Meeting the critical need: Highmark Health Options expands into Dual Special Needs market

• Dual Special Needs Plans (D-SNP) cover individuals in Medicaid and Medicare
• More than 41,000 West Virginians are currently enrolled in D-SNPs
• D-SNP coverage year for state’s only Blue Cross Blue Shield insurer begins Jan. 1

Parkersburg, WV (October 15, 2025) — Highmark Health Options West Virginia — the state’s newest managed care organization (MCO) and first Blue Cross Blue Shield-branded MCO to serve West Virginians — is announcing new coverage options that will soon be available to better serve Mountain State residents with complex health needs. Beginning Jan. 1, Highmark Health Options will offer Dual Special Needs Plans (D-SNP) for West Virginians in 18 counties who are eligible for both Medicaid and Medicare health care coverage. Highmark Health Options Duals plans will be available during the upcoming annual enrollment period, which runs from Oct. 15 until Dec. 7.

Dual Special Needs Plans are managed care health insurance plans specifically designed for individuals whose health needs require elevated levels of care. Individuals who benefit from D-SNP are often managing chronic conditions and comorbidities such as diabetes, high blood pressure, or mental and behavioral health issues. Dual Special Needs Plans help improve care coordination and health outcomes while managing cost.

Dual Special Needs Plans are closely aligned with long-term services and supports care (LTSS). Long-term services and supports include both clinical and nonclinical care. Those who benefit from this type of care are people born with a disability, who develop a disability, need home-based care instead of becoming institutionalized, or through the aging process are managing chronic conditions and comorbidities that can make everyday life more challenging. Highmark MCOs currently serve thousands of LTSS members.

“Individuals in Dual Special Needs Plans demand innovative solutions and personalized care. We're committed to bringing our expertise and resources to this space to help address the specific challenges faced by our neighbors in need of these services,” said Jason Landers, president, Highmark Health Options. “We believe our integrated approach and Living Health care model, comprehensive provider network, and strong relationships with local community organizations, will enable us to deliver on our mission of treating the whole person. This is more than just offering another plan; it's about empowering our members to live healthier, more fulfilling lives."

In coordination with Medicare and Medicaid benefits, highlights of D-SNP include:

• Flexible benefits to support a healthy lifestyle – up to $235 per month for qualified beneficiaries to use toward healthy food, utilities, over-the-counter (OTC) medications and supplies, pay-at-the-pump gas, and more
• Supplemental benefits – allowances for covered services, including dental, vision, and hearing services
• Care coordination – can include disease management programs and dedicated case managers to help beneficiaries manage their health
• Community collaboration – coordination with community organizations in the delivery of benefits

Highmark Health Options D-SNP plans will be available in the following counties beginning Jan. 1: Cabell, Clay, Doddridge, Fayette, Greenbrier, Hardy, Kanawha, Lincoln, Marshall, Mason, McDowell, Mingo, Nicholas, Ohio, Putnam, Raleigh, Wayne and Wood.

Landers added, “The need for these types of services is great throughout the state. We plan to expand into more counties in the coming years to help meet that demand.”

According to a 2021 report by the Medicaid and Children’s Health Insurance Program Payment and Access Commission, approximately 64,000 West Virginians were eligible to enroll in a D-SNP with full benefits at that time.