Additional Value for Highmark Members: Medicare Advantage House Call Visits and D-SNP Flex Card Benefits!

House Call Visits and Annual Wellness Visits: Why It's Important to Complete Both

Sometimes there is confusion regarding the differences between an Annual Wellness Visit and a House Call Visit. Highmark would like to share comparative information to help you describe the benefits of completing both kinds of visits.

Highmark Medicare Advantage members can schedule an Annual Wellness Visit and House Call Visit at no extra cost. These visits complement each other, leading to a more personalized health care experience.

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Annual Wellness Visit

Annual Wellness Visits are yearly checkups that help members stay healthy as they age. They give members and their PCPs a change to develop a personalized prevention plan, so they can find problems early and protect their long-term health.

During an Annual Wellness Visit, the member and their PCP will discuss the member's health, medical history, and genetic risk factors. They will also:

• Recommend preventive tests and screenings.
• Review medications and vaccinations.
• Refer the member to specialists if needed.
• Discuss the member's mental and physical health, including lifestyle habits and any concerns the member has.

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House Call Visit

House Call Visits are comprehensive at-home health assessments that give members one-on-one time with a licensed clinician once per plan year. Members receive preventive care from the privacy of home, or virtually if they prefer. House Calls aren't meant to replace Annual Wellness Visits, but to strengthen the relationship between members and their PCPs.

During a House Call Visit, a licensed clinician will:

• Discuss the member's medical history and risk factors.
• Review medications and address any side effects.
• Suggest or complete certain tests.
• Offer tips for keeping the member's home safe and secure.
• Connect members with relevant benefit programs based on their individual needs.
• After the House Call Visit is complete, both the member AND their PCP receive a summary of the visit

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Both Annual Wellness Visits and House Call Visits are designed to enhance the health and well-being of Highmark Medicare Advantage members. By engaging with these programs, healthcare professionals can proactively identify and address potential health risks and social determinants of health, helping to prevent further health issues.

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D-SNP My Healthy Flex Card Benefits

Highmark's D-SNP products offer supplemental benefits designed to help cover expenses not fully addressed by standard Medicare coverage and Medicaid, via an easy-to-use My Healthy Flex Card.

Depending on the plan, members can receive an allowance of up to $263 per month to spend how they choose. Any unused money rolls over month-to-month but expires at the end of the year. Here are some details on where and how members can use this benefit.

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How much is offered with the Flex Card?

In Pennsylvania

• Highmark Wholecare Medicare Assured Diamond (HMO SNP): $263/month allowance
• Highmark Wholecare Medicare Assured Ruby (HMO SNP): $82/month allowance

In Delaware

• Highmark Health Options Duals (HMO SNP): $208/month allowance

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How do members access this benefit?

The monthly allowance is loaded to the member's Flex Card at the start of each month.

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What happens to allowance that isn't spent?

Any unused allowance rolls over month-to-month but must be used before December 31, 2025.

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What are some examples of how the Flex Card benefit can be used?

The Flex Card can be used for expenses including groceries, utilities, over-the-counter items, and home safety products. Examples of these expenses include:

• Groceries
  • Fruits and vegetables
  • Meats and seafood
  • Dairy products
  • Soups
  • Healthy grains
  • Pantry staples
  • Protein bars and shakes
  • Water and vitamin water
• Over-the-counter items
  • Cold medicines
  • Incontinence supplies
  • Vitamins
  • Dental care
  • First aid care
  • Blood pressure monitors
• Utility Bills
  • Gas
  • Electric
  • Water
  • Sewage
  • Garbage
  • Internet
  • Cable
  • Mobile Phone
  • Landline
• Home Safety Products
  • Grab bars
  • Bath mats
  • Shower stools
  • Raised toilet seats

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Where can the Flex Card be used?

• For healthy groceries and over-the-counter items, members should visit participating retail stores, shop online, or from a catalog.
• For utilities, members can use the Flex Card to pay their providers directly.
• For home safety products, members can shop online or from a catalog

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Change to Beneficiary Use of Disaster SEP

This week, CMS announced a change to how beneficiaries can make an election using the Special Election Period (SEP) for individuals affected by a government-entity-declared disaster or other emergency.

Beginning on April 1, 2025, individuals wishing to use the Disaster/Emergency SEP must call 1-800-MEDICARE in order to make an election. Medicare Advantage Organizations and Part D Sponsors will no longer accept elections directly from beneficiaries using the Disaster/Emergency SEP. This change will be effective for all enrollment requests with an application date on or after April 1, 2025.

To view the full CMS release, click here.

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