Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Jefferson Health Plans Special, 2027

H9207Contract004Plan

HMO D-SNP · special needs plan, dual-eligible · 42 counties in Pennsylvania

Run by Health Partners Plans, Inc. (contract H9207), sold as Jefferson Health Plans, owned by Thomas Jefferson University

Renews for 2027

2026 star rating, contract H9207: 3.5 of 5

Jefferson Health Plans Special (H9207-004) costs $12.80 a month in 2027, down $19.90 from 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
Monthly premium	$32.70	$12.80	down $19.90
In-network out-of-pocket limit	$9,250	$9,850	up $600
Drug deductible	$615	$700	up $85
Over-the-counter items, yearly	$1,000 a year	$2,580 a year	up $1,580
Counties served	28	42	up 14
Drug tier 4, non-preferred drug	28% of the cost	29% of the cost	up 1 point
16 lines do not change
Part B premium reduction, monthly	none	none	no change
Primary care visit	20% of the cost	20% of the cost	no change
Specialist visit	20% of the cost	20% of the cost	no change
Emergency room	30% of the cost	30% of the cost	no change
Medical deductible, in network	none	none	no change
Hospital stay, in network	$1,690 a stay	$1,690 a stay	no change
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $218 a day for days 21–100	no change
Ground ambulance, in network	30% of the cost	30% of the cost	no change
Comprehensive dental, yearly limit	$5,000 a year	$5,000 a year	no change
Eyewear, yearly limit	not offered	not offered	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Drug tier 1, preferred generic	$0	$0	no change
Drug tier 2, generic	20% of the cost	20% of the cost	no change
Drug tier 3, preferred brand	24% of the cost	24% of the cost	no change
Drug tier 5, specialty tier	25% of the cost	25% of the cost	no change
Drug tier 6, select care drugs	$0	$0	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked
Tier	What the tier holds	2026	2027
Tier 1	Preferred Generic	$0	$0
Tier 2	Generic	20% of the cost	20% of the cost
Tier 3	Preferred Brand	24% of the cost	24% of the cost
Tier 4	Non-Preferred Drug	28% of the cost	29% of the cost
Tier 5	Specialty Tier	25% of the cost	25% of the cost
Tier 6	Select Care Drugs	$0	$0

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 35 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 5 plans have a lower out-of-pocket limit, 29 the same. On the premium, 26 plans have a lower premium, 8 the same.

Out-of-pocket limits of the 35 dual-eligible special needs plans

$0 to under $2,0000 plans

$2,000 to under $4,0000 plans

$4,000 to under $6,0001 plan

$6,000 to under $8,0003 plans

$8,000 to $10,000 (this plan)31 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 42 counties: $12.80 a month and $9,850.

Pennsylvania

Adams Allegheny Armstrong Beaver Bedford Berks Bradford Bucks Butler Carbon Chester Clarion Crawford Cumberland Dauphin Delaware Erie Forest Franklin Fulton Greene Huntingdon Lancaster Lebanon Lehigh Luzerne Monroe Montgomery Montour Northampton Perry Philadelphia Schuylkill Snyder Sullivan Susquehanna Venango Warren Washington Wayne Wyoming York

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H9207-004
Legal name of the contract: Health Partners Plans, Inc.
Sold as: Jefferson Health Plans
Parent company: Thomas Jefferson University
Plan type: HMO D-SNP
2026 star rating of the contract: 3.5 of 5 overall; health plan 3.5 of 5, drug plan 3.5 of 5
Members, September 2026: 6,189
Plan website, as filed with CMS: JeffersonHealthPlans.com/medicare

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Philadelphia, PAWhere most of its members live; premiums and limits side by side
Every Jefferson Health Plans plan for 2027Its contracts, counties and plans that end
The other 6 plans of contract H9207Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.