Health Partners Medicare Prime (HMO)

Medicare Advantage Plan for Pennsylvania

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHealthPartners
Plan IDH9207-5-0
CMS Rating1
Plan TypeHMO
Annual Deductible$350.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$6,700 In-network
Other health plan deductibles?
Yes
Health Plan Deductible
$0
Monthly Drug Plan Premium
$37.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Inpatient hospital coverage
$290 for days 1 through 6
$0 for days 7 through 90
Outpatient hospital coverage
$250 per visit
Doctor visits
Primary:$0 copay
Specialist:$45 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$80 per visit (always covered)
Urgent care:$45 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$225
Outpatient x-rays:$30
Mental health services
$215 for days 1 through 7
$0 for days 8 through 90
Outpatient group therapy visit with a psychiatrist:$40
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$40
Outpatient individual therapy visit:$40
Skilled Nursing Facility
$0 for days 1 through 20
$167.50 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$40
Physical therapy and speech and language therapy visit:$40
Ambulance
$200
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:$45
Routine foot care:Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:0-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:20%
Other Part B drugs:20%

Coverage Area for Health Partners Medicare Prime (HMO)

StatePennsylvania
CountyPhiladelphia

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$7 copayNot offered
Tier 2: Non-Preferred GenericNot offered$20 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered29% coinsuranceNot offered
Tier 5: Specialty TierNot offered26% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$14 copayNot offered
Tier 2: Non-Preferred GenericNot offered$40 copayNot offered
Tier 3: Preferred Brand NameNot offered$94 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered29% coinsuranceNot offered
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Not Rated
Improving or maintaining mental health
Not Rated
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Not Rated
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Health Partners Medicare Prime (HMO) for Pennsylvania

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AHSAN, SYED
101 E OLNEY AVE
PHILADELPHIA, PA 19120
VANGORE, SURYA
431 W ROOSEVELT BLVD
PHILADELPHIA, PA 19120
WALSH, BRIAN
4702 N 5TH ST
PHILADELPHIA, PA 19120
HOELLEIN, KENNETH
101 E OLNEY AVE
PHILADELPHIA, PA 19120
GRANT, RICHARD
101 E OLNEY AVE
PHILADELPHIA, PA 19120
LANOCE, GARY
4857 C ST
PHILADELPHIA, PA 19120
BLENDER, BURTON
335 E WYOMING AVE
PHILADELPHIA, PA 19120
TADLEY, GERALD
335 E WYOMING AVE
PHILADELPHIA, PA 19120
NGUYEN, KENNETH
448 E WYOMING AVE
PHILADELPHIA, PA 19120
KOWALSKI, JOHN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
TRINH, CHUONG
5920 N 5TH ST
PHILADELPHIA, PA 19120
LLUBERES, JOSELYN
101 E OLNEY AVE
PHILADELPHIA, PA 19120
BROWNSTEIN, ELLIOT
7848 OLD YORK RD
ELKINS PARK, PA 19027
SILVERSTEIN, DANIEL
8302 OLD YORK RD
ELKINS PARK, PA 19027
BIRNBAUM, MICHAEL
8380 OLD YORK RD
ELKINS PARK, PA 19027
SCHWARTZ, MELISSA
375 TOWNSHIP LINE RD
ELKINS PARK, PA 19027
MANIN, BRADLEY
8250 OLD YORK RD # 2
ELKINS PARK, PA 19027
WANNER, JEFFREY
8302 OLD YORK RD
ELKINS PARK, PA 19027
CAHAN, MICHAEL
1939 W CHELTENHAM AVE
ELKINS PARK, PA 19027
EKIZIAN, STEPHANIE
8302 OLD YORK RD
ELKINS PARK, PA 19027
JAFFEE, LEE
1939 W CHELTENHAM AVE
ELKINS PARK, PA 19027
JACOBSON, ZEV
205 YORKTOWN PLZ
ELKINS PARK, PA 19027
KIM, CHONG
7300 OLD YORK RD
ELKINS PARK, PA 19027
COOPERMAN, MICHAEL
921 WEST CHELTENHAM AVE
MELROSE PARK, PA 19027
ROTHKOPF, JAY
8302 OLD YORK RD
ELKINS PARK, PA 19027
Details
SYED AHSAN, MD
Phone Number
(215) 456-7000
Office Locations
101 E OLNEY AVE
PHILADELPHIA, PA 19120
101 E OLNEY AVE PHILADELPHIA PA, 19120

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