Effective January 1, 2026: Benefit Information for Highmark Wholecare Medicare Assured D-SNP Members

Highmark will again be offering a Dual Eligible Special Needs Plan (D-SNP) for your patients in 62 Pennsylvania counties in 2026. 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 hearing exams and hearing aids
• Additional money to spend on everyday essentials

Updates to Extra Benefits (SSBCI):

• What's Changing: The Centers for Medicare and Medicaid Services (CMS) is eliminating Value-Based Insurance Design (VBID) for 2026 but is taking important steps to address Social Determinants of Health (SDoH) through Special Supplemental Benefits for Chronically Ill (SSBCI). SSBCI benefits can include: flex card values, dental services, home-based palliative care, pest control, and home delivered meals.
  • Patient Impact: To ensure continuity of benefits, patients are encouraged to stay with their current plan or understand the impact of switching. Switching plans may delay access to these extra benefits, while staying in the same plan could allow pre-qualification for SSBCI benefits.

• NEW for 2026: 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.

Next Steps

To familiarize yourself with the Highmark Wholecare Medicare Assured 2026 plan prior to January 1, you can view the latest benefit information and resources you’ll need for next year on our website under Medicare Resources > DSNP Member Benefits.

How You Can Support Your Patients

• Open Enrollment: Remind patients about the Medicare Open Enrollment Period (October 15 – December 7).
• Discuss Implications: Encourage patients to consider how these changes impact their care and benefits.
• Highmark Resources: Direct patients to Highmark Health Options for more information and support.

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

We look forward to working with you to serve Pennsylvania D-SNP patients.