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Jefferson Health Plans Flex (PPO)

H1619 - 001 - 0
Plan Not Rated

Jefferson Health Plans Flex (PPO) is a Medicare Advantage Plan by Jefferson Health Plans.

This page features plan details for 2025 Jefferson Health Plans Flex (PPO) H1619 – 001 – 0 available in Southeastern PA, Central PA and Eastern PA.

Locations

Jefferson Health Plans Flex (PPO) is offered in the following locations.

Adams County, Pennsylvania
Berks County, Pennsylvania
Bradford County, Pennsylvania

Click to see more locations

Plan Overview

Jefferson Health Plans Flex (PPO) offers the following coverage and cost-sharing.

Insurer:Jefferson Health Plans
Health Plan Deductible:$0
MOOP:$10,000 In and Out-of-network
$7,000 In-network
Drugs Covered:Yes

Ready to sign up for Jefferson Health Plans Flex (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

Jefferson Health Plans Flex (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Jefferson Health Plans Flex (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Jefferson Health Plans Flex (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Maxillofacial Prosthetics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay (Limits Apply)
    • Out-of-Network: 50% Coins – No Copay (Limits Apply)
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • Out-of-Network: $10 copay (Authorization Required)
  • Lab services
    • Out-of-Network: $0 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $35 copay (Authorization Required)
    • Out-of-Network: $35 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: $275 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0 copay (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $250 copay (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Specialist
    • In-Network: $35 copay per visit
    • Out-of-Network: $35 copay per visit
  • Primary
    • In-Network: $0 copay
    • Out-of-Network: $0 copay

Emergency care/Urgent care

  • Emergency
    • $100 copay per visit (always covered)
  • Urgent care
    • $20 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $35 copay
  • Routine foot care
    • In-Network: $35 copay (Limits Apply)
  • Foot exams and treatment
    • Out-of-Network: $35 copay

Ground ambulance

    • In-Network: $255 copay
    • Out-of-Network: $255 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $35 copay
    • Out-of-Network: $35 copay
  • Fitting/evaluation
    • Not covered
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • Out-of-Network: $250 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • In-Network: $250 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $10,000 In and Out-of-network
      $7,000 In-network

Medical equipment/supplies

  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item (Authorization Required)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • Out-of-Network: $35 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $35 copay (Authorization Required)
  • Outpatient group therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • Out-of-Network: $250 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $35 copay (Authorization Required)
    • Out-of-Network: $35 copay (Authorization Required)
  • Inpatient hospital – psychiatric
    • In-Network: $250 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
  • Outpatient group therapy visit
    • Out-of-Network: $35 copay (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: $35 copay (Authorization Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: $375 copay per visit (Authorization Required)
    • In-Network: $375 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: $0 copay (Authorization Required)

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Occupational therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: $35 copay (Authorization Required)

Skilled Nursing Facility

    • Out-of-Network: $0 per day for days 1 through 20
      $203 per day for days 21 through 100 (Authorization Required)
    • In-Network: $0 per day for days 1 through 20
      $203 per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglass frames
    • Not covered
  • Other
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Not covered
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for Jefferson Health Plans Flex (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on Jefferson Health Plans Flex (PPO)? See 2025 Jefferson Health Plans Flex (PPO) at MedicareAdvantageRX.com.

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