Compare Plans & Benefits
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 HMO-POS plans for New Jersey residents.
| Plan Name: | Silver (HMO-POS) | Platinum (HMO-POS) | |
|---|---|---|---|
| Monthly Premium | $0 | $20 | |
| Annual Medical Deductible | $0 | $0 | |
| PCP Visits | $0 copay | $0 copay | |
| Specialist Visits | $30 copay; 20% for out-of-network-providers | $0 copay; 20% for out-of-network-providers | |
| 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) | $210 copay | $210 copay | |
| Inpatient Hospital | $290 copay per day, days 1-5; $0 copay per day, days 6-90 | $250 copay per day, days 1-5; $0 copay per day, days 6-90 | |
| Outpatient Surgery (Ambulatory Surgical Center) | $200 copay | $200 copay | |
| Outpatient Surgery (Hospital Outpatient) | $300 copay | $300 copay | |
| Physical/Occupational/Speech Therapy (Outpatient) | $25 copay | $25 copay | |
| Lab Services | $0 copay | $0 copay | |
| Radiology (X-ray) | $30 copay | $30 copay | |
| Radiology (Diagnostic) | $250 copay | $250 copay | |
| Diabetes (Test Strips, Monitors & Self-Monitoring Training) | $0 copay | $0 copay | |
| Diabetes (Other Supplies) | $0 - 20% | $0 - 20% | |
| Maximum Annual Out-of-Pocket | $5,500 | $5,400 | |
| 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: Any insulin on formulary is $10/20; not on formulary is $35 | 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: Any insulin on formulary is $10/$20; not on formulary is $35 | |
| 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: Any insulin on formulary is $10/20; not on formulary is $35 | 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: Any insulin on formulary is $10/$20; not on formulary is $35 | |
| Flexcard | $2,500 for additional vision, dental and hearing spending | $2,500 for additional vision, dental and hearing spending | |
| OTC Benefit | $75 per quarter | $75 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 | $200 | $200 | |
| Hearing Services | $0 for annual hearing exam | $0 for annual hearing exam | |
| Fitness Center Membership | $0 copay for SilverSneakers® membership or membership in the Salvation Army Kroc Center in Camden | $0 copay for SilverSneakers® membership or membership in the Salvation Army Kroc Center in Camden | |
| JeffConnect | Included | Included | |
| Worldwide Emergency Coverage | $50,000 | $50,000 |
