Prime & Complete (2023) - Pennsylvania
Health Partners Medicare Prime (HMO-POS) offers more benefits than Original Medicare, including transportation, over-the-counter items and prescription drug coverage for an affordable premium.
Health Partners Medicare Complete (HMO-POS) offers medical and prescription drug coverage, plus added benefits, for a $0 premium.
Our Prime and Complete plans are available in Pennsylvania and provide comprehensive coverage and additional benefits, including:
- $0 copay for PCP visits and no referrals to see specialists
- Comprehensive Part D prescription drug coverage with affordable copays
- No medical or prescription drug deductibles
- Vision care, dental and hearing aid benefits with generous allowances
- $10 copay on select insulin drugs
- Transportation to medical appointments and pharmacies
- Quarterly benefit for over-the-counter health items
- Fitness center membership through SilverSneakers®, or a membership to the Salvation Army Kroc Center in Philadelphia
Benefit/ Service |
Prime |
Complete |
Original Medicare |
Primary Care Provider (PCP) Visit | $0 | $0 | 20% |
Specialist Visit (No referrals) | $20 in-network, 20% out-of-network* |
$25 in-network, 20% out-of-network* |
20% |
Prescription Drugs (for each 30-day supply during initial coverage period) |
$0 Deductible $0 Preferred Generic |
$0 Deductible $0 Preferred Generic |
Not covered (standalone Part D plan required) |
Part D Senior Savings - Select Insulin Drugs |
$10 copay (30 day refill) $20 copay (90 day refill) |
$10 copay (30 day refill) $20 copay (90 day refill) |
Not covered (standalone Part D plan required) |
Diagnostic Testing and Lab Services |
$0 copay for lab & Medicare-covered diagnostic tests and procedures; $250 copay for advanced radiology services like MRI/CT/PET |
$0 copay for lab & Medicare-covered diagnostic tests and procedures; $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 | 22 one-way trips | Not included |
Fitness Center Memebership | $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 $2,000 toward supplemental comprehensive dental services |
$0 for 2 exams and cleanings, plus X-rays (limits apply) Plan pays $1,200 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 $0 for one of the following, up to $300:
|
$0 for routine annual vision exam $0 for one of the following, up to $250:
|
Routine services not covered |
Over-the-Counter Items |
$165 quarterly allowance
|
$150 quarterly allowance
|
Not covered |
Maximum Out-of-Pocket | $7,900 per year (medical care) | $7,900 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. Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Call Today to Learn More and Enroll
Call 1-833-477-4773 (TTY 1-877-454-8477) to speak with a licensed benefits advisor.
Hours of operation
8 a.m.–8 p.m., seven days a week, October 1 through March 31
8 a.m.–8 p.m., Monday–Friday, April 1 through September 30
You can also request a home visit or phone call from one of Health Partners Medicare's licensed benefits advisors:
- Request a home visit to discuss Health Partners Medicare options
- Request a phone call to discuss Health Partners Medicare options
More Information
- View our Medicare Star Rating
- Learn more about Health Partners Plans
- For a personalized plan evaluation, visit our online enrollment site and enter your ZIP code. Then click the “View plans” button.