Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
Available to residents of Montour County, PA for 2026. Contract H5932, plan 009, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Montour County
- Plan website
- Browse the Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $17.60 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $17.60? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | $3.00 a month?You must continue to pay your Medicare Part B premium. |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $8,000.00? |
| Drug deductible | $615.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO D-SNP? |
| Special needs plan | Dual-eligible SNP |
| Contract / plan | H5932-009-0 |
| Offered by | Highmark Wholecare Medicare Assured |
| Parent organization | Highmark Health |
| Formulary drugs | 3,545 |
| Pharmacy search | www.highmark.com/wholecare |
| Member services | (877)935-2168TTY 711 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H5932 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $30 copay |
| Other health care professional | $25–$30 copay(authorization required) |
| Additional telehealth services | $0–$30 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $5 copay(authorization required) |
| Lab services | $5 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | 10% coinsurance(authorization required) |
| Therapeutic radiology | $60 copay(authorization required) |
| Outpatient x-rays | $20 copay(authorization required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $25 copay |
| Worldwide emergency coverage | Not covered |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | $275 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient hospital services | $250 copay(authorization required) |
| Outpatient observation | $250 copay |
| Ambulatory surgical center | $225 copay(authorization required) |
| Outpatient blood services | 20% coinsurance |
| Skilled nursing and home health | |
| Skilled nursing facility | Original Medicare cost-sharing(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | $25 copay(authorization required) |
| Physical therapy and speech-language therapy | $25 copay(authorization required) |
| Cardiac rehabilitation | $0 copay |
| Pulmonary rehabilitation | $0 copay |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $275 per day for days 1–6; $0 per day for days 7–90(authorization required) |
| Outpatient mental health, individual session | $10 copay |
| Outpatient mental health, group session | $10 copay |
| Psychiatrist, individual session | $10 copay |
| Psychiatrist, group session | $10 copay |
| Partial hospitalization | $55 copay(authorization required) |
| Intensive outpatient program | $55 copay(authorization required) |
| Outpatient substance use, individual session | $30 copay |
| Outpatient substance use, group session | $30 copay |
| Opioid treatment program | $0 copay |
| Ambulance and transportation | |
| Ground ambulance | $250 copay(authorization required) |
| Air ambulance | $250 copay(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 10% coinsurance |
| Diabetic therapeutic shoes or inserts | 10% coinsurance |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $15 copay(authorization required) |
| Routine chiropractic care | $15 copay(authorization required, limits apply) |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $25 copay |
| Routine foot care | $25 copay(limits apply) |
| Dental? | |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | Not covered |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Comprehensive dental plan limit | $2,000 plan limit every year |
| Restorative services (fillings, crowns) | $0 copay(limits apply) |
| Endodontics (root canals) | $0 copay(limits apply) |
| Periodontics (gum disease) | $0 copay(limits apply) |
| Dentures and other removable prosthodontics | $0 copay(limits apply) |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | $0 copay |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0–$30 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $30 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | $0 copay |
| Fitness benefit | $0 copay |
| Health education | $0 copay |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | $0 copay |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay |
| Home and bathroom safety devices | $0 copay |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | $0 copay |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | 25% | 25% | 25% | 25% | 25% | 25% |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 56 other PA counties
- Adams
- Allegheny
- Armstrong
- Beaver
- Bedford
- Berks
- Blair
- Bradford
- Butler
- Cambria
- Cameron
- Carbon
- Centre
- Clarion
- Clearfield
- Clinton
- Crawford
- Cumberland
- Dauphin
- Elk
- Erie
- Fayette
- Forest
- Franklin
- Fulton
- Greene
- Huntingdon
- Indiana
- Jefferson
- Juniata
- Lancaster
- Lawrence
- Lebanon
- Lehigh
- Lycoming
- McKean
- Mercer
- Mifflin
- Monroe
- Northampton
- Perry
- Potter
- Schuylkill
- Snyder
- Somerset
- Sullivan
- Susquehanna
- Tioga
- Union
- Venango
- Warren
- Washington
- Wayne
- Westmoreland
- Wyoming
- York
Benefits in plain text
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) (H5932-009-0) is a 2026 HMO D-SNP Medicare Advantage plan offered by Highmark Wholecare Medicare Assured, available to residents of Montour County, PA.
The monthly premium is $17.60 (Part C and Part D together).
The plan reduces the member's Medicare Part B premium by $3.00 a month (a "giveback"); the Part B premium itself must still be paid.
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $8,000.00.
The drug deductible is $615.00.
It is a special needs plan (Dual-eligible SNP).
The plan's formulary lists 3,545 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: 25%.
CMS gives the plan's contract (H5932) an overall rating of 4 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.