Medicare D-SNP Frequently Asked Questions

Visit your Member Portal and follow these steps to print your Highmark Wholecare D-SNP Member ID:

1. Log in to your Member Portal with your username and password.  If you haven’t signed up yet, you can create your Member Portal account.
2. At the top of your screen, place your mouse over My Health Plan, then select View ID card.
3. Select the printer icon in the top right corner of your screen to print.

If your Highmark Wholecare D-SNP Member ID card is damaged, lost or stolen, please call Member Services as soon as possible:

1-800-685-5209
TDD/TTY: 711

October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week

April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday

Note, If you’d like a digital version of your ID card, you can save your card to your mobile device using our Wholecare member app. To begin, visit the Apple App Store or visit the Google Play Store App Store.

Keeping your information up-to-date helps keep your D-SNP coverage active. If your information changes, including your name address or phone number, please contact Member Services.

1-800-685-5209
TDD/TTY: 711

October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week

April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday

Note, if you move or change your mailing address, you’ll also need to contact Social Security.

Your Primary Care Physician (PCP) is named on your Highmark Wholecare D-SNP Member ID Card.

When you become a D-SNP member, you must select a PCP from our provider network. Your PCP coordinates your care and can be a:

• Family doctor
• General doctor
• Internal medicine doctor

If you don’t choose a PCP, one will get selected for you. As a reminder, you can change your PCP at any time. Find a doctor near you.

In most cases, you must receive in-network care. However, your D-SNP may cover out-of-network care when you need:

• Emergency care
• Urgently needed services
• Care and can’t find an in-network doctor
• Kidney dialysis

Prior authorization means that, in some instances, your doctor will need Highmark Wholecare to review and approve your care plan before your actual visit. Your doctor may also need prior authorization from Highmark Wholecare if you want to use a hospital or specialist that isn’t in your D-SNP network.

You may change your PCP for any reason, at any time. You’ll have a few ways to make this change.

Call Member Services

If you’d like to work with our Member Services Team, they will:

• Help you with your PCP selection
• Record your new PCP
• Let you know when the change will take effect

Member Services will also order a new membership card for you that shows your new PCP’s office name and phone number. Once you receive your new Highmark Wholecare D-SNP card, you can throw away your old one.

You can call Member Services:

1-800-685-5209
TDD/TTY: 711

October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week

April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday

Use Online Tool

If you’d like to choose your new PCP online, you can use our Provider Tool.

Yes, your D-SNP may include covered telehealth visits for some preventive, specialist, nutritional and mental health services.

Some examples of covered telehealth services may include:

• Primary care provider (PCP) services
• Physician specialist services
• Individual sessions for mental health specialty services
• Individual sessions for psychiatric services
• Nutritional counseling with a Registered Dietician (RD)

Remember to ask your provider if telehealth services are offered before scheduling an appointment. For telehealth-approved care, you can choose either getting in-person care or a telehealth visit. If you choose a telehealth visit, you must use a network provider who offers the service by telehealth.

No, as a Highmark Wholecare D-SNP member, you have the right to self-refer to mental health treatment. The amount you’ll pay for each mental health visit will depend on your D-SNP. 

All Pennsylvania state-licensed, in-network mental health providers are covered, including:

• Psychiatrists
• Clinical psychologists
• Clinical social workers
• Other Medicare-qualified mental health care professionals

If you’d like to find a psychiatrist online, you can use our Provider Tool. 

As a Highmark Wholecare D-SNP member, you’re not always required to get a referral from your PCP before getting covered specialty care. However, you’re encouraged to coordinate your treatment with your PCP at each stage of your care. 

As a D-SNP member, you also have the right to get appointments and covered services from the plan’s provider network within a reasonable amount of time. Your copay for each visit with a specialist doctor is based on your D-SNP.

Generally, your D-SNP prescription drug benefits cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. As examples, prescriptions filled at an out-of-network pharmacy could get covered if:

• The prescriptions are related to a medical emergency or urgently needed services.
• You’re traveling within the United States, but outside of the plan’s service area, and you become ill, or run out of your prescription drugs. 

In both cases, have the out-of-network pharmacy call the Highmark Wholecare Medicare Assured Pharmacy Services Department at 1-800-685-5209 to ask for an out-of-network pharmacy override.

As a reminder, your D-SNP has a network of pharmacies outside of your service area where you can get prescriptions. Please call Member Services at 1-800-392-1147 (TTY 711) to see if there is a network pharmacy nearby. You’ll most likely pay the difference between what you pay for the drug at the out-of-network pharmacy versus an in-network pharmacy.

Your doctor will likely include a Health Risk Assessment (HRA) as part of your Annual Wellness Visit. Your HRA gives you and your doctor the chance to talk about important health-related factors, such as your:

• Medical and family history
• Height, weight and body mass index (BMI)
• Cognitive or chronic conditions, if any
• Potential depression risk or mood disorders
• Overall safety

Your doctor may include these details as a part of needed treatment plans.

Whenever you need a prescription filled, remember to show your D-SNP membership card to use your prescription drug benefits.

If you don’t have your D-SNP membership information with you when you fill your prescription, you or the pharmacy can call Member Services at 1-800-392-1147 (TTY 711) to get your information.

Note, if the pharmacy isn’t able to get your D-SNP information, you may have to pay the full cost of the prescription when you pick it up. You can then ask Highmark Wholecare to pay you back.

Yes, your Highmark Wholecare D-SNP Dental Care covers non-routine dental care, such as:

• Surgery of the jaw or related structures
• Setting fractures of the jaw or facial bones
• Extraction of teeth to prepare the jaw for radiation treatments of neoplastic cancer disease, or services that would be covered when provided by a doctor

Note, if your dental surgeon is located within a hospital, you may be charged a facility fee in addition to your regular physician copay. Remember to ask if your surgeon is based out of a hospital and if a facility fee will be charged.

Yes, your Highmark Wholecare D-SNP offers you Transportation Benefits.  Depending on your D-SNP the number of one-way trips and approved locations you’re allowed each year will vary. You may also have a $0 copay for routine services. 

To book your transportation services, please call 1-877-797-0339 (TTY 711).  Note, you’ll need to call at least 72 hours in advance.

Yes, your D-SNP Healthy Food Card is filled with a monthly amount of money so you can buy healthy food items, like fresh produce.  Examples of non-healthy food items may include alcohol and nicotine products.

You can learn more about your Food Assistance benefit or call 1-833-560-1817 (TTY 711) with questions.