Speak with a licensed insurance agent

1-800-557-6059
|
TTY 711, 24/7

Highmark Health Options Duals (HMO D-SNP) - H7710-001-000

Plan too new to be measured* for plan year 2025

$0.00

Monthly Premium

Highmark Health Options Duals (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Highmark Health

Plan ID: H7710-001-000

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$0.00

Monthly Premium

Delaware Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Delaware Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

CoverageDetails
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$9,350.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$2,000.00
Primary care doctor visitIn-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty doctor visitIn-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0
Inpatient hospital careIn-Network:

Acute Hospital Services:
Copayment for Acute Hospital Services per Stay $0
Deductible $1340.00
Prior Authorization Required for Acute Hospital Services
Urgent care
Urgent Care:
Copayment for Urgent Care $0
Emergency room visit
Emergency Care:
Copayment for Emergency Care $0
Ambulance transportationIn-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $0

Air Ambulance:
Copayment for Air Ambulance Services $0
Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

Highmark Health Options Duals (HMO D-SNP) covers a range of additional benefits. Learn more about Highmark Health Options Duals (HMO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

CoverageDetails
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $0
Copayment for Routine Care $0
  • Maximum 20 Routine Care every year
Prior Authorization Required for Chiropractic Services
Additional routine care visits include chronic and/or subluxation and treatment to extra spinal regions that include the head, upper and lower extremities, ribcage and abdomen.
Diabetes supplies, training, nutrition therapy and monitoringIn-Network:

Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0
If the member receives diabetic supplies and services at a DME provider, there is no limit to manufacturer. If the member receives diabetic supplies and services from a pharmacy, specified manufacturers are limited.
Durable medical equipment (DME)In-Network:

Durable Medical Equipment:
Copayment for Medicare-covered Durable Medical Equipment $0
Prior Authorization Required for Durable Medical Equipment
Diagnostic tests, lab and radiology services, and X-raysIn-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0
Copayment for Medicare-covered Lab Services $0
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0
Copayment for Medicare-covered Therapeutic Radiological Services $0
Copayment for Medicare-covered X-Ray Services $0
Home health careIn-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0
Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient careIn-Network:

Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Outpatient services/surgeryIn-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $0

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0
Prior Authorization Required for Ambulatory Surgical Center Services
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Over-the-counter itemsIn-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0
  • Maximum plan benefit of $208.00 every month for Over-The-Counter (OTC) Items
Maximum Plan Benefit of $208 every month
An OTC catalog of CMS-approved non-prescription over-the-counter medications and health-related items is available. Plan restrictions apply.Members can use the $208 allowance to purchase OTC at select retail locations, online, or via catalog. Unused allowances will carry over from month to month. Any unused allowance will expire at the end of the calendar year. Fees and plan restrictions apply.
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $0
Copayment for Routine Foot Care $0
  • Maximum 20 visits every year
Skilled Nursing Facility (SNF) careIn-Network:

Skilled Nursing Facility Services:
Copayment for Skilled Nursing Facility Services per Stay $0
Prior Authorization Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Dental careIn-Network:

Medicare Covered Preventive Dental:
Copayment for Office Visit $0
Prior Authorization Required for Medicare Covered Preventive Dental
Authorization may be required for Medicare Covered Services.

Non-Medicare Covered Preventive Dental:
Copayment for Non-medicare preventive $0
  • Maximum plan benefit of $3000.00 every year for Non-medicare preventive
Copayment for Oral exams $0
  • Maximum 1 visit every six months
Copayment for Dental x-rays $0
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Prophylaxis $0
  • Maximum 4 visits every year
Maximum Plan Benefit of $3,000 every year

Non-Medicare Covered Comprehensive Dental:
Copayment for Non-medicare comprehensive $0
Copayment for Restorative services $0
  • Maximum 1 visit (Please see Evidence of Coverage for details)
Copayment for Endodontics $0
  • Maximum 2 visits every year
Copayment for Periodontics $0
  • Maximum 1 visit every year
Copayment for Prothodontics, removable $0
  • Maximum 1 visit every year
Copayment for Maxillofacial surgery $0

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage

CoverageDetails
Vision careIn-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exam every year

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
  • Maximum 1 Pair every year
  • Maximum plan benefit of $400.00 every year for Contact Lenses
Copayment for Eyeglass Lenses $0
  • Maximum 1 Pair every year
Copayment for Eyeglass Frames $0
  • Maximum 1 Pair every year
  • Maximum plan benefit of $400.00 every year for Eyeglass Frames
Copayment for Upgrades $0
Limited to one (1) pair of lenses and frames or contact lenses each year. The following lenses are covered in full: single vision, lined bifocals, lined trifocals, lenticular. The following lens upgrades are covered: Scratch coating, oversized lenses, Tints, Standard progressives, Photochromic lenses, UV coating, and Polycarbonate lenses. Plan restrictions apply.

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Hearing careIn-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0

Hearing Aids:
Copayment for Hearing Aids $0
  • Maximum 2 Hearing Aids every three years
Up to two TruHearing-branded hearing aids every 3 years (one per ear every 3 years). Benefit is limited to TruHearing-branded Advanced hearing aids, which come in various styles and colors. $0 copayment per aid for TruHearing Advanced. You must see a TruHearing provider to use this benefit. Hearing aid purchase includes: First year of follow-up provider visits 60-day trial period 3-year extended warranty 80 batteries per aid for non-rechargeable models Benefit does not include or cover any of the following: Over the counter (OTC) hearing aids Ear molds Hearing aid accessories Additional provider visits Batteries when a rechargeable hearing aid is purchased Hearing aids that are not TruHearing-branded [Standard Aids] [Advanced Aids] [or in the DSNP Formulary] Costs associated with loss & damage warranty claims Costs associated with excluded items are the responsibility of the member and not covered by the plan. Services not covered under any condition: Hearing aids and provid

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Preventive services and health/wellness education programsIn-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit

    When reviewing Delaware Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

    You may be able to find plans in your part of Delaware that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

    Plan Documents

    Links to plan documents

    Delaware Counties Served

    We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

    Back to plans in Delaware

    Compare plans today.

    Speak with a licensed sales agent

    1-800-557-6059
    |
    TTY 711, 24/7

    Every minute we help someone compare their Medicare Advantage plan options.2

    Ready to find your plan?

    Or call a licensed insurance agent

    1-800-557-6059
    |
    TTY 711, 24/7