Medicare
Pennsylvania 2024 Plans
With more Medicare plans in more counties, Jefferson Health Plans offers $0 premium plans, a Part B Giveback plan that pays you back, PPO plans with added freedom on where you go for care and more. All of our plans include comprehensive benefits for an affordable price.
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Jefferson Health Plans offers 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 plans for Pennsylvania residents.
| Plan Name: | Complete (HMO-POS) | Prime (HMO-POS) | Giveback (HMO-POS) | Special (HMO-SNP) | Dual Pearl (HMO-SNP) | Flex (PPO) | Flex Plus (PPO) | |
|---|---|---|---|---|---|---|---|---|
| Monthly Premium | $0 | $40.20 | $0 / $105 giveback | $0 | $0 | $0 | $49 | |
| PCP Visits | $0 copay | $0 copay | $0 copay | $0 copay | $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 | $0 copay | $0 copay | $35 copay | $20 copay | |
| Referrals | Not required | Not required | Not required | Not required | Not required | Not required | Not required | |
| Urgent Care | $55 copay | $55 copay | $55 copay | $0 copay | $0 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) | $0 copay | $0 copay | $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 | $0 copay | $0 copay | $250 copay, days 1-7 | $400 copay, unlimited days | |
| 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 | $0 copay on all prescription drugs | $0 copay on all prescription drugs | 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) | 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 | $0 copay on all prescription drugs | $0 copay on all prescription drugs | 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) | $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 | $8,850 | $8,850 | $7,000 (in network) $10,000 (combined) | $5,900 (in network) $9,000 (combined) |
