Jefferson Health Plans Special (HMO D-SNP)
HEALTH PARTNERS PLANS, INC. · 2026 plan year
Plan ID H9207-004-000
HMO★ 3.5 CMS StarsDual-Eligible SNP
- MOOP (in-network)
- $9,250
- MOOP (combined)
- —
- Monthly premium
- $32.70/mo
- Part C $0 + Part D $32.70, before Extra Help
- Prescription drugs
- Included
This plan in 2027
Plan information
- Contract / Plan / Segment
- H9207-004-000
- Medical deductible
- Medicare Part B deductible ($283 in 2026)
- Part D premium
- $32.70/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
- Part D deductible
- $615/yr
- Also owed
- Your Medicare Part B premium, paid separately
More HEALTH PARTNERS PLANS, INC. plans in PA
Benefits & cost sharing
Hospital
| Benefit | In-network |
|---|---|
| Inpatient Hospital — Acute | $1,690 per stay |
| Inpatient Hospital — Psychiatric | $2,080 per stay |
| Worldwide Urgent Care Coverage | No charge |
Pharmacy
| Benefit | In-network |
|---|---|
| Part B Drugs | See plan details |
| Chemotherapy & Radiation Drugs (Part B) | 0%-20% coinsurance |
| Other Part B Drugs | 0%-20% coinsurance |
Mental Health
| Benefit | In-network |
|---|---|
| Mental Health Specialty Services | See plan details |
| Mental Health — Individual Sessions | 30% coinsurance |
| Mental Health — Group Sessions | 30% coinsurance |
| Supplemental Health Benefits | See plan details |
Other
| Benefit | In-network |
|---|---|
| Vision — Eye Exams | See plan details |
| Skilled Nursing Facility (SNF) | $0/day for days 1–20, $218/day for days 21–100 |
| Cardiac & Pulmonary Rehabilitation | See plan details |
| Cardiac Rehabilitation — Additional Sessions | 30% coinsurance |
| Intensive Cardiac Rehabilitation — Additional Sessions | 30% coinsurance |
| Pulmonary Rehabilitation — Additional Sessions | 30% coinsurance |
| Supervised Exercise Therapy (SET) | 30% coinsurance |
| Emergency Services | 30% coinsurance (max $115) |
| Urgently Needed Services | 30% coinsurance (max $40) |
| Worldwide Emergency & Urgent Coverage | See plan details |
| Worldwide Emergency Coverage | No charge |
| Partial Hospitalization Program | 30% coinsurance |
| Intensive Outpatient Program (IOP) | 30% coinsurance |
| Home Health Services | No charge |
| Primary Care Physician Services | 20% coinsurance |
| Chiropractic Services | 30% coinsurance |
| Occupational Therapy Services | 30% coinsurance |
| Physician Specialist Services | 20% coinsurance |
| Podiatry Services | 30% coinsurance |
| Podiatry Services | No charge |
| Other Health Care Professional Services | 20% coinsurance |
| Psychiatric Services | See plan details |
| Psychiatric Services — Individual Sessions | 30% coinsurance |
| Psychiatric Services — Group Sessions | 30% coinsurance |
| Physical Therapy & Speech-Language Pathology | 30% coinsurance |
| Additional Telehealth Services (Part B) | 30% coinsurance |
| Opioid Treatment Program Services | 30% coinsurance |
| Diagnostic Tests & Lab Services | See plan details |
| Diagnostic Procedures & Tests | 30% coinsurance |
| Laboratory Services | 30% coinsurance |
| Radiological Services | See plan details |
| Diagnostic Radiology | 30% coinsurance |
| Therapeutic Radiology | 20% coinsurance |
| X-Ray Services | 30% coinsurance |
| Outpatient Hospital Services | 30% coinsurance |
| Hospital Observation Services | 30% coinsurance |
| Ambulatory Surgical Center (ASC) | 30% coinsurance |
| Outpatient Substance Abuse Services | See plan details |
| Substance Abuse — Individual Sessions | 30% coinsurance |
| Substance Abuse — Group Sessions | 30% coinsurance |
| Outpatient Blood Services | 30% coinsurance |
| Ambulance Services | See plan details |
| Ground Ambulance | 30% coinsurance |
| Air Ambulance | 30% coinsurance |
| Non-Emergency Transportation — Health Facility | No charge |
| Durable Medical Equipment (DME) | 20% coinsurance |
| Prosthetics & Orthotics | See plan details |
| Prosthetic Devices | 20% coinsurance |
| Medical Supplies | 20% coinsurance |
| Diabetic Supplies & Services | See plan details |
| Diabetic Therapeutic Shoes & Inserts | 20% coinsurance |
| Dialysis Services | 20% coinsurance |
| Acupuncture | No charge |
| Diabetic Supplies | 20% coinsurance |
| Over-the-Counter (OTC) Items | No charge |
| Meal Benefit | No charge |
| Medicare-Covered Preventive Services | See plan details |
| Annual Physical Exam | 20% coinsurance |
| Fitness Benefit | No charge |
| Telemonitoring Services | No charge |
| Kidney Disease Education Services | 20% coinsurance |
| Glaucoma Screening | 30% coinsurance |
| Diabetes Self-Management Training | 30% coinsurance |
| Digital Rectal Exams | 30% coinsurance |
| Welcome to Medicare EKG | 30% coinsurance |
| Insulin (Part B) | 0%-20% coinsurance (max $35) |
| Dental — Medicare-Covered Services | No charge |
| Dental — Preventive | See plan details |
| Dental — Oral Exams | No charge |
| Dental — X-Rays | No charge |
| Dental — Diagnostic Services | No charge |
| Dental — Prophylaxis (Cleaning) | No charge |
| Dental — Other Preventive Services | No charge |
| Dental — Comprehensive | See plan details |
| Dental — Restorative Services | No charge |
| Dental — Endodontics (Root Canal) | No charge |
| Dental — Periodontics (Gum Care) | No charge |
| Dental — Removable Prosthodontics (Dentures) | No charge |
| Dental — Maxillofacial Prosthetics | No charge |
| Dental — Fixed Prosthodontics (Bridges) | No charge |
| Dental — Oral & Maxillofacial Surgery | No charge |
| Vision — Eye Exams | 30% coinsurance |
| Vision — Routine Eye Exams | No charge |
| Vision — Eyewear | No charge |
| Vision — Eyewear | See plan details |
| Vision — Contact Lenses | No charge |
| Vision — Eyeglasses (Lenses & Frames) | No charge |
| Hearing — Exams | 30% coinsurance |
| Hearing — Exams | See plan details |
| Hearing — Routine Exams | No charge |
| Hearing — Prescription Hearing Aids | See plan details |
| Hearing — Hearing Aids (All Types) | $0-$1,475 |
Service area
- PA: 28 counties
Reviewing your Medicare coverage for 2027?
Plans change every year. Leave your email and we'll let you know when Medicare open enrollment opens.