Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Highmark Wholecare Medicare Assured Ruby, 2027
H5932Contract013Plan
HMO D-SNP · special needs plan, dual-eligible · 5 counties in Pennsylvania
Run by Gateway Health Plan, Inc. (contract H5932), sold as Highmark Wholecare Medicare Assured, owned by Highmark Health
Highmark Wholecare Medicare Assured Ruby (H5932-013) costs $12.80 a month in 2027, down $0.30 from 2026, with an in-network out-of-pocket limit of $6,500 ($8,000 in 2026).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | $13.10 | $12.80 | ▼down $0.30 |
| In-network out-of-pocket limit | $8,000 | $6,500 | ▼down $1,500 |
| Drug deductible | $615 | $700 | ▲up $85 |
| Part B premium reduction, monthly | $3 | $0.10 | ▼down $2.90 |
| Specialist visit | $30 copay | $35 copay | ▲up $5 |
| Emergency room | $115 copay | $130 copay | ▲up $15 |
| Hospital stay, in network | $275 a day for days 1–6, then $0 a day for days 7–90 | $290 a day for days 1–6, then $0 a day for days 7–90 | ▲up $75for a 5-day stay |
| Skilled nursing facility, in network | not filed | $10 a day for days 1–20, then $221 a day for days 21–100 | changed |
| 8 lines do not change | |||
| Primary care visit | $0 copay | $0 copay | no change |
| Medical deductible, in network | none | none | no change |
| Ground ambulance, in network | $250 copay | $250 copay | no change |
| Comprehensive dental, yearly limit | $2,000 a year | $2,000 a year | no change |
| Eyewear, yearly limit | not offered | not offered | no change |
| Hearing aids, yearly limit for both ears | not offered | not offered | no change |
| Over-the-counter items, yearly | not offered | not offered | no change |
| Counties served | 5 | 5 | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | not offered | $0 |
| Tier 2 | Generic | not offered | 25% of the cost |
| Tier 3 | Preferred Brand | not offered | 25% of the cost |
| Tier 4 | Non-Preferred Drug | not offered | 25% of the cost |
| Tier 5 | Specialty Tier | not offered | 25% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 21 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 1 plan has a lower out-of-pocket limit, 19 a higher one. On the premium, 14 plans have a lower premium, 6 the same.
Out-of-pocket limits of the 21 dual-eligible special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 5 counties: $12.80 a month and $6,500.
Pennsylvania
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Who runs this plan?
- Plan ID
- H5932-013
- Legal name of the contract
- Gateway Health Plan, Inc.
- Sold as
- Highmark Wholecare Medicare Assured
- Parent company
- Highmark Health
- Plan type
- HMO D-SNP
- 2026 star rating of the contract
- 4 of 5 overall; health plan 3.5 of 5, drug plan 4 of 5
- Members, September 2026
- 300
- Plan website, as filed with CMS
- www.highmark.com/wholecare
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Philadelphia, PAWhere most of its members live; premiums and limits side by side
- Every Highmark Wholecare Medicare Assured plan for 2027Its contracts, counties and plans that end
- The other 3 plans of contract H5932Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.