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Medicare Advantage · HMO
Highmark Wholecare Medicare Assured
Plan year 2026

Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) H5932-013

4.0 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$13.10
+ your Part B premium
Max out-of-pocket
$8,000
in-network annual cap
Primary care
$0
per visit copay
Specialist
$30
per visit
This plan includes a Part B giveback that can lower your Medicare Part B premium by up to $3 a month — up to $36 a year. If Medicaid or someone else pays your Part B premium, you generally will not receive the reduction directly. Processing can take time; confirm how the plan applies the reduction in your situation.
Eligibility required for this D-SNP
You must be entitled to Medicare Part A, enrolled in Part B, and have a Medicaid category this plan accepts. The plan must verify your Medicaid status. Eligibility alone does not create a year-round right to enroll.
Integration status
CO
Some partial-dual categories accepted
Verify the exact Medicaid levels in the official plan documents.
Common dual-eligibility labels

These definitions are educational. They do not confirm which Medicaid categories this specific plan accepts.

FBDE
Full Medicaid benefits in addition to Medicare.
QMB+
QMB help with Medicare costs plus full Medicaid benefits.
SLMB+
SLMB help with the Part B premium plus full Medicaid benefits.
QMB
Help with Medicare premiums and Medicare-covered cost sharing.
Check the Summary of Benefits or Evidence of Coverage for the exact Medicaid levels this plan accepts.
Could a Medicare Savings Program help?

Medicare Savings Programs are run by each state. The 2026 federal baseline monthly income limits are:

  • QMB: $1,350 for one person or $1,824 for a married couple
  • SLMB: $1,616 for one person or $2,184 for a married couple
  • QI: $1,816 for one person or $2,455 for a married couple
Alaska, Hawaii, and some states use different limits or resource rules. Qualifying for an MSP does not by itself confirm eligibility for this D-SNP. Apply through your state Medicaid office.
Learn about QMB, SLMB, and QI

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$615
Inpatient hospital
Days 1-6: $275/day, Days 7-90: $0/day
Inpatient mental health
Days 1-6: $275/day, Days 7-90: $0/day
Outpatient surgery
$250
Emergency room
$115
Urgent care
$25

Your Medicare cost sharing may be lower depending on your category of Medicaid eligibility.

What's included, and what it's actually worth4 benefits included. Tap any card for the detail

Part B giveback

$3/month
DetailsThis plan includes a Part B giveback that can lower your Medicare Part B premium by up to $3 a month.
If Medicaid or someone else pays your Part B premium, you generally will not receive the reduction directly.

Vision

$150eyewear allowance
Eyewear allowance$150 eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$30 copay
In-network$30 copay per visit
Inpatient Hospital$275/day, days 1–6
In-networkDays 1-6: $275/day, Days 7-90: $0/day
Outpatient Surgery$250 copay
In-network$250 copay per procedure
Mental HealthDays 1-6: $275/day, Days 7-90: $0/day
Inpatient psychiatricDays 1-6: $275/day, Days 7-90: $0/day
HearingHearing exam ($30 copay)
DetailsHearing exam ($30 copay)
This is a supplemental benefit with plan-specific limits. See plan documents for details.
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
25%
Preferred Generic

Our take

Where this plan shines

See your primary doctor for $0.
Highly rated by CMS (4 stars).

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Summary of Benefits (PDF)
Download the plan's official Summary of Benefits document
Evidence of Coverage (PDF)
Complete plan details and rules
Check Your Doctors
See if your doctors accept this plan
Documentos en español
Llame al (877)935-2168 (TTY: 711) para solicitar documentos en español

Helpful next steps

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We do not offer every plan available in your area. Currently we represent a limited number of organizations which offer a limited number of products in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are based on 2026 data and may change annually.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

The plan formulary, pharmacy network, and/or copays may change at any time. You will receive notice when necessary.

To join a Dual Eligible Special Needs Plan (D-SNP), you must be entitled to Medicare Part A, enrolled in Medicare Part B, and receive full Medicaid benefits or assistance from your state. Eligibility requirements vary by state and may require further verification. Enrollment in the plan depends on contract renewal.

Membership in this plan depends on your continued Medicaid eligibility. If you lose your Medicaid eligibility, you may be disenrolled from this plan. Contact your state Medicaid office or 1-800-MEDICARE (TTY: 1-877-486-2048) for more information.

The standard Part B premium for 2026 is $202.90. Monthly reduction on Medicare Part B premium varies and may be subject to processing delays and may not be immediate. If your Medicare Part B premium is paid by Medicaid, or others on your behalf, you will not see the reduction.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

  1. The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
  2. The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.

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Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) - Highmark Wholecare Medicare Assured | The Pocket Protector