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Highmark Wholecare Medicare Plans

Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association and formerly known as Gateway Health Plan, was founded in 1992 to provide customers with an alternative to the Pennsylvania Department of Welfare Medical Assistance Program. Since that time, Highmark Wholecare has grown into a top-ranked company that serves thousands of people throughout the state of Pennsylvania.

The Centers for Medicare and Medicaid Services issues star ratings to let consumers know how a plan is doing compared to other plans. For 2022, Highmark Wholecare Medicare Assured received a 4.5 star rating overall for both Diamond and Ruby plans.

Where Are Highmark Wholecare Medicare Plans Available?

Currently, Highmark Wholecare offers Medicare Special Needs plans in Pennsylvania. The company offers a Ruby and a Diamond Plan, both of which are dual special needs plans for Medicare members with specific needs. In addition to medical care and prescription drug coverage, the plans also offer vision, dental and hearing coverage. Each plan includes wellness coaching over the phone at no additional charge. Coaches include certified rehabilitation experts, dietitian nutritionists and diabetes counselors.

Highmark Wholecare plans also include membership in SilverSneakers healthcare facilities in an effort to promote a healthier lifestyle among senior citizens. Highmark Wholecare members are also eligible for the Goodness Rewards program, which provides them with a reloadable gift card that can be used at over 100 locations. Each time a member completes an eligible activity, rewards are added to the gift card. Plans also include access to a 24/7 nurse hotline.

Pricing and availability for Highmark Wholecare Medicare Advantage plans will vary based on your eligibility, where you live and other factors. These plans are only available to people who meet certain income requirements as described below.

Highmark Wholecare Medicare Advantage Plans in 2022

Highmark Wholecare Medicare Advantage (2022)
Diamond Plan*Ruby Plan*
Monthly premium$0$0
Copay (primary)$0$0
Deductibles$0 medical / $0 drug$0 medical / $0 or $99 drug
NetworkIn-network coverage onlyIn-network coverage only
Rx coverage?YesYes
Rx cost$0 copay for tier 1$0 copay for tier 1
Special featuresPreventive and comprehensive dental, hearing aids and eyewear; transportation, chiropractic and credit for over-the-counter items; home safety devices, a disease management program, and meals after hospitalizationPreventive and comprehensive dental, hearing aids and eyewear; transportation, chiropractic and credit for over-the-counter items
Out-of-pocket max$3,450$6,700
CMS Star Rating4.54.5
*Both plans require enrollment in original Medicare plus eligibility for Medical Assistance.

Some Medicare plans require you to meet income or special needs eligibility for enrollment. In 2022, Highmark Wholecare only sells products to people who meet specific guidelines for eligibility.

The Diamond plan requires you to have Medicare Parts A and B and qualify for the QMB program with Medicare. The Ruby plan also requires enrollment in Parts A and B and eligibility for a Medicare assistance program (FBDE, SLMB, QI or QDI). To learn more about these assistance programs and what those initials stand for, check out the website for eligibility information and the specifics of each program.

Not sure if you qualify for these or other Medicare programs? We can help you sort it out. Medicare Advantage doesn’t have to be a headache when you talk to a licensed Medicare professional about your options. Get a personalized quote today from a licensed medicare professional to learn what’s out there for you.