Benefit Information for Highmark Wholecare Medicare Assured D-SNP Members Beginning Jan. 1, 2027

Highmark will again be offering a Dual Eligible Special Needs Plan (D-SNP) for your patients in 62 Pennsylvania counties in 2027. This plan serves those with Medicare Parts A and B, and who qualify for full Medical Assistance.

Highmark Wholecare Medicare Assured will cover all Medicare-approved services in addition to extra benefits not traditionally covered by Medicare, such as:

• Comprehensive and preventive dental coverage
• Free or low-cost hearing exams and hearing aids
• Additional money to spend on everyday essentials 

Extra Benefits (SSBCI):

To ensure their D-SNP patients receive SSBCI benefits, providers must attest to the patient's eligibility. This can be done by submitting an attestation form for new Highmark Wholecare D-SNP patients, OR, for existing D-SNP patients, by documenting proper diagnosis codes in the patient's chart for qualifying conditions. We appreciate your help with this one-time patient confirmation, which is required because of CMS regulatory changes. Once your patient is qualified, they do not need to re-qualify each year.

Next Steps

To familiarize yourself with the Highmark Wholecare Medicare Assured 2027 plan prior to Jan. 1, you can view the latest benefit information and resources you’ll need for next year on our Provider Resource Center under Medicare Resources > DSNP Member Benefits, which will be available to view on Oct. 1, 2026.

How You Can Support Your Patients

• Open Enrollment: Remind patients about the Medicare Open Enrollment Period (Oct. 15 – Dec. 7).
• Discuss Implications: Encourage patients to consider how benefit changes impact their care and benefits.
• Highmark Resources: Direct patients to Highmark Wholecare for more information and support.

The Highmark Wholecare Medicare Assured plan is available in the 62 counties highlighted below in blue:

The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.