Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
The Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) is a 2026 HMO D-SNP Dual Special Needs (D-SNP) plan from Highmark Wholecare Medicare Assured with a $17.60/mo premium and a 4-star CMS rating. It may include allowances for dental and part b giveback. It's available in 57 counties across 1 state.
Reviewed by the Medicare Advocates team · 2026 plan year · sourced from CMS data
Offered in 57 counties across 1 state
- Monthly premium$17.60
- Overall star rating4 / 5
- In-network max out-of-pocket$8,000
- Dental$2,000
- Part B giveback$36
2026 plan-year figures (premium, star rating, MOOP) from the CMS Landscape file; allowance amounts from CMS PBP data. Amounts vary by plan; not all plans offer all benefits.
What the Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) plan may include
- Dental: up to $2,000 per year in plan allowance (2026).
- Part B giveback: up to $36 per year in plan allowance (2026).
Costs & coverage detail
Annual Part D drug deductible: $615 (2026).
Doctor visits
- Specialist visit$30 copay
Emergency & urgent care
- Emergency room$115 copay
- Urgent care$25 copay
Tests, labs & imaging
- Lab services$5 copay
- Diagnostic tests & procedures$5 copay
- X-rays$20 copay
Outpatient hospital & surgery
- Outpatient hospital services$250 copay
- Ambulatory surgical center$225 copay
- Outpatient substance abuse (individual)$30 copay
Medical equipment & supplies
- Durable medical equipment (DME)20% coinsurance
Ambulance
- Ground ambulance$250 copay
Vision
- Routine eye exam$0–$30 copay
Hearing
- Routine hearing exam$30 copay
Hospital stays
- Inpatient hospital$275/day, days 1–6; $0/day, days 7–90
In-network, Medicare-covered cost sharing for the 2026 plan year (CMS PBP data). Costs vary by service and setting; see the Summary of Benefits for full detail.
Extra benefit allowances
- Comprehensive dental allowance$2,000 per year
Preventive services
This plan covers $0 for all preventive services covered under Original Medicare when you use an in-network provider — including annual wellness visits, recommended screenings, and vaccines.
Common questions
- What is the Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) plan?
- It is a Dual Special Needs (D-SNP) plan (CMS plan ID H5932-009-000) offered by Highmark Wholecare Medicare Assured for the 2026 plan year. Dual Special Needs (D-SNP) plans are for people who qualify for both Medicare and Medicaid.
- What extra benefits could this plan include?
- Depending on the plan, supplemental benefits may include allowances toward dental, part b giveback. Amounts shown are for the 2026 plan year and vary by plan and area. A licensed agent can confirm what is available to you.
- Where is this plan available?
- For 2026, this plan is offered in 57 counties across 1 state. Availability and benefits depend on your specific ZIP code.
- How do I enroll or compare plans?
- Call to speak with a licensed insurance agent who can review this plan alongside the other options in your area at no cost. There is no obligation to enroll, and enrollment may be limited to certain times of year unless you qualify for a Special Enrollment Period.
Counties served
Pennsylvania (57 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, Montour, Northampton, Perry, Potter, Schuylkill, Snyder, Somerset, Sullivan, Susquehanna, Tioga, Union, Venango, Warren, Washington, Wayne, Westmoreland, Wyoming, York
Plan documents
Official 2026 documents for this plan:
Ready when you are.
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