Jefferson Health Plans Premier (PPO) Medicare Advantage Plan H3124-003 • 2027
- Monthly Premium
- $55.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $7000.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 0 beneficiaries
Jefferson Health Plans Premier (PPO) Introduction
Jefferson Health Plans Premier is a Medicare Advantage PPO plan offered by Jefferson Health Plans. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $55.00 monthly premium, $0.00 medical deductible, and $7000.00 in-network maximum out-of-pocket. CMS Plan ID H3124-003 identifies this plan. The 2027 Part D prescription drug deductible is $0.00.
Plan Benefits
Jefferson Health Plans Premier has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H3124-003.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Specialist | In-network: $20 copay Out-of-network: $20 copay |
Coming soon |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Telehealth benefit | In-network: $0-$25 copay | Coming soon |
| Routine chiropractic | Not covered | Coming soon |
| Fitness benefits | Coming soon | Coming soon |
| Health education | Not covered | Coming soon |
| Counseling services | Not covered | Coming soon |
| Over-the-counter drug benefits | Not covered | Coming soon |
| Health transportation (non-emergency) | Coming soon | Coming soon |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $250 copay Out-of-network: $250 copay |
Coming soon |
| Lab services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Outpatient x-rays | In-network: $30 copay Out-of-network: $30 copay |
Coming soon |
| Diagnostic tests and procedures | In-network: $0 copay Out-of-network: $0 copay |
Coming soon |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $100 copay | Coming soon |
| Worldwide emergency care | Coming soon | Coming soon |
| Urgent care | $10 copay | Coming soon |
| Inpatient hospital care | In-network: Tier 1 $300 per day for days 1-5 $0 per day for days 6-90 $800 Lifetime Reserve Days for days 1-60 $0 per stay Out-of-network: $300 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Coming soon |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $185 per day for days 21-100 Out-of-network: $0 per day for days 1-20 $185 per day for days 21-100 $0 per stay |
Coming soon |
| Ground ambulance | In-network: $225 copay Out-of-network: $225 copay |
Coming soon |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $25 copay Out-of-network: $25 copay |
Coming soon |
| Outpatient group therapy | In-network: $25 copay Out-of-network: $25 copay |
Coming soon |
| Inpatient psychiatric hospital care | In-network: Tier 1 $300 per day for days 1-5 $0 per day for days 6-90 $800 Lifetime Reserve Days for days 1-60 $0 per stay Out-of-network: $300 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Coming soon |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $15 copay Out-of-network: $15 copay |
Coming soon |
| Occupational therapy | In-network: $15 copay Out-of-network: $15 copay |
Coming soon |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Coming soon |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Coming soon |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 20% coinsurance |
Coming soon |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Coming soon |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Coming soon |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Dental x-rays | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Cleaning | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Periodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Endodontics | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Restorative services | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Implant services | Not covered | Coming soon |
| Orthodontics | Not covered | Coming soon |
| Oral/Maxillofacial surgery | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Eyeglass frames only | Not covered | Coming soon |
| Eyeglass lenses only | Not covered | Coming soon |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Upgrades | Not covered | Coming soon |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: $0 copay, 0% coinsurance |
Coming soon |
| Fitting/evaluation | Not covered | Coming soon |
| Prescription hearing aids | In-network: $500-$1975 copay Out-of-network: $500-$1975 copay |
Coming soon |
| OTC hearing aids | Not covered | Coming soon |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Coming soon |
| Home-based palliative care | Not covered | Coming soon |
| Personal emergency response system | Coming soon | Coming soon |
| Weight management programs | Not covered | Coming soon |
| Wigs for chemotherapy-related hair loss | Coming soon | Coming soon |
| Alternative therapies | Not covered | Coming soon |
| Massage therapy | Not covered | Coming soon |
| Home/bathroom safety devices | Not covered | Coming soon |
Certain preventive services are covered 100% by Jefferson Health Plans Premier as a Part B benefit.
Prescription Drug Coverage
Jefferson Health Plans Premier includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $13.50 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $13.50 |
| Low-Income Premium Subsidy: | $36.28 |
| Low-Income Premium Subsidy Paid by CMS: | $13.50 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Jefferson Health Plans starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Jefferson Health Plans Premier may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 29% coinsurance | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H3124)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for Jefferson Health Plans
- Website
- Jefferson Health Plans Plan Page
- Providers
- Jefferson Health Plans Providers Page
- Formulary
- Jefferson Health Plans Formulary Page
- Pharmacy
- Jefferson Health Plans Pharmacy Page
- New Member Health Plan Help
- (833)477-4773
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)477-4773
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Jefferson Health Plans Premier (H3124-003-0) is available in the following locations:
New Jersey Counties Served
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Jefferson Health Plans Premier (PPO)
How much does plan H3124-003 cost per month?
The plan’s monthly premium is $55.00 for 2027. The Part B premium is not included.
What is the MOOP for Jefferson Health Plans Premier in 2027?
The 2027 in-network MOOP is $7000.00. Once this limit is reached, covered in-network costs are fully covered.
What is the CMS star rating for Jefferson Health Plans Premier?
The 2027 CMS star rating for Jefferson Health Plans Premier is ★2.5 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 0 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Jefferson Health Plans (official source) | http://jeffersonhealthplans.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
MedicarePlans.com is an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.