A non-government entity
Jefferson Health Plans Select (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Jefferson Health Plans Select (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Jefferson Health Plans Select (HMO D-SNP) in 2026, please refer to our full plan details page.
Jefferson Health Plans Select (HMO D-SNP) is a HMO D-SNP plan offered by Thomas Jefferson University available for enrollment in 2026 to people living in Southeastern PA, Central PA and Eastern PA. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Jefferson Health Plans Select (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Jefferson Health Plans Select (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Jefferson Health Plans Select (HMO D-SNP).
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 Select (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 a $615.00 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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Select (HMO D-SNP)
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 Select (HMO D-SNP) features an annual prescription drug deductible of $615. For most formulary drug tiers, including Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance at standard retail pharmacies and through standard mail-order services. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard pharmacies and mail-order options. For select care drugs in Tier 6, this plan offers no copay for one-month, two-month, and three-month supplies filled at standard retail pharmacies or standard mail-order services. This cost-effective structure helps beneficiaries manage their essential daily medication expenses with zero out-of-pocket costs for select treatments. Understanding these copayment and coinsurance details ensures you can maximize your Medicare prescription drug benefits with Jefferson Health Plans.
Additional Benefits
The Jefferson Health Plans Select (HMO D-SNP) offers comprehensive medical coverage with no copays for most outpatient, emergency, and doctor visits, though these services generally require a 20% to 30% coinsurance. For hospital stays, members pay a copay of $1,640 per stay for acute inpatient care and $2,080 per stay for psychiatric care with no coinsurance. Skilled nursing facility stays feature no copay for the first 20 days and a $218 daily copay for days 21 through 100. This plan also provides valuable supplemental benefits, including home health services with no copay and no coinsurance. Routine dental, vision, and hearing services are covered with no copays, featuring annual allowance limits of $800 each for dental care, eyewear, and prescription hearing aids. Additionally, members can access covered acupuncture treatments and receive up to $300 every three months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Jefferson Health Plans Select (HMO D-SNP) partially covers inpatient hospital care with no coinsurance, requiring a $1,640 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and additional days, non-Medicare-covered stays, and acute room upgrades are not covered.
Outpatient Services See details
Jefferson Health Plans Select (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 30% coinsurance. Prior authorization is required for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Jefferson Health Plans Select (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Jefferson Health Plans Select (HMO D-SNP), featuring a 30% coinsurance and no copay for both ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Jefferson Health Plans Select (HMO D-SNP) covers emergency and urgently needed services with a 30% coinsurance and no copay, with the emergency coinsurance waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are partially covered up to a $50,000 lifetime limit with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Jefferson Health Plans Select (HMO D-SNP) covers primary care and specialist visits with no copay and 20% coinsurance. Other services, including physical, occupational, mental health, and speech therapies, as well as podiatry and telehealth, are covered with no copay and 30% coinsurance, while chiropractic services are not covered.
Preventive Services See details
Jefferson Health Plans Select (HMO D-SNP) covers preventive services, including annual physical exams with no copay and 20% coinsurance, as well as kidney disease education and other screenings with no copay and 30% coinsurance. Additional preventive services, including fitness benefits and health education, are not covered.
Hearing Services See details
Hearing services are partially covered by Jefferson Health Plans Select (HMO D-SNP), featuring routine hearing exams with no copay and a 30% coinsurance, as well as fitting evaluations with no copay. Prescription hearing aids are covered with no copay and no coinsurance up to an $800 annual limit, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Jefferson Health Plans Select (HMO D-SNP) covers one annual routine eye exam with no copay, 30% coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible up to an $800 annual limit, but eyewear upgrades are excluded.
Dental Services See details
Jefferson Health Plans Select (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance, up to a maximum annual benefit of $800. While preventive and comprehensive services like cleanings, exams, and surgeries are covered, fluoride treatments, adjunctive general services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Jefferson Health Plans Select (HMO D-SNP) with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Jefferson Health Plans Select (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Jefferson Health Plans Select (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and 20% coinsurance. Prior authorization is required for these services, and some items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
Jefferson Health Plans Select (HMO D-SNP) covers diagnostic and radiological services with no copays, subject to prior authorization requirements. You will pay a 30% coinsurance for diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Jefferson Health Plans Select (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Jefferson Health Plans Select (HMO D-SNP) with no copay, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Jefferson Health Plans Select (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Jefferson Health Plans Select (HMO D-SNP) covers acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, but does not cover meal benefits. Acupuncture is limited to 20 treatments per year, and OTC items are covered up to $300 every three months via reimbursement, excluding Naloxone.
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