Haris Ashley
Highmark Health Options Delaware offers a range of health insurance plans, including Medicaid and D-SNP, which provide comprehensive coverage for individuals and families. Understanding the specifics of your insurance plan is essential, as certain medications may be covered under one plan but not another. Highmark Delaware emphasizes preventative care and offers benefits such as discounted gym memberships, weight loss programs, and preventive screenings. Additionally, they provide access to wellness professionals and nurse health coaches to help members manage their health and understand their coverage. To determine if a specific medication is covered by your Highmark Delaware insurance plan, it is advisable to review the plan's details or contact their member services for personalized assistance.
| Characteristics | Values |
|---|---|
| Insurance Type | Medicaid and D-SNP |
| Coverage | Prescription drugs, vision, dental care, hearing aids, glasses, eye exams, contacts |
| Additional Benefits | Free transportation to pharmacy, grocery store, community events, etc.; Online doctor visits for urgent care and behavioral health; Wellness classes; Discounted gym memberships, weight loss programs, massage therapy |
| Eligibility | Delaware residents with income under certain limits based on family size; US citizens or legally residing noncitizens |
| Address | 800 Delaware Avenue, Wilmington, DE 19801 |
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What You'll Learn
Medicaid and D-SNP insurance
Medicaid and D-SNP are two types of health insurance that protect your health and well-being. Medicaid is available for adults and children and offers medical services, prescription coverage, and dental coverage. Highmark Health Options Duals (HMO SNP) offers the same benefits as Original Medicare, plus extras like prescription drugs, vision, and dental care.
D-SNP stands for Dual Eligible Special Needs Plan. People who qualify for both Medicare and Medicaid are considered "dual-eligible". A D-SNP is your Medicare plan, and it also helps coordinate your Medicaid benefits. When you enroll, you receive primary coverage for hospital, medical, and prescription drug benefits through one plan. Your plan provider helps coordinate care between your doctors, so you get the most comprehensive care available to you.
Highmark Health Options Duals (HMO D-SNP) is a Medicare Advantage (Medicare Part C) plan offered by Highmark Health. It covers a range of additional benefits, including dental, vision, and hearing services. Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits that Original Medicare doesn’t cover.
Highmark Wholecare has D-SNPs in Pennsylvania for various Medicaid assistance levels, and beginning in 2025, Highmark BCBS will offer Dual Special Needs Plans (D-SNP) for Delaware residents eligible for both Medicaid and Medicare coverage.
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Prescription drugs
Highmark Health Options Duals (HMO SNP) offers the same benefits as Original Medicare, plus extras such as prescription drugs, vision, and dental care. Medicaid is a public health insurance program that covers millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. If you meet the residency and household income criteria, you can apply for Delaware Medicaid coverage. Medicaid coverage for adults and children offers medical services and more, like prescription and dental coverage.
Highmark Health Options Member Services is available Monday through Friday, from 8 a.m. to 8 p.m. You can also call Member Services for help with Highmark Health Options Medicaid questions.
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Vision and dental care
Highmark Health Options Delaware offers Medicaid and D-SNP coverage with extra benefits. This includes prescription drugs, vision, and dental care. Vision coverage is a vital step in caring for overall health, as early identification of chronic diseases such as diabetes, hypertension, and high cholesterol can reduce medical costs.
Highmark Delaware also offers the First State Basic Plan and Comprehensive PPO Plan, which are funded by the State of Delaware Group Health Fund. These plans are administered by Highmark Delaware and may include vision and dental care.
Highmark Inc. and its affiliated Blue companies, including Blue Cross Blue Shield, serve members in all of Delaware. They are committed to providing outstanding services to their applicants and members. Highmark Health Options is an independent licensee of the Blue Cross Blue Shield Association.
Highmark Health Options Duals (HMO SNP) offers the same benefits as Original Medicare, plus extras like prescription drugs, vision, and dental care. This is offered by Highmark Blue Cross Blue Shield, which is also an independent licensee of the Blue Cross Blue Shield Association.
Highmark Delaware provides a range of resources and services to support the health and well-being of its members, including preventive screenings, wellness classes, and a Custom Care Management Unit with specially trained wellness professionals.
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Preventative screenings
Highmark Delaware offers a range of health insurance plans, including Medicaid and D-SNP, which provide coverage for preventive screenings. Preventive screenings are routine tests that help detect potential health issues early on, making them easier to treat. These screenings are typically done when an individual is not exhibiting any symptoms or diagnosed with a disease.
Coverage for Children
Highmark Delaware's Children's Medicaid Programs provide screening tests to check for physical, mental, and dental issues, among other potential problems. These screenings are offered at no cost to members. Children can have regular check-ups with their pediatrician or primary care provider to ensure good health. Lead exposure, for example, can be detected early through blood lead testing, preventing long-term damage.
Coverage for Adults
Highmark Delaware plans encourage members to stay on top of their health by recommending preventive screenings. For women, this includes mammograms and PAP tests, while men can benefit from colorectal exams and annual physical exams. These screenings can help detect issues early, such as cervical cancer through annual or triennial Pap smear screenings.
Cost Considerations
Preventive screenings are typically covered at no cost to Highmark members. However, cost-sharing practices like copays, deductibles, and coinsurance may apply to diagnostic care, even during a preventive office visit. It is advisable to check with your doctor or contact Highmark through the member portal or service number for specific cost details.
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Wellness classes
Highmark Health Options provides Medicaid and D-SNP coverage with extra benefits. Highmark Delaware offers a range of wellness programs and resources to help improve and maintain the health and well-being of its members.
Wellness Coaches
Wellness coaches are available to help with goal setting and accountability in various areas, including weight management, stress management, tobacco cessation, sleep improvement, exercise planning, and healthy eating. These coaches work with members to create personalized health plans and provide access to helpful health resources.
Social Workers
Highmark Delaware also provides access to social workers who can connect members with local resources such as meal delivery, food supplies, and transportation assistance. The Highmark Community Resource tool helps members locate specific services in their area.
Preventive Screenings
Highmark emphasizes the importance of preventive care and offers on-site wellness screenings to identify health concerns early on. Members are encouraged to stay on top of their health by keeping up with preventive screenings, such as colorectal exams and annual physical exams.
Health and Wellness Classes/Events
Highmark Delaware offers various health and wellness classes and events, including:
- Diabetes Resources
- Behavioral Health and Emotional Wellbeing Programs
- Nutrition and Dietetics Education
- Physical Activity Initiatives
- Lt. Governor's Challenge
- Tobacco Cessation Programs
Discounted Services
Highmark Delaware members can also access discounted services through the Highmark Delaware Member website and the Blue 365 website. These include discounted gym memberships, weight loss programs, and massage therapy.
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Frequently asked questions
Highmark Delaware offers Medicaid and D-SNP insurance plans.
The Highmark Delaware Medicaid plan covers medical services, prescription drugs, dental coverage, vision, and hearing.
The Highmark Delaware D-SNP plan offers the same benefits as Original Medicare, plus extras like prescription drugs, vision, and dental care.
To qualify for full Medicaid benefits in Delaware, you must be a Delaware resident, a US citizen or legally residing noncitizen, and have a household income under certain limits based on family size.
