Plan Details
| Complete (HMO-POS) |
Prime (HMO-POS) |
Special (HMO-SNP) |
|
|---|---|---|---|
| Monthly Premium | $0 | $41.10 | $0 |
| Primary Care Visits | $0 | $0 | $0 |
| Specialist Visits | $25 (20% coinsurance out-of-network) | $20 (20% coinsurance out-of-network) | $0 |
| Referrals | Not required | Not required | Not required |
| Urgent Care | $55 copay | $55 copay | $0 |
| Emergency Room | $90 copay (waived if admitted within 24 hours) | $90 copay (waived if admitted within 24 hours) | $0 copay |
| Inpatient Hospital | Days 1-5: $230/day
Days 6-90: $0/day |
Days 1-5: $235/day
Days 6-90: $0/day |
$0 copay |
| Outpatient Surgery | Surgery center: $200 copay
Outpatient hospital visit: $300 copay |
Surgery center: $200 copay
Outpatient hospital visit: $300 copay |
$0 copay |
| Prescription Drugs
(30-day supply) |
Preferred Generic: $0
Generic: $10 Preferred Brand: $47 Non-preferred drug: $100 Specialty: 33% |
Preferred Generic: $0
Generic: $10 Preferred Brand: $47 Non-preferred drug: $100 Specialty: 33% |
$0 copay on all prescription drugs |
Additional Benefits
| Complete (HMO-POS) |
Prime (HMO-POS) |
Special (HMO-SNP) |
|
|---|---|---|---|
| Part D Senior Savings | $10 copay for insulin (30 day supply) | $10 copay for insulin (30 day supply) | N/A |
| Over-the-Counter Benefit | $150 per quarter | $165 per quarter | $305 per quarter; includes OTC and eligible food items |
| Dental Exams | $0 copay; 2 per year and annual X-rays | $0 copay; 2 per year and annual X-rays | $0 copay; 2 per year and annual X-rays |
| Dental Allowance | $1,200 | $2,000 | $3,500 |
| Annual Vision Exam | $0 copay | $0 copay | $0 copay |
| Vision Allowance | $250 for one pair of eyeglasses (lenses and frames) or contact lenses | $300 for one pair of eyeglasses (lenses and frames) or contact lenses | $500 for one pair of eyeglasses (lenses and frames) or contact lenses |
| Annual Hearing Exam | $0 copay | $0 copay | $0 copay |
| Hearing Aid Allowance | $1,000 (every 2 years) | $1,500 (every 2 years) | $1,500 (every year) |
| Transportation | 22 one-way rides | 50 one-way rides | Unlimited one-way rides |
| SilverSneakers / Kroc Center Membership | Included | Included | Included |
| Teladoc | Included | Included | Included |
2023 Coverage Area
- Berks
- Bucks
- Carbon
- Chester
- Cumberland
- Dauphin
- Delaware
- Lancaster
- Lebanon
- Lehigh
- Montgomery
- Northampton
- Perry
- Philadelphia
- Schuylkill
This is not a full description of benefits; benefits, copays, limits and periodicity vary by plan.
Health Partners Medicare is an HMO plan with Medicare and Pennsylvania State Medicaid program contracts. Enrollment in Health Partners Medicare depends on contract renewal.
Plan Details
| Silver (HMO-POS) |
Platinum (HMO-POS) |
|
|---|---|---|
| Monthly Premium | $0 | $20 |
| Primary Care Visits | $0 | $0 |
| Specialist Visits | $30 (20% coinsurance out-of-network) | $0 (20% coinsurance out-of-network) |
| Referrals | Not required | Not required |
| Urgent Care | $55 copay | $55 copay |
| Emergency Room | $90 copay (waived if admitted within 24 hours) | $90 copay (waived if admitted within 24 hours) |
| Inpatient Hospital | Days 1-5: $290/day
Days 6-90: $0/day |
Days 1-5: $275/day
Days 6-90: $0/day |
| Outpatient Surgery | Surgery center: $200 copay
Outpatient hospital visit: $300 copay |
Surgery center: $200 copay
Outpatient hospital visit: $300 copay |
| Prescription Drugs
(30-day supply) |
Preferred Generic: $0
Generic: $10 Preferred Brand: $47 Non-preferred drug: $100 Specialty: 33% |
Preferred Generic: $0
Generic: $10 Preferred Brand: $47 Non-preferred drug: $100 Specialty: 33% |
Additional Benefits
| Silver (HMO-POS) |
Platinum (HMO-POS) |
|
|---|---|---|
| Part D Senior Savings | $10 copay for insulin (30-day supply) | $10 copay for insulin (30-day supply) |
| Over-the-Counter Benefit | $60 per quarter | $60 per quarter |
| Dental Exams | $0 copay; 2 per year and annual X-rays | $0 copay; 2 per year and annual X-rays |
| Dental Allowance | $1,000 | $1,000 |
| Annual Vision Exam | $0 copay | $0 copay |
| Vision Allowance | $200 for one pair of eyeglasses (lenses and frames) or contact lenses | $200 for one pair of eyeglasses (lenses and frames) or contact lenses |
| Annual Hearing Exam | $0 copay | $0 copay |
| Hearing Aid Allowance | $1,000 (every 2 years) | $1,500 (every 2 years) |
| SilverSneakers / Kroc Center Membership | Included | Included |
| Teladoc | Included | Included |
2023 Coverage Area
- Burlington
- Camden
- Gloucester
This is not a full description of benefits; benefits, copays, limits and periodicity vary by plan.
Health Partners Medicare is an HMO plan with Medicare and Pennsylvania State Medicaid program contracts. Enrollment in Health Partners Medicare depends on contract renewal.