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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 2026, 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 2026.
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 $29.00. 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)
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Drug Coverage
The Jefferson Health Plans Choice Plus (PPO) plan offers a $0 drug deductible, allowing your prescription coverage to begin immediately without any upfront out-of-pocket costs. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay for one, two, or three-month supplies filled at standard pharmacies or through standard mail order. This ensures that essential everyday medications remain highly accessible and affordable. For brand-name and specialty prescriptions, cost-sharing is based on a percentage of the drug cost at standard pharmacies and standard mail order. You will pay a 25% coinsurance for Tier 3 preferred brand drugs, a 32% coinsurance for Tier 4 non-preferred drugs, and a 33% coinsurance for Tier 5 specialty medications. These clear coinsurance rates make it simple to anticipate your expenses for advanced healthcare needs.
Additional Benefits
The Jefferson Health Plans Choice Plus (PPO) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low $20 copay, while inpatient hospital stays feature copays for initial days and no copay for days 6 through 90. Emergency services are available with a $100 copay, and urgent care visits cost just $10, with both offering no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $5,000 annual limit with no copay for most services, and vision coverage featuring a $45 routine exam copay alongside no copay for eyewear up to $200. Additionally, members benefit from a routine hearing exam for a $35 copay, a quarterly $125 over-the-counter allowance with no copay, and medical equipment coverage typically requiring a 20% coinsurance.
Inpatient Hospital See details
Jefferson Health Plans Choice Plus (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring copayments for the initial days of a stay and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Jefferson Health Plans Choice Plus (PPO) covers outpatient services with no coinsurance, featuring a $300 copay for outpatient hospital and observation services and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $20 copay with no coinsurance, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Jefferson Health Plans Choice Plus (PPO) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Jefferson Health Plans Choice Plus (PPO) partially covers ambulance and transportation services, requiring prior authorization for ambulance transfers. Ground ambulance services incur a $225 copay and air ambulance services require 20% coinsurance, while plan-approved and health-related transportation services are not covered.
Emergency Services See details
Jefferson Health Plans Choice Plus (PPO) covers emergency services with a $100 copay and urgently needed services with a $10 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered with no copay and no coinsurance up to a $50,000 maximum, though worldwide emergency transportation is not covered.
Primary Care See details
Jefferson Health Plans Choice Plus (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits for a $20 copay and no coinsurance. Therapy, mental health, podiatry, and telehealth services are also covered with no coinsurance and copays ranging from $0 to $30, though chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by Jefferson Health Plans Choice Plus (PPO) with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, memory fitness, and telemonitoring. However, this benefit is partially covered as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, remote access technologies, home/bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services are partially covered by Jefferson Health Plans Choice Plus (PPO), featuring a $35 copay and no coinsurance for one routine hearing exam per year, while fitting evaluations and OTC hearing aids are not covered. Prescription hearing aids are covered once every two years with a copay ranging from $500 to $1,975 and no coinsurance, though inner ear, outer ear, and over-the-ear prescription models are excluded.
Vision Services See details
Jefferson Health Plans Choice Plus (PPO) provides partially covered vision services with no deductibles, featuring one routine eye exam per year for a $45 copay and no coinsurance, and eyewear with no copay and no coinsurance. Covered eyewear includes unlimited contact lenses and one pair of eyeglasses per year up to a $200 maximum limit, while other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Jefferson Health Plans Choice Plus (PPO), featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $5,000 annual maximum. Fluoride treatment, adjunctive general services, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Jefferson Health Plans Choice Plus (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is available for a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Jefferson Health Plans Choice Plus (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Jefferson Health Plans Choice Plus (PPO) with no copay and generally a 20% coinsurance, though diabetic supplies range from no coinsurance up to 20% coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, and coverage may be limited to preferred manufacturers.
Diagnostic and Radiological Services See details
Jefferson Health Plans Choice Plus (PPO) diagnostic and radiological services are covered, though diagnostic services are only partially covered as lab services are not covered. Covered diagnostic tests have no copay and no coinsurance, while radiological services require a $30 copay for X-rays, a minimum $175 copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Jefferson Health Plans Choice Plus (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered with no copay and no coinsurance under Jefferson Health Plans Choice Plus (PPO), but in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Jefferson Health Plans Choice Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $185 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Jefferson Health Plans Choice Plus (PPO) provides partial coverage for other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Acupuncture is limited to 20 treatments per year, and the OTC benefit provides up to $125 every three months via reimbursement, though Naloxone is not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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