Here are a few examples of covered mental health care services you’ll have as a Highmark Wholecare member. Based on your D-SNP, you may also have a $0 copay for some care. Please check your Evidence of Coverage (EOC) for all mental health care coverage.
As a D-SNP member, you have the right to self-refer to mental health treatment and substance abuse treatment. Your covered services include mental health services provided by a:
You may also have covered services when seen by other Medicare-qualified mental health care professionals as allowed under state law.
Mental health care, including care in a partial-hospitalization program, is covered if a doctor certifies that inpatient treatment would be required without it.
Your D-SNP covers mental health care services that require a hospital stay. Note, you may have lifetime limits for inpatient services in a hospital.
Partial hospitalization is a structured program of active psychiatric treatment provided as a hospital outpatient service or by a community mental health center. It’s more intense care you’d receive in your doctor’s or therapist’s office and is an alternative to inpatient hospitalization.
Telehealth services may be available through an in-network provider and are covered for individual sessions of outpatient mental health care only. Remember to ask your doctor if telehealth is an option for you.
Telehealth covered services include services for:
Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Medicare Ombudsman Website
Best Available Evidence
Y0037_1359_M_2024
Last Updated: Oct 1, 2023
