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Highmark Health Options Duals Select (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Highmark Health Options Duals Select (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Highmark Health Options Duals Select (HMO D-SNP) in 2026, please refer to our full plan details page.
Highmark Health Options Duals Select (HMO D-SNP) is a HMO D-SNP plan offered by Highmark Health available for enrollment in 2026 to people living in Kent, New Castle, Sussex. The overall rating for this plan is not yet available for 2026.
It's important to know that Highmark Health Options Duals Select (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Highmark Health Options Duals Select (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Highmark Health Options Duals Select (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.
For Highmark Health Options Duals Select (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.20. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.60. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Highmark Health Options Duals Select (HMO D-SNP) Medicare 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 deductible is essential for estimating your yearly healthcare expenses with this plan. Specific drug coverage tier details, including individual copayments and coinsurance rates for different medication levels, are currently not available for this plan. To understand how your specific prescriptions are covered, it is recommended to review the plan formulary or contact the provider directly. This ensures you obtain the most accurate cost estimates for your specific medication needs.
Additional Benefits
The Highmark Health Options Duals Select (HMO D-SNP) plan offers comprehensive healthcare coverage with no copay and no coinsurance for inpatient hospital stays, home health services, and skilled nursing facility care. For outpatient care, doctor visits, diagnostics, and durable medical equipment, members generally pay no copay alongside a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, while urgent care visits require a $40 copay. This plan also includes essential dental, vision, and hearing benefits, offering no copays for preventive and comprehensive dental services, routine eye exams, and prescription hearing aids. Routine hearing exams and select vision services typically carry no copay and a 20% coinsurance, with allowances provided for frames and contact lenses. Additionally, members can access over-the-counter items and chronic illness meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Highmark Health Options Duals Select (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required for acute and psychiatric stays. Under this plan, additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Highmark Health Options Duals Select (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Highmark Health Options Duals Select (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Highmark Health Options Duals Select (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Highmark Health Options Duals Select (HMO D-SNP) with a $115.00 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services feature a $40.00 copay and no coinsurance, while worldwide emergency services only cover some services, as worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation are not covered.
Primary Care See details
Highmark Health Options Duals Select (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, telehealth, and opioid treatment services with no copay and 20% coinsurance. Chiropractic services are partially covered, with other chiropractic services not covered, requiring a $15 copay and 20% coinsurance for up to 6 routine visits, while podiatry services require a $25 copay for Medicare-covered services and 20% coinsurance for up to 6 routine visits.
Preventive Services See details
Highmark Health Options Duals Select (HMO D-SNP) covers preventive services, offering annual physical exams and kidney disease education with no copay and no coinsurance. Other preventive services, including glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome-visit EKGs, are covered with no copay and 20% coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Highmark Health Options Duals Select (HMO D-SNP) covers hearing services, including one routine hearing exam annually with no copay and a 20% coinsurance, plus unlimited fitting evaluations with no copay. Prescription hearing aids are covered with no copay or coinsurance for up to two devices every three years, though OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription models, are not covered.
Vision Services See details
Highmark Health Options Duals Select (HMO D-SNP) partially covers vision services with no copays, no deductibles, and a 20% coinsurance for routine eye exams and contact lenses, while eyeglass lenses and frames have no coinsurance. Covered benefits include one annual routine eye exam, one pair of eyeglass lenses, one frame up to $150, and contact lenses up to $150, while other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by Highmark Health Options Duals Select (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental care, and no copay and no coinsurance for covered preventive and comprehensive services. Sub-services that are not covered under this plan include fluoride treatment, implants, fixed prosthodontics, orthodontics, maxillofacial prosthetics, adjunctive general services, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Highmark Health Options Duals Select (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Highmark Health Options Duals Select (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Highmark Health Options Duals Select (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for DME and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Highmark Health Options Duals Select (HMO D-SNP) covers diagnostic and radiological services, including lab work, diagnostic procedures, radiology, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Highmark Health Options Duals Select (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Highmark Health Options Duals Select (HMO D-SNP) with no copay, though only some services are covered; standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Highmark Health Options Duals Select (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay, though prior authorization is required. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Highmark Health Options Duals Select (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and highly integrated services are not covered under this plan.
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