Medicare Parts A and B Cost-Sharing

All members enrolled in Highmark Wholecare Medicare Assured Diamond^SM and Highmark Wholecare Medicare Assured Ruby^SM also have Medicaid (Medical Assistance) or receive some assistance from the State.

Some members will be eligible for Medicaid coverage to pay for cost sharing-deductibles, copayments, and coinsurance. They may also have coverage for Medicaid covered services, depending on their level of Medicaid eligibility.

As a reminder, our dually eligible Medicare Assured members shall not be held liable for Medicare Parts A and B cost-sharing when the appropriate state Medicaid agency is liable for the cost-sharing.

Providers further agree that upon payment from Highmark Wholecare’s Medicare Assured Plans, providers will accept the plan payment as payment in full or will bill the appropriate State source. Please make sure to follow Medicaid coverage and claims processing guidelines. Balance billing a dual eligible for a deductible, coinsurance, or copayment is prohibited by Federal law.

Our organization and provider network are also prohibited from excluding or denying benefits to or otherwise discriminating against, any eligible and qualified individual regardless of race, color, national origin, religious creed, sex, sexual orientation, gender identity, disability, English proficiency, or age.

Highmark Wholecare Medicaid and Medicare Assured plan members have certain rights and responsibilities as members of our plans. To detail those rights and responsibilities in full, we maintain a Member Rights and Responsibilities statement which is reviewed and revised annually.

The Member Rights and Responsibilities statement can be located in either the Member Handbook for Medicaid members or the Evidence of Coverage for Medicare Assured members. The Member Rights and Responsibilities Statement is also available for review online at Highmark.com/Wholecare.

Providers are encouraged to contact us if you have questions about this Provider Update or need additional member-specific information.

Our Provider Services Department can be reached at one of the following numbers, Monday – Friday, 7 a.m.– 5:00 p.m.:

Medicare Assured
1-800-685-5209 (TTY: 711)

Medicaid
1-800-392-1147 (TTY: 711)