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2021 Health Partners Medicare Special

Health Partners Medicare Special is the perfect choice if you have Medicare and full Medicaid health coverage. You get medical and prescription drug coverage plus extra benefits not covered by Original Medicare like an over-the-counter health items allowance, transportation and SilverSneakers®. Cost sharing depends on your Medicaid category and level of Extra Help. Most members will pay no monthly premium!

Your plan will feature:

  • $0 copay for PCP visits + no referrals
  • Comprehensive Part D prescription drug coverage
  • Unlimited transportation to medical appointments + pharmacies
  • Healthcare at home with telehealth + Teladoc®
  • A $300 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/Service Health Partners Medicare Special (HMO-SNP) Original Medicare
Primary Care Provider (PCP) Visit $0 20%
Specialist Visit (No referrals) $0 20%
Prescription Drugs (for each 30-day supply during initial coverage period)

$0 Deductible

$0 or $1.30 or $3.70 for generic drugs

$0 or $4.00 or $9.20 for all other drugs

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

$0 coinsurance for lab & Medicare-covered diagnostic tests and procedures

0% coinsurance for X-ray

0% coinsurance for advanced radiology services like MRI/CT/PET

20%
Emergency Room 0% coinsurance 20%
Urgent Care 0% coinsurance 20%
Routine Transportation Unlimited one-way trips Not covered
Fitness $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 $3,500 a year toward supplemental comprehensive dental services

Routine services not covered
Hearing

Hearing aids: $0 copay

Up to $1,500 every year

Hearing aids not covered
Vision

$0 for routine annual vision exam

$0 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
20% for Medicare-covered services; routine services not covered
Over-the-Counter Items

$300 quarterly allowance, plus rollover

Balance must be used by December 31, 2021

Not covered
Maxiumum Out-of-Pocket $3,450 per year (medical care) No annual limit

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.

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