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Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
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Monthly Premium
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) is a HMO D-SNP plan offered by Highmark Health
Plan ID: H5932-013
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.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) - H5932-013 by Highmark Health as well as other Medicare Advantage plans available in your area.
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Monthly Premium
Pennsylvania Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $615 |
| Out of Pocket Max |
In-Network: $8000 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| 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 $30 |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: $275 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Acute Hospital Services |
| Urgent Care | Urgent Care: Copayment for Urgent Care $0 or $25 |
| Emergency Room Visit | Emergency Care: Copayment for Emergency Care $0 or $115 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours |
| Ambulance Transportation | In-Network: 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: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $0 or $15 Copayment for Routine Care $0 or $15
|
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies and Services: Coinsurance for Medicare-covered Diabetic Supplies 0% or 10% Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 0% or 10% 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 Equipment (DME) | In-Network: Durable Medical Equipment: Coinsurance for Medicare-covered Durable Medical Equipment 0% or 20% Prior Authorization Required for Durable Medical Equipment |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Prior Authorization Required for Outpatient Radiology/Therapeutic/X-Ray |
| Home Health Care | In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $275 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $0 or $10 Copayment for Medicare-covered Group Sessions $0 or $10 |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 or $250 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 $225 Prior Authorization Required for Ambulatory Surgical Center Services |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 or $30 Copayment for Medicare-covered Group Sessions $0 or $30 |
| Over-the-counter (OTC) Items | In-Network: |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $0 or $25 Copayment for Routine Foot Care $0 or $25
|
| Skilled Nursing Facility Care | In-Network: |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network: Medicare-covered benefits: $30 specialist office visit copayment; $225 ASC Services; $250 OP Observation Services/OP Hospital
Copayment for Dental x-rays $0
Copayment for Prophylaxis $0
Copayment for Endodontics $0
Copayment for Periodontics $0
Copayment for Prothodontics, removable $0
Copayment for Maxillofacial surgery $0 |
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 $30 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 $30 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $0
• First year of follow-up provider visits • 60-day trial period • 3-year extended warranty • 80 batteries per aid for non-rechargeable models Benefit does not include or cover any of the following: • Over the counter (OTC) hearing aids • Ear molds • Hearing aid accessories • Additional provider visits • Additional batteries, Batteries when a rechargeable hearing aid is purchased • Hearing aids that are not TruHearing-branded Advanced Aids • Costs associated with loss & damage warranty claims Costs associated with excluded items are the responsibility of the member and not covered by the plan. Services not covered under any condition: Hearing aids and provider visits to service hearing aids (except as specifically described in the Covered Benefits), over the counter (OTC) hearing aids, ear molds, hearing aid accessories, warranty claim fees, and hearing aid batteries (beyond the 80 free batteries per non-rechargeable aid purchased). |
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 |