March 31, Medicare Advantage members can make a one-time Medicare Advantage plan switch or return to Original Medicare.

Highmark BCBS maintains contracts with nearly 3,000 physicians across Western New York, representing every other major physician group. Our 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 our members’ concerns and disappointment with this decision and are here to support them. Our dedicated member service team is available to answer any questions you may have. Please call 1-800-329-2792 (TTY 711), 7 days a week, 8am – 8pm.

Why can’t you just pay Buffalo Medical Group what it’s asking?

• Highmark has presented several enhanced offers to Buffalo Medical Group.
• BMG’s for-profit partner, Agilon, has requested terms for our Medicare Advantage members that would make their requested compensation significantly higher, in comparison to other providers in our network.
• At a time where our members are facing increased costs, especially with their health care, we could not agree to their demands.
• As a not-for-profit health plan, we must ensure our members’ health care remains affordable and within reach.  

With the Annual Enrollment Period ending on December 7, am I stuck in the plan I chose? 

• You can change health plans only at certain times during the year. From October 15 – December 7, you can join, switch, or drop a Medicare health or drug plan for the following year.
• Please note, Highmark Medicare Advantage members with employer group Medicare plans have different enrollment periods. Contact your group representative for specific dates and details, as these are determined by the group in which you receive coverage through.
• Medicare beneficiaries also have an additional window, between January 1 – March 31, to make a one-time plan switch or return to Original Medicare

Are there any Highmark BCBS Medicare Advantage products that will include BMG? 

• Highmark BCBS offers Medicare Advantage plans known as Preferred Provider Organization (PPO) products offer 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.

How does this decision impact Highmark BCBS Medicare HMO Plans? 

• If you have a Highmark Medicare Advantage HMO plan and would like to continue seeing your BMG primary care physician after July 1, 2025, you will be responsible for the full cost of your care.
• Your Highmark Medicare Advantage HMO plan does not cover out-of-network services, except in emergencies.

How does this decision impact Highmark BCBS Medicare PPO Plans?

• If you have a Highmark Medicare Advantage PPO plan, you can continue to see your BMG primary care physician, even though they're out-of-network.
• However, it may cost you more. Also, be aware that out-of-network providers are not required to provide care to Highmark Medicare Advantage members and BMG may refuse to see you unless it is an emergency.
• We recommend contacting your BMG physician’s office directly to discuss your coverage and potential costs before your next appointment.

Will my lab work at BMG be covered?

• If your lab work was requested and billed by an in-network physician (ie. BMG specialists), it will be covered as in-network.
• If your lab work was requested and billed by an out-of-network physician (ie. BMG PCPs), it will be considered out-of-network.

How does this change impact Federal Employee Programs (FEP), specifically Postal Employees?

• These changes affect only Medicare Advantage members, not those with employer-sponsored insurance (including Federal Employee Program, FEP, and Affordable Care Act plans). This includes Postal employees.
• BMG made the decision to terminate its contract with Highmark Blue Cross Blue Shield for Medicare Advantage.
• However, because you carry Medicare coverage as your primary as FEP employees, BMG must continue to see you, as they accept Medicare. 

Which Buffalo Medical Group practices will be OON and when?  

• Our commercial (employer-based, FEP, ACA) members are not involved in these negotiations. We have reached agreement with BMG to ensure our commercial members have continued access to BMG’s practices into the future.
• Our Medicare Advantage agreement with BMG’s primary care providers will end on June 30, 2025.
• These primary care providers are: