Jefferson Health Plans
Medicare Advantage Plans for Pennsylvania Residents

With more Medicare Advantage plans and more doctors in more counties, Jefferson Health Plans offers a wide range of options including a $0 premium plan that pays you back, PPO plans with added freedom, Special Needs Plans and so much more. All of our plans include comprehensive benefits for an affordable price.

(HMO-POS)
(PPO)
(HMO-SNP)

Complete (HMO-POS)

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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)

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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)

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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!

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Our Prime, Complete and Giveback plans are available in Pennsylvania and provide comprehensive coverage and additional benefits, including:

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$0 copay for PCP visits

No referrals for specialists

Flex card benefit for dental, hearing and vision spending

Fitness benefits

Low or no copays for specialist visits

Access to a large and growing provider network

Over-the-counter health items allowance

Virtual access to Jefferson providers 24/7 via JeffConnect On Demand

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

Flex (PPO)

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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)

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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!

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Our Prime, Complete and Giveback plans are available in Pennsylvania and provide comprehensive coverage and additional benefits, including:

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$0 copay for PCP visits

No referrals for specialists

Flex card benefit for dental, hearing and vision spending

Fitness benefits

Low or no copays for specialist visits

Access to a large and growing provider network

Over-the-counter health items allowance

Virtual access to Jefferson providers 24/7 via JeffConnect On Demand

Plan Benefits

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

Special (HMO-SNP)

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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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Dual Pearl (HMO-SNP)

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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!

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Our Prime, Complete and Giveback plans are available in Pennsylvania and provide comprehensive coverage and additional benefits, including:

View All Benefits & Coverage

$0 copay for PCP visits

No referrals for specialists

Flex card benefit for dental, hearing and vision spending

Fitness benefits

Low or no copays for specialist visits

Access to a large and growing provider network

Over-the-counter health items allowance

Virtual access to Jefferson providers 24/7 via JeffConnect On Demand

Plan Benefits

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

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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.

Medicare Advantage plans for Pennsylvania residents

Compare Plans

Our Medicare Advantage plans offer comprehensive benefits for an affordable price. Learn more and find a perfect plan for you!

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Pennsylvania - Complete

Jefferson Health Medicare Complete (HMO-POS)

Pennsylvania - Prime

Jefferson Health Medicare Prime (HMO-POS)

Pennsylvania - Giveback

Jefferson Health Medicare Giveback (HMO-POS)

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Jefferson Health Plans Medicare Advantage Plans for Pennsylvania Residents

Shop. Compare. Enroll.

Complete (HMO-POS) offers medical and prescription drug coverage, plus added benefits, for a $0 premium.

or view coverage area

Prime (HMO-POS)

Shop. Compare. Enroll.

Prime (HMO-POS) offers flex card and over-the-counter benefits, medical and prescription drug coverage, plus more, for an affordable premium.

or view coverage area

Shop. Compare. Enroll.

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.

or view coverage area

Special (HMO-SNP)

Shop. Compare. Enroll.

Our Special plan (HMO-SNP) offers $0 prescription drugs and more benefits for people who are eligible for both Medicare and Medicaid.

or view coverage area

Dual Pearl (HMO-SNP)

Shop. Compare. Enroll.

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.

or view coverage area

Plan Benefits

Medicare Advantage plans for Pennsylvania residents

Compare 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)

Jefferson Health Plans
Medicare Advantage Plans for Pennsylvania Residents