Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) H5932-009 Plan Details
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Highmark Health
Plan ID: H5932-009
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$0.00
Monthly Premium
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Highmark Health
Plan ID: H5932-009
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Pennsylvania Counties Served
Elk
Somerset
Bedford
Jefferson
Clarion
Clearfield
Cameron
Huntingdon
Blair
Potter
Erie
Forest
Mckean
Venango
Mercer
Warren
Crawford
Northampton
Lehigh
Carbon
Schuylkill
Monroe
Susquehanna
Wyoming
Beaver
Fayette
Sullivan
Westmoreland
Allegheny
Washington
Butler
Greene
Cambria
Armstrong
Fulton
Cumberland
Clinton
York
Lawrence
Juniata
Lycoming
Tioga
Bradford
Mifflin
Dauphin
Perry
Lebanon
Snyder
Adams
Berks
Lancaster
Wayne
Montour
Union
Indiana
Centre
Franklin
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 or $25 |
| Inpatient Hospital Care | 0 or $In-Network: Acute Hospital Services: $250 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services Prior authorization required |
| Urgent Care | Copayment for Urgent Care $0 or $25 |
| Emergency Room Visit | Copayment for Emergency Care $0 or $125 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $0 or $250 Air Ambulance: Copayment for Air Ambulance Services $0 or $250 Prior Authorization Required for Air Ambulance Prior authorization required |
Health Care Services and Medical Supplies
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Copayment for Medicare-covered Chiropractic Services $0 or $15 Copayment for Routine Care $0 or $15
Additional routine care visits include chronic and/or subluxation and treatment to extra spinal regions that include the head, upper and lower extremities, ribcage, and abdomen. Prior authorization required |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Copayment for Medicare-covered Diabetic Supplies $0 Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0 If the member receives diabetic supplies and services at a DME provider, there is no limit to manufacturer. If the member receives diabetic supplies and services from a pharmacy, specified manufacturers are limited. |
| Durable Medical Eqipment (DME) | In-Network: Coinsurance for Medicare-covered Durable Medical Equipment 0% or 20% Prior Authorization Required for Durable Medical Equipment Prior authorization required |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 Copayment for Medicare-covered Lab Services $0 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 or $20 to $175 Copayment for Medicare-covered Therapeutic Radiological Services $0 or $60 Copayment for Medicare-covered X-Ray Services $0 or $20 Prior authorization required |
| Home Health Care | In-Network: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Prior authorization required |
| Mental Health Inpatient Care | 0 or $In-Network: Psychiatric Hospital Services: $250 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required |
| Mental Health Outpatient Care | In-Network: Copayment for Medicare-covered Individual Sessions $0 or $25 Copayment for Medicare-covered Group Sessions $0 or $25 |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 or $200 Prior Authorization Required for Outpatient Hospital Services Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $0 or $250 Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 or $200 Prior Authorization Required for Ambulatory Surgical Center Services Prior authorization required |
| Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $0 or $25 Copayment for Medicare-covered Group Sessions $0 or $25 |
| Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0
An OTC catalog of CMS-approved non-prescription over-the-counter medications and health-related items is available. Plan restrictions apply.Members can use the $82 allowance to purchase OTC at select retail locations, online, or via catalog. Unused allowances will carry over from month to month. Any unused allowance will expire at the end of the calendar year. Fees and plan restrictions apply. |
| Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $0 or $25 Copayment for Routine Foot Care $0 or $25 |
| Skilled Nursing Facility Care | 0 or $In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $214 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services Prior authorization required |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Medicare Covered Preventive Dental: Copayment for Office Visit $0 or $25 to $250 Prior Authorization Required for Medicare Covered Preventive Dental Authorization may be required for Medicare Covered Services. Medicare-covered benefits: $25 specialist office visit copayment$200 OP Hospital/ASC Services$250 OP Observation Services Non-Medicare Covered Preventive Dental: Copayment for Non-medicare preventive $0 Copayment for Oral exams $0
Non-Medicare Covered Comprehensive Dental: Copayment for Non-medicare comprehensive $0 Copayment for Restorative services $0
Maximum Plan Benefit of $3,500 every year Prior authorization required |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 to $25 Copayment for Routine Eye Exams $0
Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0
|
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0 or $25 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $0
|
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit |
