If you’re looking for new health care coverage or want to change your current health plan, Highmark Wholecare helps save time and money while staying healthy.
If you’re changing your current coverage to a D-SNP, changing to your new plan will be completed for you.
For your convenience, our D-SNP coverage is accepted by thousands of board-certified doctors throughout Pennsylvania.
The Goodness Rewards Program helps you earn gift card rewards for over 100 locations when you complete healthy activities.
Your Dual Eligible Special Needs Plan (D-SNP) is Medicare Part A and Part B, Medicaid, medication benefits and more. You can choose between our Diamond D-SNP and Ruby D-SNP if you:
Thinking about the care you’ll need may help you know which D-SNP could be right for you. You can also think about what’s most important to you, like out-of-pocket costs and benefits and programs.
You may consider a Diamond D-SNP if you live within our 53 Pennsylvania service area counties. In addition to not having to pay a monthly cost for your D-SNP, you’ll get prescription drug benefits and other helpful assistance programs.
Other plan highlights include zero-dollar costs for:
You’ll find coverage – and out-of-pocket cost – specifics in your Evidence of Coverage (EOC) booklet.
A Ruby D-SNP is available in the same service areas as a Diamond D-SNP and you won’t have to pay a monthly cost for your D-SNP each month. Plus, you’ll get zero-cost benefits like:
However, in some instances, the amount you’ll pay for some services with a Ruby D-SNP are slightly different. You’ll find coverage – and out-of-pocket cost – specifics in your Evidence of Coverage (EOC) booklet.
When you’re covered by a D-SNP, the way you’ll get care is like getting care with a Health Maintenance Organization (HMO) health plan.
When you have a D-SNP, you’ll select your primary care provider (PCP) from our Highmark Wholecare provider network for your routine care.
Your PCP will oversee the rest of your care and get approval for you to work with other providers if needed.
In most cases you’ll use a network pharmacy to ensure your prescriptions are covered.
Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Medicare Ombudsman Website
Best Available Evidence
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Last Updated: Oct 1, 2024
