Medicare Advantage Plan H1619-003-0 in Dauphin County, PA Jefferson Health Plans Flex Pro (PPO) • 2026
Plan-ID H1619-003-0 refers to Jefferson Health Plans Flex Pro (PPO), a Medicare Advantage Plan (Part C) offered by Jefferson Health Plans for the 2026 plan year. This plan is a Preferred Provider Organization (PPO) model with Part D prescription drug coverage.
According to CMS enrollment data, an estimated 2,483 beneficiaries are enrolled in this plan, 11 enrollees reside in Dauphin County.
Jefferson Health Plans Flex Pro Overview
Plan Overview for H1619-003-0 |
|
|---|---|
| CMS Plan ID: |
H1619-003-0
|
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: |
$18.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $6000.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Dauphin County, PA |
| Enrollment (Nationwide): | 2,483 beneficiaries |
| Enrollment (CMS – Local) | 11 beneficiaries in Dauphin County |
| Provided By: | Jefferson Health Plans |
To learn more about your plan options, costs, and enrollment periods without agent assistance, try our helpful Medicare Resources below (click to open).
Frequently Asked Questions About Jefferson Health Plans Flex Pro (PPO)
Here are some of the most frequently asked questions people have about Plan ID H1619-003-0:
How much does Jefferson Health Plans Flex Pro cost per month?
Jefferson Health Plans Flex Pro has a $18.00 monthly premium for 2026. You must also continue to pay any Medicare Part B premium you owe.
What is the out-of-pocket maximum for Plan ID H1619-003-0?
The in-network maximum out-of-pocket (MOOP) limit for Jefferson Health Plans Flex Pro is $6000.00 in 2026. After you reach this limit, the plan pays covered in-network Part A and Part B costs for the remainder of the year.
Is prescription drug coverage included with Jefferson Health Plans Flex Pro?
Yes. Jefferson Health Plans Flex Pro includes Medicare Part D prescription drug coverage. The 2026 Part D deductible is $0.00.
How is Plan ID H1619-003-0 rated by CMS?
Contract H1619, which includes this plan, has a ★0.0 out of 5 CMS Star Rating for 2026.
What type of provider network does Jefferson Health Plans Flex Pro use?
Jefferson Health Plans Flex Pro is a Preferred Provider Organization (PPO) Medicare Advantage plan.
How many people are enrolled in Jefferson Health Plans Flex Pro?
The most recent CMS enrollment data shows approximately 2,483 beneficiaries enrolled in Plan ID H1619-003-0.
Who provides Jefferson Health Plans Flex Pro (PPO)?
Plan ID H1619-003-0 is offered by Jefferson Health Plans.
Covered Services & Costs
Office Visits
This plan lists in-network cost sharing for primary care and specialist visits, along with related office-based services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Specialist: | In-network: $0 copay | Out-of-network: $0 copay |
Preventive and Wellness Services
Preventive and wellness benefits may include routine exams, telehealth, fitness programs, health education, and other in-network services.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$20 copay |
| Routine chiropractic: | In-network: $20 copay | Out-of-network: $20 copay |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency): | Not covered |
Diagnostic, Lab, and Imaging Services
Diagnostic coverage includes in-network cost sharing for lab tests, x-rays, radiology, and other diagnostic procedures used to evaluate health conditions.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $170 copay | Out-of-network: $170 copay |
| Lab services: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Outpatient x-rays: | In-network: $35 copay | Out-of-network: $35 copay |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
Emergency and Urgent Care Services
Emergency and inpatient coverage includes cost sharing for urgent care, emergency room visits, ambulance transportation, hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $100 copay |
| Worldwide emergency care: | $0 copay |
| Urgent care: | $15 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $800 Lifetime Reserve Days for days 1-60 | $375 per stay | Out-of-network: | $375 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $160 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $160 per day for days 21-100 | $0 per stay |
| Ground ambulance: | In-network: $225 copay | Out-of-network: $225 copay |
Mental Health Services
Mental health coverage includes in-network cost sharing for outpatient individual and group therapy, as well as inpatient psychiatric hospital care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $20 copay | Out-of-network: $20 copay |
| Outpatient group therapy: | In-network: $20 copay | Out-of-network: $20 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $800 Lifetime Reserve Days for days 1-60 | $375 per stay | Out-of-network: | $375 per stay |
Rehabilitation Services
Rehabilitation coverage includes in-network cost sharing for physical therapy, speech and language therapy, and occupational therapy services.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20 copay | Out-of-network: $20 copay |
| Occupational therapy: | In-network: $20 copay | Out-of-network: $20 copay |
Medical Equipment and Supplies
Medical equipment coverage includes in-network cost sharing for diabetes supplies, durable medical equipment, prosthetics, and related supplies.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
Medicare Part B Drugs
Medicare Part B drug coverage includes in-network cost sharing for chemotherapy and other medications covered under Medicare Part B.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
Dental Services
Dental coverage includes in-network cost sharing for preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Periodontics: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Endodontics: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Restorative services: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: 50% coinsurance |
Vision Services
Vision coverage includes in-network cost sharing for routine eye exams, contact lenses, eyeglass frames and lenses, and related eyewear services.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Upgrades: | Not covered |
Hearing Services
Hearing coverage includes in-network cost sharing for hearing exams, fittings and evaluations, prescription hearing aids, and over-the-counter hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | In-network: $500-$1975 copay | Out-of-network: $500-$1975 copay |
| OTC hearing aids: | Not covered |
Additional and Special Needs Services
Additional benefits may include in-network services for adult day health, palliative care, personal emergency response systems, weight management, alternative therapies, and home safety needs.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Jefferson Health Plans Flex Pro covers 100% of certain preventive services as a required Part B benefit.
Prescription Drug Coverage
Part D Coverage Level (Benefit Design)
Jefferson Health Plans Flex Pro includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $18.00 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $18.00 |
| Low Income Premium Subsidy: | $32.71 |
| Low Income Premium Subsidy CMS Pays: | $18.00 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. This is the amount you must pay at the pharmacy before Jefferson Health Plans begins paying its share.
Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Jefferson Health Plans Flex Pro has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 34% coinsurance | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Medicare Star Ratings
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage PPOs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this Jefferson Health Plans plan.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
Contact Jefferson Health Plans
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (M-F 8AM-10PM, Sat 9AM-8PM EST) and learn more about this plan and other plans on this site. You may also Enroll Online .
| Contact Type | Details |
|---|---|
| Website: | Jefferson Health Plans Plan Page |
| New Members: | 1-833-477-4773 |
| Existing Members: | 1-866-901-8000 |
| Plan Address: | 1101 Market Street | Suite 3000 | Philadelphia, PA 19107 |
Medicare Plan Decision Resources
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | 202608 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-08 |
| Publisher | Reference | Last Accessed |
|---|---|---|
| Jefferson Health Plans (official source) | http://JeffersonHealthPlans.com/medicare | October 13, 2025 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
Medicare.org independently compiles and interprets Medicare plan information using data published by the Centers for Medicare & Medicaid Services (CMS), official plan information, and other authoritative Medicare sources. The sources used for this plan are documented below.
Medicare.org is an independent Medicare information and enrollment resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program. Enrollment assistance is provided through HealthCompare, an Allstate company.
Medicare plan data and editorial content curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for Medicare plan interpretation and publication.