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HealthPartners Journey Smart (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthPartners Journey Smart (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthPartners Journey Smart (PPO) in 2025, please refer to our full plan details page.
HealthPartners Journey Smart (PPO) is a PPO plan offered by HealthPartners, Inc. available for enrollment in 2025 to people living in Metro and Central Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that HealthPartners Journey Smart (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 HealthPartners Journey Smart (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 HealthPartners Journey Smart (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $80.00. You must continue to pay paying your reduced 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 a $400.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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:
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Drug Coverage
The HealthPartners Journey Smart (PPO) plan has a $400 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, for preferred generic drugs, you will pay an $8 copay. For standard generic drugs, you will pay 20% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HealthPartners Journey Smart (PPO) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay, while outpatient services such as primary care, hearing, vision, and dental have copays. The plan also covers services like ambulance, emergency, and home health with copays or coinsurance. Additionally, the plan offers benefits for diagnostic and radiological services, medical equipment, and skilled nursing facilities, with specific copays or coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $450 for days 1-5 and no copay for days 6-90. Additional days are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $450 copay, observation services with a $350 copay, ambulatory surgical center services with a $400 copay, outpatient substance abuse services with a $50 copay for individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the HealthPartners Journey Smart (PPO) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $350 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HealthPartners Journey Smart (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $50 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a 20% coinsurance.
Primary Care See details
The HealthPartners Journey Smart (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $50 copay, and mental health specialty services with a $25-$50 copay depending on the service. The plan also covers other health care professionals with a $0-$50 copay, psychiatric services with a $25-$50 copay depending on the service, physical therapy and speech-language pathology services with a $45 copay, additional telehealth benefits with a $0-$50 copay, and opioid treatment program services with a $50 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered by the HealthPartners Journey Smart (PPO) plan. The plan also covers nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, in-home support services, support for caregivers, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $499 and $999 for all types, with a limit of two visits per year. Prescription hearing aids for the inner, outer, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a $50 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. There is a combined maximum benefit of $350 every year for eyewear.
Dental Services See details
The HealthPartners Journey Smart (PPO) plan covers dental services, with a maximum benefit of $2,000 per year, for both in-network and out-of-network services. This plan covers oral exams (2 per year), dental x-rays (1 per year), other diagnostic dental services (1 per year), prophylaxis (cleaning) (2 per year), fluoride treatments (2 per year), other preventive dental services (1 visit every three years), and orthodontic services, while it does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HealthPartners Journey Smart (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices and Medical Supplies also have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures with a copay of $50 and lab services with coinsurance up to 10%. Diagnostic radiological services have a copay of at most $275, while therapeutic radiological services have coinsurance up to 20%. Outpatient X-ray services have a copay of $50.
Home Health Services See details
Home Health Services are covered by the HealthPartners Journey Smart (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HealthPartners Journey Smart (PPO) plan. Although the plan covers some services, it does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HealthPartners Journey Smart (PPO) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HealthPartners Journey Smart (PPO) plan covers acupuncture with a $50 copay, up to 20 treatments per year. Other services like over-the-counter items, meal benefits, and several other specific services are not covered.
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