Dual Eligible Special Needs Plans (D-SNPs)

Your Dual Eligible Special Needs Plan (D-SNP) focuses on you

When you need care, your Medicare and Medicaid benefits work together within one D-SNP plan. Plus, your D-SNP assistance programs can help with daily expenses like utility bills or transportation.

Considering Highmark Wholecare D-SNP

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.

Eliminating Benefits Paperwork

If you’re changing your current coverage to a D-SNP, changing to your new plan will be completed for you.

Using Expansive Network

For your convenience, our D-SNP coverage is accepted by thousands of board-certified doctors throughout Pennsylvania.

Earning Heathy Rewards

The Goodness Rewards Program helps you earn gift card rewards for over 100 locations when you complete healthy activities.

Your D-SNP Choices

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:

• Have been on disability for the past 2+ years
• Are age 65 or older
• Have Medicare Part A, Medicare Part B and Medicaid cards
• Live in our Pennsylvania service area

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.

Diamond D-SNP

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:

• Preventive screenings
  
• Primary care provider office visits
• Emergency care
  

You’ll find coverage – and out-of-pocket cost – specifics in your Evidence of Coverage (EOC) booklet.

Diamond D-SNP Resources

Ruby D-SNP

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:

• Medicare Part D prescription drugs
• Preventive care services
• Over-the-Counter (OTC) allowance

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.

Ruby D-SNP Resources

How Your D-SNP Works

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.

Visiting Network Doctors

When you have a D-SNP, you’ll select your primary care provider (PCP) from our Highmark Wholecare provider network for your routine care.

Coordinating Your Services 

Your PCP will oversee the rest of your care and get approval for you to work with other providers if needed.

Paying For Prescriptions

In most cases you’ll use a network pharmacy to ensure your prescriptions are covered.