Highmark Wholecare Medicare Assured Ruby (HMO D-SNP)
H5932-009 • 2026 • Huntingdon County, PA
Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) H5932-009 • 2026 • Huntingdon County, PA
Highmark Wholecare Medicare Assured Ruby is a Medicare Dual-Eligible plan offered by Highmark Wholecare Medicare Assured for the 2026 plan year. It is identified by CMS Plan ID H5932-009 and serves individuals who meet defined eligibility criteria.
Highmark Wholecare Medicare Assured Ruby Overview
Plan Overview for H5932-009-0 | |
|---|---|
| CMS Plan ID: | H5932-009-0 |
| Plan Type: | HMO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $17.60 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $8000.00 (In-Network) |
| Part B Give Back: | −$3.00 reduction |
| Prescription Drug Coverage: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Huntingdon County, PA |
| Enrollment (Nationwide) | 5,451 beneficiaries |
| Enrollment (CMS – Local) | 12 beneficiaries in Huntingdon County |
| Provided By: | Highmark Wholecare Medicare Assured |
Plan Overview and Eligibility
Highmark Wholecare Medicare Assured Ruby is a Medicare D-SNP plan for people who qualify for both Medicare and Medicaid.
- To enroll, you must have Medicare Part A and Part B, live in the plan’s service area, and qualify for Medicaid.
- Prescription drug coverage (Medicare Part D) is included. The annual Part D deductible is $615.00.
- Cost-sharing and benefits may be coordinated with Medicaid, depending on your eligibility level.
- People who qualify for Medicare Extra Help may receive additional assistance with prescription drug costs.
Highmark Wholecare Medicare Assured Ruby operates on a Health Maintenance Organization (HMO) network. Members usually access care through in-network providers, and referrals are often needed for specialty services. The plan covers emergency services and out-of-area dialysis regardless of network status.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $0 or $30 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 or $0-$30 copay |
| Routine chiropractic: | In-network: $15 copay |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: 0% or 10% coinsurance |
| Lab services: | In-network: $0 or $5 copay |
| Outpatient x-rays: | In-network: $0 or $20 copay |
| Diagnostic tests and procedures: | In-network: $0 or $5 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $0 or $115 copay |
| Worldwide emergency care: | Not covered |
| Urgent care: | $0 or $25 copay |
| Inpatient hospital care: | Tier 1 | $0 or $275 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $0 or $209.5 per day for days 21-100 |
| Ground ambulance: | In-network: $0 or $250 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $0 or $10 copay |
| Outpatient group therapy: | In-network: $0 or $10 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $0 or $275 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 or $25 copay |
| Occupational therapy: | In-network: $0 or $25 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 0% or 10% coinsurance |
| Durable medical equipment: | In-network: 0% or 20% coinsurance |
| Prosthetics: | In-network: 0% or 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0% or 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0% or 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-network: $0 copay |
| Endodontics: | In-network: $0 copay |
| Restorative services: | In-network: $0 copay |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $17.60 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $17.60 |
| Low Income Premium Subsidy: | $32.71 |
| Low Income Premium Subsidy CMS Pays: | $17.60 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Highmark Wholecare Medicare Assured begins paying its share.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, Highmark Wholecare Medicare Assured Ruby has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Plan Star Ratings
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
CMS Star Ratings for Plan H5932-009-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Highmark Wholecare Medicare Assured
| Contact Type | Details |
|---|---|
| Website: | Highmark Wholecare Medicare Assured Plan Page |
| New Members: | 1-877-935-2168 |
| Existing Members: | 1-800-685-5209 |
| Plan Address: | PO Box 535191 | Pittsburgh, PA 15253 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- Highmark Wholecare Medicare Assured (official source), http://www.highmarkwholecare.com — Last accessed April 30, 2026
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)" — Last accessed April 28, 2026
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed April 28, 2026
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed April 28, 2026
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