Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H1619-003

Medicare Plan

Jefferson Health Plans Flex Pro (PPO) · Jefferson Health Plans · Local PPO · Southern PA, Eastern PA

Full CMS plan ID: H1619-003-000

H1619-003-000 is the full CMS identifier for the H1619-003 Medicare plan. Common searches include H1619 003 and H1619003.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Jefferson Health Plans Flex Pro (PPO)

H1619-003-000 Southern PA, Eastern PA Local PPO

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $375 per stay
Plan-listed inpatient copay $375
02

Emergency transport

Ambulance

Ground · in-network$225 copay
Air · in-network20% coinsurance
03

Emergency services

Emergency room

$100 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$6,000
Combined in + out$9,000
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkCost share not reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$18 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkCost share not reported
Out-of-networkCost share not reported

Specialist

In-network$0 copay
Out-of-network$0 copay

Preventive care

In-networkCost share not reported
Out-of-networkCost share not reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network$0 copay
Out-of-networkCost share not reported

Laboratory services

In-networkCost share not reported
Out-of-networkCost share not reported

X-rays & standard imaging

In-network$170 copay
Out-of-network$170 copay

MRI, CT & PET imaging

In-network20% coinsurance
Out-of-network20% coinsurance
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$100 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$225 copay
Out-of-network$225 copay

Air ambulance

In-network20% coinsurance
Out-of-network20% coinsurance

Outpatient hospital

In-network$200 copay
Out-of-network$200 copay

Outpatient surgery / ASC

In-network$125 copay
Out-of-network$125 copay
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkCost share not reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network$0 copay
Out-of-networkCost share not reported

Occupational therapy

In-network$20 copay
Out-of-network$20 copay

Physical & speech therapy

In-network$20 copay
Out-of-network$20 copay
Behavioral health2 benefits

Mental health services

In-network$70 copay
Out-of-network$70 copay

Substance use treatment

In-network$70 copay
Out-of-network$70 copay
Specialty care2 benefits

Podiatry

In-network$15 copay
Out-of-network$15 copay

Chiropractic

In-network$20 copay
Out-of-network$20 copay
Supplemental benefits7 benefits

Dental

In-network$15 copay
Out-of-network$15 copay

Vision

In-networkCost share not reported
Out-of-networkCost share not reported

Hearing

In-network$500–$1,975 copay
Out-of-network$500–$1,975 copay

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

In-networkCost share not reported
Out-of-networkCost share not reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

In-networkCost share not reported
Out-of-networkCost share not reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$6,000
Combined in + out$9,000

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs5 tiers

Part D deductible

Not reported

Drug tier 1

$0 retail copay · 30-day supply

Drug tier 2

$0 retail copay · 30-day supply

Drug tier 3

25% retail coinsurance · 30-day supply

Drug tier 4

34% retail coinsurance · 30-day supply

Drug tier 5

33% retail coinsurance · 30-day supply

Using this plan

Understand H1619-003-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Jefferson Health Plans Flex Pro (PPO) is a 2026 Local PPO offered by Jefferson Health Plans in Southern PA, Eastern PA. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $375 across null charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Cost share not reported
Specialist
$0 copay
Laboratory services
Cost share not reported

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
$0 copay
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
$200 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$100 copay
Listed inpatient stages
$375 total

null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Southern PA, Eastern PA (PA)
Plan type
Local PPO
Contract / plan
H1619-003
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental$15 copay
VisionCost share not reported
Hearing$500–$1,975 copay
Fitness & wellnessCost share not reported
MealsCost share not reported

Plan-specific answers

Frequently asked questions

Where is H1619-003-000 available?

Jefferson Health Plans Flex Pro (PPO) is listed for Southern PA, Eastern PA (PA). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H1619-003-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $6,000. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H1619-003-000?

The listed consolidated Part C and Part D premium is $18 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H1619-003-000?

The plan record lists $100 copay, waived when an admission meets the plan's stated timing rule.

Does H1619-003-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H1619-003-000 fits

Full CMS plan ID
H1619-003-000
Contract
H1619
Base plan code
H1619-003
Segment
000
Carrier
Jefferson Health Plans
Plan type
Local PPO
Service area
Southern PA, Eastern PA (PA)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Adams, PA
  • Berks, PA
  • Bradford, PA
  • Bucks, PA
  • Carbon, PA
  • Chester, PA
  • Cumberland, PA
  • Dauphin, PA
  • Delaware, PA
  • Franklin, PA
  • Lancaster, PA
  • Lebanon, PA

8 additional service-area entries are retained in the data record.

Same CMS contract

H1619-001-000 Jefferson Health Plans Flex (PPO) Southeastern PA, Central PA and Eastern PA · Local PPO H1619-002-000 Jefferson Health Plans Flex Plus (PPO) Southeastern PA, Central PA and Eastern PA · Local PPO

About this code

What H1619-003-000 identifies

H1619-003-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H1619-003, H1619 003, or the compact full CMS ID H1619003000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.