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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 2026, please refer to our full plan details page.
HealthPartners Journey Smart (PPO) is a PPO plan offered by HealthPartners, Inc. available for enrollment in 2026 to people living in Metro and Central MN Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $75.00. 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 features an annual prescription drug deductible of $400. Tier 1 preferred generic drugs are highly affordable, offering no copay for 1-month and 3-month supplies at standard pharmacies and through mail order. Tier 2 generic medications require a $5 copay for a 1-month supply, with 3-month supplies costing $15 at standard pharmacies or a reduced $10 through preferred mail order. For brand-name and specialty medications, the plan uses coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs have a 38% coinsurance for both short- and long-term supplies. Specialty drugs in Tier 5 are covered with a 25% coinsurance for a 1-month supply through standard pharmacies and mail-order options.
Additional Benefits
The HealthPartners Journey Smart (PPO) plan offers comprehensive coverage for core medical needs, featuring no copay and no coinsurance for primary care visits and preventive care. For specialized treatment, members pay a $50 copay for specialist visits and physical therapy, while emergency room visits carry a $130 copay. Inpatient hospital stays require a $450 daily copay for the first five days with no copay for subsequent days, and outpatient hospital services have a $500 copay. Supplemental benefits are also highly accessible, including dental care with no copay and no coinsurance up to a $2,000 annual maximum. Routine eye and hearing exams are available for a $50 copay, with eyewear covered up to $250 and prescription hearing aids requiring copays starting at $499. Additionally, home health services are provided with no copay, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
HealthPartners Journey Smart (PPO) partially covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $450 copay per day for days 1 to 5 and no copay for days 6 and beyond. Upgrades and non-Medicare-covered stays are not covered, and prior authorization is required for acute stays.
Outpatient Services See details
Outpatient services are covered by HealthPartners Journey Smart (PPO) with no coinsurance, featuring a $500 copay for outpatient hospital services, a $350 daily copay for observation services, and a $400 copay for ambulatory surgical center services. Outpatient substance abuse individual and group sessions require a $50 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the HealthPartners Journey Smart (PPO) plan with a $55.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance services under HealthPartners Journey Smart (PPO) require prior authorization, with ground ambulance services carrying a $350 copay and coinsurance, and air ambulance services carrying a 20% coinsurance and a copayment. Transportation services are not covered under this plan.
Emergency Services See details
HealthPartners Journey Smart (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services feature no copay and a 20% coinsurance.
Primary Care See details
HealthPartners Journey Smart (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services carry a $50 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, but routine chiropractic and podiatry services are not covered.
Preventive Services See details
HealthPartners Journey Smart (PPO) covers annual physical exams, kidney disease education, and other preventive screenings with no copay and no coinsurance. Additional preventive benefits are partially covered with no coinsurance, offering fitness and nutritional benefits alongside remote access technologies (with a $0 to $50 copay), though services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthPartners Journey Smart (PPO) partially covers hearing services, offering one routine hearing exam per year for a $50 copay and no coinsurance, with no deductible. Up to two prescription hearing aids are covered annually with no coinsurance and copays ranging from $499.00 to $999.00, but over-the-counter (OTC) hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
HealthPartners Journey Smart (PPO) partially covers vision services with no deductibles, featuring a $50 copay and no coinsurance for one routine eye exam per year. Eyewear is covered with no copay and no coinsurance up to a $250 annual maximum for contact lenses and combined eyeglasses, though other eye exams, individual eyeglass lenses, and individual frames are not covered.
Dental Services See details
HealthPartners Journey Smart (PPO) provides partially covered dental services with no copay and no coinsurance up to a $2,000 annual maximum for both in-network and out-of-network care. Covered services include exams, cleanings, and implants, while orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthPartners Journey Smart (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs have a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the HealthPartners Journey Smart (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
HealthPartners Journey Smart (PPO) covers medical equipment with no copays and a 20% coinsurance for durable medical equipment, prosthetics, and therapeutic shoes, while diabetic supplies range from no coinsurance to 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthPartners Journey Smart (PPO) with prior authorization required. Diagnostic procedures and outpatient X-rays carry a $50 copay, diagnostic radiological services require a $275 copay, lab services require a 10% coinsurance, and therapeutic radiological services require a 20% coinsurance, with both copays and coinsurance applying depending on the service.
Home Health Services See details
Home health services are covered under the HealthPartners Journey Smart (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HealthPartners Journey Smart (PPO) plan with no coinsurance, but only some services are covered in practice. Standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($30 copay), and supervised exercise therapy for PAD ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HealthPartners Journey Smart (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthPartners Journey Smart (PPO) partially covers other services, including acupuncture for a $50 copay and no coinsurance (up to 20 treatments yearly), treatment at the scene for a $350 copay and no coinsurance, and emergency travel logistics and travel counseling with no copay and no coinsurance. Over-the-counter items, meal benefits, and dual-eligible SNP services are not covered.
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