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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)

Pennsylvania 2024 Coverage Area

  • Berks
  • Bucks
  • Carbon
  • Chester
  • Cumberland
  • Dauphin
  • Delaware
  • Lancaster
  • Lebanon
  • Lehigh
  • Montgomery
  • Northampton
  • Perry
  • Philadelphia
  • Schuylkill
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Pa Coverage Area Map

This is not a full description of benefits. Copays, limits, benefits and periodicity vary by plan.

Pennsylvania Medicare
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