Jefferson Health Plans Complete (HMO)

Pennsylvania Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$0
by Jefferson Health Plans

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 3.5
out of 5 stars

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Plan Name
Jefferson Health Plans Complete (HMO)
Insurance Carrier
Jefferson Health Plans
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Jefferson Health Plans Complete (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Pennsylvania and offered by the health insurance company Jefferson Health Plans. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$5,700
Primary doctor visit
$0 copay
Specialist visit
$25 copay per visit
ER visit
$100 copay per visit (always covered)
Ambulance
$250 copay

Jefferson Health Plans Complete (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,700 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Jefferson Health Plans Complete (HMO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Jefferson Health Plans Complete (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Jefferson Health Plans Complete (HMO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Jefferson Health Plans Complete (HMO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Jefferson Health Plans Complete (HMO) received an overall government quality rating of 3.5 stars out of 5 stars.

Jefferson Health Plans Complete (HMO) performed worse than Pennsylvania’s State average overall quality score of 4.2 stars.

This Plan’s 5-star Gov’t Quality Score
Pennsylvania State Average Score
Overall Government 5 Star Quality Rating
 3.5
 4.2
Summary rating of health plan quality
 3.5
 4.2
Staying healthy: screenings, tests, & vaccines
 4
 3.6
Managing chronic (long term) conditions
 3
 3.6
Member experience with health plan
 3
 4.1
Member complaints & changes in the health plan's performance
 4
 4.3
Health plan customer service
 4
 4.2
Summary rating of drug plan quality
 4
 4.1
Drug plan customer service
 4
 3.9
Member complaints & changes in the drug plan's performance
 4
 3.9
Member experience with the drug plan
 4
 4.4
Drug safety & accuracy of drug pricing
 4
 3.6

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Jefferson Health Plans Complete (HMO) received 3.5 stars for its health plan quality score which is worse than the Pennsylvania State average health plan quality score of 4.2 stars.

Jefferson Health Plans Complete (HMO) received 4 stars for its drug plan quality score which is worse than the Pennsylvania State average drug plan quality score of 4.1 stars.


Monthly Premium
$0
Health Portion of Premium
$0
Drug Portion of Premium
$0
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$5,700 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
$0 copay
Specialist visit
$25 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
$5 copay
Lab services
$0 copay
Diagnostic radiology services (like MRI)
$250 copay
Outpatient x-rays
$25 copay
Emergency care
$100 copay per visit (always covered)
Urgent care
$10 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
$250 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient hospital coverage
$300 copay per visit

Skilled nursing facility

Skilled nursing facility
$0 per day for days 1 through 20
$203 per day for days 21 through 100

Preventive services

Preventive services
$0 copay

Ambulance

Ground ambulance
$250 copay

Therapy services

Occupational therapy visit
$25 copay
Physical therapy & speech & language therapy visit
$25 copay

Mental health services

Outpatient group therapy with a psychiatrist
$25 copay
Outpatient individual therapy with a psychiatrist
$25 copay
Outpatient group therapy visit
$25 copay
Outpatient individual therapy visit
$25 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
20% coinsurance per item
Prosthetics (like braces, artificial limbs)
20% coinsurance per item
Diabetes supplies
0-20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$0.00 copay$0 copay
Generic$10.00 copay$0 copay
Preferred Brand25% coinsurance$0 copay
Non-Preferred Drug35% coinsurance$0 copay
Specialty Tier33% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
0-20% coinsurance
Other Part B drugs
0-20% coinsurance

Hearing

Hearing exam
$35 copay
Fitting/evaluation
Not covered
Hearing aids - Inner ear
Not covered
Hearing aids - Outer ear
Not covered
Hearing aids - Over the ear
Not covered

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Fluoride treatment
Not covered
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: $0 copay
Endodontics
In-network: $0 copay
Out-of-network: $0 copay
Periodontics
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, removable
In-network: $0 copay
Out-of-network: $0 copay
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: $0 copay
Maxillofacial prosthetics
In-network: $0 copay
Out-of-network: $0 copay
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: $0 copay
Orthodontics
Not covered
Adjunctive general services
Not covered

Vision

Routine eye exam
$0 copay
Contact lenses
$0 copay
Eyeglasses (frames & lenses)
$0 copay
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

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