Highmark Wholecare Medicare Assured Diamond (HMO D-SNP)

Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) is a HMO D-SNP plan offered by Highmark Health available for enrollment in 2025 to people living in SW NW NE Central Pennsylvania Counties. This plan received an overall rating of 4 out of 5 stars in 2026.

It's important to know that Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about Highmark Wholecare Medicare Assured Diamond (HMO D-SNP).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) plan features an annual drug deductible of $615 for its prescription drug coverage. This deductible is the amount you must pay out-of-pocket for your medications before the plan begins to cover its share of the costs. Understanding this upfront cost is an important step in evaluating whether this Medicare plan fits your budget and healthcare needs. Specific details regarding drug coverage tiers, copayments, and coinsurance are currently unavailable for this plan. To fully understand your potential out-of-pocket expenses for specific prescriptions, you should contact the plan provider directly for a complete formulary. This will help ensure your necessary medications are covered and clarify your ongoing costs after meeting the annual deductible.

Additional Benefits

The Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for inpatient hospital stays, primary care visits, and specialist consultations. While inpatient, skilled nursing, and home health services require no copay and no coinsurance, outpatient services and diagnostics generally involve no copay and a 24% coinsurance. Emergency care requires a $115 copay and urgent care carries a $40 copay, both of which apply to the plan-level deductible. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care up to a $6,500 annual limit and eyewear up to $600 with no copay or coinsurance. Additionally, members receive no copay coverage for up to 24 one-way transportation trips annually and routine hearing aids every three years. Medical equipment, dialysis, and Part B drugs are covered with no copays and coinsurance ranging from 20% to 24%.