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2021 Health Partners Medicare Prime and Complete

Health Partners Medicare Prime is a competitive low-cost plan that costs just $37.50 per month, with medical and prescription coverage, plus lots of extra benefits.

Health Partners Medicare Complete is a plan with a $0 plan premium with all the benefits of Original Medicare plus extra benefits!

No matter which plan you choose, you'll get:

  • $0 copay for PCP visits + no referrals
  • Comprehensive Part D prescription drug coverage
  • Transportation to medical appointments + pharmacies
  • Healthcare at home with telehealth + Teladoc®
  • $150 quarterly allowance for over-the-counter health items
  • No medical or Rx deductibles
  • Vision care, dental + hearing benefits with generous allowances
  • SilverSneakers® or Salvation Army Kroc Center of Philadelphia membership

 

Benefit or
Service
Health Partners Medicare Prime
(HMO-POS)
Health Partners Medicare Complete 
(HMO-POS)
Original Medicare
Primary Care Provider (PCP) Visit $0 $0 20%
Specialist Visit (No referrals) $30 in-network,
20% out-of-network*
$45 in-network,
20% out-of-network*
20%
Prescription Drugs (for each 30-day supply during initial coverage period)

$0 Deductible 

$0 Preferred Generic
$10 Generic
$47 Preferred Brand
$100 Non-Preferred Drug 
33% Specialty

$0 Deductible 

$0 Preferred Generic
$10 Generic
$47 Preferred Brand
$100 Non-Preferred Drug 
33% Specialty

Not covered (standalone Part D plan required)
Diagnostic Testing and Lab Services

$0 copay for lab & Medicare-covered diagnostic tests and procedures
$30 copay for X-ray

$250 copay for advanced radiology services like MRI/CT/PET

$0 copay for lab & Medicare-covered diagnostic tests and procedures
$30 copay for X-ray 

$250 copay for advanced radiology services like MRI/CT/PET

20%
Emergency Room $90 copay (waived if admitted) $90 copay (waived if admitted) 20%
Urgent Care $55 $55 20%
Routine Transportation 50 one-way trips 24 one-way trips Not included
Fitness $0 copay for SilverSneakers® membership or membership in the Salvation Army Kroc Center of Philadelphia $0 copay for SilverSneakers® membership or membership in the Salvation Army Kroc Center of Philadelphia Not included
Dental Care

$0 for 2 exams and cleanings, plus X-rays (limits apply)

Plan pays $1,500 a year toward supplemental comprehensive dental services

$0 for 2 exams and cleanings, plus X-rays (limits apply)

Plan pays $1,200 a year toward supplemental comprehensive dental services

Routine services not covered
Hearing

Hearing aids: $0 copay

Up to $1,500 every two years

 

Hearing aids: $0 copay

Up to $1,000 every two years

Routine services not covered
Vision

$0 for routine annual vision exam

$40 for exam to diagnose and treat diseases and conditions of the eye

$0 for Medicare-covered eyewear after cataract surgery

$0 for one of the following:

  • one pair of eyeglasses (lenses and up to $150 for frame)
  • one pair of eyeglass lenses
  • up to $150 for one eyeglass frame
  • up to $200 for contact lenses

$0 for routine annual vision exam

$45 for exam to diagnose and treat diseases and conditions of the eye

$0 for Medicare-covered eyewear after cataract surgery

$0 for one of the following:

  • one pair of eyeglasses (lenses and up to $150 for frame)
  • one pair of eyeglass lenses
  • up to $150 for one eyeglass frame
  • up to $200 for contact lenses
Routine services not covered
Over-the-Counter Items

$150 quarterly allowance, plus rollover

Must be used by December 31, 2021

$150 quarterly allowance, plus rollover

Must be used by December 31, 2021

Not covered
Maxiumum Out-of-Pocket $7,500 per year (medical care) $7,500 per year (medical care) No annual limit

*Out-of-Network specialists must accept Original Medicare. Out-of-network services do not count toward maximum out-of-pocket for medical care.

Ready to talk with a licensed benefit advisor?

We’re happy to explain plan benefits in detail. Just call us at 1-833-477-4773 (TTY 1-877-454-8477). You can call 8 a.m. – 8 p.m., seven days a week, from October 1 through March 31. Call 8 a.m. – 8 p.m., Monday – Friday, the rest of the year.

Or if it’s more convenient, use the links below to schedule a home visit or phone call:

Get more details about our Prime and Complete plans using the information and tools linked below.