Health Partners Medicare Prime's monthly premium in Berks County is $35.60. That includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H9207-002 Summary of Benefits).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $350.00 per year. That means you pay 100% of your prescription costs until you've spent $350.00, then the plan will begin paying it's share.
IMPORTANT: When evaluating Health Partners Medicare Prime, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
Maximum Out-of-Pocket (MOOP) Limit
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Health Partners Medicare Prime plan MOOP is $6,700 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in Berks County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
Contact Health Partners
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the Health Partners Medicare website.
Additional Medicare Plan Options in Berks County
Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
- UPMC for Life Dual (Local HMO), for Dual-Eligible beneficiaries
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
- AmeriHealth Caritas VIP Care (Local HMO), for Dual-Eligible beneficiaries
- Humana Gold Plus SNP-DE H6622-038 (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Freedom Blue PPO Standard (PPO)
- BlueJourney Premier (HMO)
- Lasso Healthcare (MSA)
- Aetna Medicare Advantra Core (HMO)
- HumanaChoice H5525-038 (PPO)