- (HMO-POS)
- (PPO)
- (HMO-SNP)
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Complete (HMO-POS) offers medical and prescription drug coverage, plus added benefits, for a $0 premium.
- $0 copay for PCP visits and no referrals to see specialists
- No medical or prescription drug deductibles
- $400 benefit for eyeglasses or contact lenses
- Generous comprehensive dental, eyewear and hearing aid allowances
- $2,250 flex card benefit for additional dental, hearing and vision spending
- Plus more!
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Prime (HMO-POS) offers flex card and over-the-counter benefits, medical and prescription drug coverage, plus more, for an affordable premium.
- $0 copay for PCP visits and no referrals to see specialists
- No medical or prescription drug deductibles
- Generous comprehensive dental, eyewear and hearing aid allowances
- $2,250 flex card benefit for additional dental, hearing and vision spending
- Plus more!
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Giveback (HMO-POS) includes a Part B Giveback benefit, plus comprehensive dental benefits including dental implant coverage. Giveback plans pay you back by offering a Part B monthly premium reduction. As a member of this plan, we’ll cover $105 each month toward your Part B premium. See more in our FAQs.
- $105 Giveback benefit per month
- $0 copay for PCP visits and no referrals to see specialists
- No medical deductible
- Flex card benefit for additional dental, hearing and vision expenses
- Plus more!
Plan Benefits
Jefferson Health Plans offers a variety of Medicare Advantage plans with affordable premiums, no-cost or low-cost doctor’s visits, no referrals and prescription drug coverage. Review the chart below to learn more about our HMO-POS plans for Pennsylvania residents.
| Plan Name: | Complete (HMO-POS) | Prime (HMO-POS) | Giveback (HMO-POS) | |
|---|---|---|---|---|
| Monthly Premium | $0 | $40.20 | $0 / $105 giveback | |
| PCP Visits | $0 copay | $0 copay | $0 copay | |
| Specialist Visits | $25 copay; 20% for out-of-network providers | $20 copay; 20% for out-of-network providers | $40 copay; 20% for out-of-network providers | |
| Referrals | Not required | Not required | Not required | |
| Urgent Care | $55 copay | $55 copay | $55 copay | |
| Emergency Room | $100 copay (waived if admitted within 24 hours) | $100 copay (waived if admitted within 24 hours) | $100 copay (waived if admitted within 24 hours) | |
| Inpatient Hospital | $250 copay per day, days 1-6; $0 copay per day, days 7-90 | $235 copay per day, days 1-5; $0 copay per day, days 6-90 | $275 copay per day, days 1-6; $0 copay per day, days 7-90 | |
| Outpatient Surgery | $200 copay for ASC; $300 copay for outpatient hospital | $200 copay for ASC; $300 copay for outpatient hospital | $300 copay for ASC; $350 copay for outpatient hospital | |
| Prescription Drugs (30-day retail and mail order) | Preferred Generic: $0 Generic: $10 Preferred Brand: $47 Non-Preferred Brand: $100 Specialty: 33% Select CareDrugs: $0; includes gap coverage | Preferred Generic: $0 Generic: $10 Preferred Brand: $47 Non-Preferred Brand: $100 Specialty: 33% Select Care Drugs: $0; includes gap coverage | Preferred Generic: $0 Generic: $10 Preferred Brand*: $47 Non-Preferred Brand*: $100 Specialty*: 30% Select Care Drugs: $0; includes gap coverage *$200 deductible applies to tiers 3, 4 and 5 | |
| Prescription Drugs (100-day retail and mail order) | Preferred Generic: $0 Generic: $20 Preferred Brand: $94 Non-Preferred Brand: $200 Specialty: N/A Select Care Drugs: $0; includes gap coverage | Preferred Generic: $0 Generic: $20 Preferred Brand: $94 Non-Preferred Brand: $200 Specialty: N/A Select Care Drugs: $0; includes gap coverage | Preferred Generic: $0 Generic: $20 Preferred Brand: $94 Non-Preferred Brand: $200 Specialty: N/A Select Care Drugs: $0; includes gap coverage | |
| Preferred Insulin (Retail and mail order) | $10 copay (30 day); $20 copay (100 day) | $10 copay (30 day); $20 copay (100 day) | $10 copay (30 day); $20 copay (100 day) | |
| Maximum Out-of-Pocket | $4,000 | $7,900 | $7,500 |
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Flex (PPO) offers more benefits than Original Medicare, plus the same affordable copays in and out of network for most covered services, for a $0 premium.
- No referrals for specialists
- Flex card benefit for dental, hearing and vision spending
- Generous OTC benefit, separate from flex card
- Plus more!
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Flex Plus (PPO) offers generous allowances for additional benefits, including dental and vision spending, and the same copays for in and out of network for most covered services, for an affordable premium.
- No referrals for specialists
- Flex card benefit for dental, hearing and vision spending
- Generous OTC benefit, separate from flex card
- Plus more!
Plan Benefits
Jefferson Health Plans offers a variety of Medicare Advantage plans with affordable premiums, no-cost or low-cost doctor’s visits, no referrals and prescription drug coverage. Review the chart below to learn more about our PPO plans for Pennsylvania residents.
| Plan Name: | Flex (PPO) | Flex Plus (PPO) | |
|---|---|---|---|
| Monthly Premium | $0 | $49 | |
| Annual Medical Deductible | $0 | $0 | |
| PCP Visits | $0 copay | $0 copay | |
| Specialist Visits | $35 copay | $20 copay | |
| Referrals | Not required | Not required | |
| Urgent Care | $55 copay | $55 copay | |
| Emergency Room | $100 copay (waived if admitted within 24 hours) | $100 copay (waived if admitted within 24 hours) | |
| Ambulance (Ground) | $240 | $225 | |
| Inpatient Hospital | $250 copay, days 1-7 | $400 copay, unlimited days | |
| Outpatient Surgery (Ambulatory Surgical Center) | $245 copay | $150 copay | |
| Outpatient Surgery (Hospital Outpatient) | $375 copay | $250 copay | |
| Physical/Occupational/Speech Therapy (Outpatient) | $35 copay | $20 copay | |
| Lab Services | $0 | $0 | |
| Radiology (X-ray) | $40 | $35 | |
| Radiology (Diagnostic) | $250 | $250 | |
| Diabetes (Test Strips, Monitors & Self-Monitoring Training) | 0% | $0 | |
| Diabetes (Other Supplies) | 0% - 20% | 0% - 20% | |
| Maximum Out-of-Pocket | $7,000 (in network) $10,000 (combined) | $5,900 (in network) $9,000 (combined) | |
| Prescription Drugs (30-day retail and mail order) | Part D Deductible: $0 Preferred Generic: $0 Generic: $10 Preferred Brand: $47 Non-Preferred Brand: $100 Specialty: 33% Select Care Drugs: $0; includes gap coverage Preferred Insulin: $10 | Part D Deductible: $0 Preferred Generic: $0 Generic: $10 Preferred Brand: $47 Non-Preferred Brand: $100 Specialty: 33% Select Care Drugs: $0; includes gap coverage Preferred Insulin: $10 | |
| Prescription Drugs (100-day retail and mail order) | Part D Deductible: $0 Preferred Generic: $0 Generic: $20 Preferred Brand: $94 Non-Preferred Brand: $200 Specialty: N/A Select Care Drugs: $0; includes gap coverage Preferred Insulin: $20 | Part D Deductible: $0 Preferred Generic: $0 Generic: $20 Preferred Brand: $94 Non-Preferred Brand: $200 Specialty: N/A Select Care Drugs: $0; includes gap coverage Preferred Insulin: $20 | |
| Preferred Insulin (retail and mail order) | |||
| Flexcard | $2,250; dental, vision and hearing spending | $2,500; dental, vision and hearing spending | |
| OTC Benefit | $70 per quarter | $125 per quarter | |
| Dental Exams & Cleanings | $0 copay; three visits per year | $0 copay; three visits per year | |
| Dental Allowance | $1,000 | $2,000 | |
| Annual Vision Exam | $0 copay | $0 copay | |
| Vision Allowance | $100 | $200 | |
| Hearing & Hearing Aids | Hearing exam: $0 copay $1,000 every two years | Hearing exam: $0 copay $1,000, every two years | |
| Transportation | Not covered | Not covered | |
| Fitness Center Membership | $0 copay for SilverSneakers® membership; or membership to the Kroc Center or PASSi Evergreen Center | $0 copay for SilverSneakers® membership; or membership to the Kroc Center or PASSi Evergreen Center | |
| JeffConnect | Included | Included | |
| Worldwide Emergency Coverage | $50,000 | $50,000 |
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Our Special plan (HMO-SNP) offers $0 prescription drugs and more benefits for people who are eligible for both Medicare and Medicaid.
- $0 copay on all prescription drugs
- $0 copay for covered medical services
- Flex card benefit that includes generous quarterly credit for food and utilities
- Generous OTC benefit, separate from flex card
- Plus more!
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Our Dual Pearl (HMO-SNP) plan offers a $10,000 comprehensive dental benefit with implant coverage, and $0 copays for medical services, for low-income individuals.
- $10,000 dental benefit with dental implant coverage
- $0 copay on all prescription drugs
- $0 copay for covered services
- Flex card benefit that includes generous quarterly credit for food and utilities
- Plus more!
Plan Benefits
Jefferson Health Plans offers a variety of Medicare Advantage plans with affordable premiums, no-cost or low-cost doctor’s visits, no referrals and prescription drug coverage. Review the chart below to learn more about our PPO plans for Pennsylvania residents.
| Plan Name: | Special (HMO-SNP) | Dual Pearl (HMO-SNP) | |
|---|---|---|---|
| Monthly Premium | $0 | $0 | |
| Annual Medical Deductible | $0 | $0 | |
| PCP Visits | $0 copay | $0 copay | |
| Specialist Visits | $0 copay | $0 copay | |
| Referrals | Not required | Not required | |
| Urgent Care | $0 copay | $0 copay | |
| Emergency Room | $0 copay | $0 copay | |
| Ambulance (Ground) | $0 copay | $0 copay | |
| Inpatient Hospital | $0 copay | $0 copay | |
| Outpatient Surgery (Ambulatory Surgical Center) | $0 copay | $0 copay | |
| Outpatient Surgery (Hospital Outpatient) | $0 copay | $0 copay | |
| Physical/Occupational/Speech Therapy (Outpatient) | $0 copay | $0 copay | |
| Lab Services | $0 copay | $0 copay | |
| Radiology (X-ray) | $0 copay | $0 copay | |
| Radiology (Diagnostic) | $0 copay | $0 copay | |
| Diabetes (Test Strips, Monitors & Self-Monitoring Training) | $0 copay | $0 copay | |
| Diabetes (Other Supplies) | $0 | $0 | |
| Maximum Out-of-Pocket | $8,850 | $8,850 | |
| Prescription Drugs (30-day retail and mail order) | $0 copay on all prescription drugs | $0 copay on all prescription drugs | |
| Prescription Drugs (100-day retail and mail order) | $0 copay on all prescription drugs | $0 copay on all prescription drugs | |
| Preferred Insulin (retail and mail order) | $0 | $0 | |
| Flexcard | $315 per quarter; food and produce and utilities | $210 per quarter; food and produce and utilities | |
| OTC Benefit | $315 per quarter | $210 per quarter | |
| Dental Exams & Cleanings | $0 copay; three visits per year | $0 copay; three visits per year | |
| Dental Allowance | $5,000 | $10,000; includes dental implant coverage | |
| Annual Vision Exam | $0 copay | $0 copay | |
| Vision Allowance | $500 | $200 | |
| Hearing & Hearing Aids | Hearing exam: $0 copay Up to $1,500 every year | Hearing exam: $0 copay Up to $1,500 every year | |
| Transportation | Unlimited | Unlimited | |
| Fitness Center Membership | $0 copay for SilverSneakers® membership; or membership to the Kroc Center or PASSi Evergreen Center | $0 copay for SilverSneakers® membership; or membership to the Kroc Center or PASSi Evergreen Center | |
| JeffConnect | Included | Included | |
| Worldwide Emergency Coverage | $50,000 | $50,000 |
Medicare Advantage plans for Pennsylvania residents
Learn More and Enroll
Call 1-833-4773 (TTY 1-877-454-8488) to speak with a licensed benefit advisor.
From October 1 to March 31, we’re available 8 a.m. to 8 p.m., 7 days a week. And from April 1 to September 30, we’re available 8 a.m. to 8 p.m., Monday to Friday.
Call Us
Call 833-477-4773 to have a conversation with a licensed benefits advisor.
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More Information
For a personalized plan evaluation, visit our online enrollment site and enter your ZIP code. Then click the “View plans” button.
Learn more about Jefferson Health Plans.
Pennsylvania - Complete
Jefferson Health Medicare Complete (HMO-POS)
Pennsylvania - Prime
Jefferson Health Medicare Prime (HMO-POS)
Pennsylvania - Giveback
Jefferson Health Medicare Giveback (HMO-POS)