A non-government entity
Jefferson Health Plans Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Jefferson Health Plans Choice Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Jefferson Health Plans Choice Plus (PPO) in 2025, please refer to our full plan details page.
Jefferson Health Plans Choice Plus (PPO) is a PPO plan offered by Thomas Jefferson University available for enrollment in 2025 to people living in Southern New Jersey. The overall rating for this plan is not yet available for 2025.
It's important to know that Jefferson Health Plans Choice Plus (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Jefferson Health Plans Choice Plus (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Jefferson Health Plans Choice Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Jefferson Health Plans Choice Plus (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Jefferson Health Plans Choice Plus (PPO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a $5 copay for preferred generic drugs at standard and mail-order pharmacies, with no copay at preferred pharmacies. For standard generic drugs, you pay 25% coinsurance at both standard and mail-order pharmacies. Brand name drugs have 40% coinsurance, and non-preferred drugs have 33% coinsurance.
Additional Benefits
The Jefferson Health Plans Choice Plus (PPO) plan offers coverage for a wide range of services. This includes inpatient hospital stays with a copay, outpatient services with copays, and ambulance services with copays or coinsurance. The plan also covers primary care, preventive, hearing, vision, and dental services, each with its own copay structure and limitations. Additional benefits include coverage for partial hospitalization, emergency services, home health, medical equipment, and other services like acupuncture and over-the-counter items. The plan utilizes copays, coinsurance, and prior authorization requirements for some services, and has certain coverage limits and exclusions.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $285 copay for days 1-5, and no copay for days 6-90, and the plan does not cover additional days or non-Medicare-covered stays.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services, observation services, and ambulatory surgical center services, each with a copay. Outpatient hospital and observation services have a $350 copay, while ambulatory surgical center services have a $300 copay. Individual and group sessions for outpatient substance abuse have a copay between $30 and $30. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Jefferson Health Plans Choice Plus (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Jefferson Health Plans Choice Plus (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Jefferson Health Plans Choice Plus (PPO) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $10 copay, while Worldwide Emergency Services has a maximum plan benefit coverage amount of $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Jefferson Health Plans Choice Plus (PPO) plan covers Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $25 copay, Mental Health Specialty Services, Podiatry Services with a $20-$30 copay, Other Health Care Professional services with a $0-$30 copay, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth benefits with a $0-$30 copay, and Opioid Treatment Program Services with a $30 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The Jefferson Health Plans Choice Plus (PPO) plan covers preventive services including Medicare-covered services, annual physical exams, and additional preventive services. Some additional preventive services like Health Education, In-Home Safety Assessment, and Personal Emergency Response System (PERS) are not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams with a $35 copay, and prescription hearing aids with a combined maximum benefit of $1000 every two years, but fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered. Routine hearing exams are limited to one per year.
Vision Services See details
Vision services include eye exams with a $45 copay, and are covered annually. Eyewear is also covered, with contact lenses covered, and eyeglasses (lenses and frames) covered up to $100 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Jefferson Health Plans Choice Plus (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services including oral exams (3 per year), dental x-rays (1 per year), other diagnostic dental services, prophylaxis (cleaning) (3 per year), restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, and oral and maxillofacial surgery. Fluoride treatment, adjunctive general services, implant services, and orthodontics are not covered. Orthodontic Services are covered up to a maximum of $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Jefferson Health Plans Choice Plus (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Jefferson Health Plans Choice Plus (PPO) plan, with Durable Medical Equipment (DME) subject to 20% coinsurance, and Prosthetic Devices, and Medical Supplies subject to 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and therapeutic radiological services. Diagnostic procedures have a $5 copay, while therapeutic radiological services have 20% coinsurance, and outpatient X-ray services have a $30 copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Jefferson Health Plans Choice Plus (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for the Medicare-covered services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Jefferson Health Plans Choice Plus (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Jefferson Health Plans Choice Plus (PPO) plan covers acupuncture with a $10 copay per visit, up to 20 treatments per year, and provides over-the-counter (OTC) items, including nicotine replacement therapy, with a maximum benefit of $75 every three months. Other services such as meal benefits, EPSDT services, and home and community based services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved