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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
$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)
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;
$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 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:

  • One pair of eyeglasses (lenses and frames)
  • Contact lenses

$0 for routine annual vision exam

$0 for one of the following, up to $250:

  • One pair of eyeglasses (lenses and frames)
  • Contact lenses
 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:

More Information