In-network
Inpatient hospital
Per admission $1,300 per stay
Out-of-network
Tier 1: $1,300 per stay
Point of service
Not separately reported
● CMS 2027 plan record
Longevity Health Plan (PPO I-SNP)
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Emergency transport
Ambulance
Ground · in-network20% coinsurance
Air · in-network20% coinsurance
Emergency services
Emergency room
$115 copay
Waived if admitted within 3 days
Medical maximum
Maximum out-of-pocket
In-network$9,850
Combined in + out$14,800
Skilled care at home
Home health
In-network$0 cost share
Out-of-network30% coinsurance
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$18.80 / month
CMS reports no Part B premium reduction for this plan.
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Primary care physician
In: Primary Care Physician Services: $0 cost share · Out: 7a: 30% coinsurance
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Specialist
In: Physician Specialist Services: 0%–20% coinsurance · Out: 7d: 30% coinsurance
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Preventive care
In: Annual Physical Exam: Not applicable; Kidney Disease Education Services: $0 cost share; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share · Out: 14d: 30% coinsurance; 14e1: 30% coinsurance; 14e2: 30% coinsurance; 14e4: 30% coinsurance; 14e5: 30% coinsurance; 14a: 30% coinsurance
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Diagnostic procedures & tests
In: Diagnostic Procedures/Tests: 20% coinsurance · Out: 8a1: 30% coinsurance
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Laboratory services
In: Not separately reported · Out: 8a2: 30% coinsurance
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X-rays & standard imaging
In: Outpatient X-Ray Services: 20% coinsurance · Out: 8b3: 30% coinsurance
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MRI, CT & PET imaging
In: Diagnostic Radiological Services: 20% coinsurance · Out: 8b1: 30% coinsurance
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Urgent care
In: Urgently Needed Services: 20% coinsurance · Out: Not separately reported
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Emergency room
In: $115 copay · Out: Not separately reported
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Ground ambulance
In: 20% coinsurance · Out: 20% coinsurance
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Air ambulance
In: 20% coinsurance · Out: 20% coinsurance
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Outpatient hospital
In: Outpatient Hospital Services: 20% coinsurance; Observation Services: 20% coinsurance · Out: 9a1: 30% coinsurance; 9a2: 30% coinsurance
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Outpatient surgery / ASC
In: Ambulatory Surgical Center (ASC) Services: 20% coinsurance · Out: 9b: 30% coinsurance
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Home health
In: $0 cost share · Out: 30% coinsurance
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Skilled nursing facility
In: Skilled nursing facility: $0 cost share · Out: Skilled nursing facility: Tier 1: 30% coinsurance for days 1–999; 30% coinsurance
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Cardiac & pulmonary rehabilitation
In: Cardiac Rehabilitation Services: 20% coinsurance; Intensive Cardiac Rehabilitation Services: 20% coinsurance; Pulmonary Rehabilitation Services: 20% coinsurance; SET for PAD Services: 20% coinsurance; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable · Out: 3-1: 30% coinsurance; 3-2: 30% coinsurance; 3-3: 30% coinsurance; 3-4: 30% coinsurance
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Occupational therapy
In: Occupational Therapy Services: $0 cost share · Out: 7c: 30% coinsurance
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Physical & speech therapy
In: Physical Therapy and Speech-Language Pathology Services: $0 cost share · Out: 7i: 30% coinsurance
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Mental health services
In: Partial Hospitalization Program: 20% coinsurance; Individual Sessions for Mental Health Specialty Services: 20% coinsurance; Group Sessions for Mental Health Specialty Services: 20% coinsurance; Individual Sessions for Psychiatric Services: 20% coinsurance; Group Sessions for Psychiatric Services: 20% coinsurance; Inpatient psychiatric hospital: Tier 1: $1,300 per stay · Out: 5a: 30% coinsurance; 7e1: 30% coinsurance; 7e2: 30% coinsurance; 7h1: 30% coinsurance; 7h2: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: $1,300 per stay
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Substance use treatment
In: Intensive Outpatient Program Services: 20% coinsurance; Individual Sessions for Outpatient Substance Abuse: 20% coinsurance; Group Sessions for Outpatient Substance Abuse: 20% coinsurance · Out: 5b: 30% coinsurance; 9c1: 30% coinsurance; 9c2: 30% coinsurance
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Podiatry
In: Podiatry Services: 20% coinsurance · Out: 7f: 30% coinsurance; 7f_2: 30% coinsurance
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Chiropractic
In: Chiropractic Services: 20% coinsurance · Out: 7b: 30% coinsurance
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Dental
In: Medicare Dental Services: 20% coinsurance · Out: 16a: 30% coinsurance
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Vision
In: Eye Exams: 20% coinsurance; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: $0 cost share · Out: 17a: 30% coinsurance; 17a1: 30% coinsurance; 17b: 30% coinsurance; 17b1: 30% coinsurance; 17b2: 30% coinsurance; 17b3: 30% coinsurance; 17b4: 30% coinsurance; 17b5: 30% coinsurance
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Hearing
In: Hearing Exams: 20% coinsurance; Prescription Hearing Aids (all types): $0 cost share; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable; OTC Hearing Aids: $0 cost share · Out: 18a: 30% coinsurance; 18a1: 30% coinsurance; 18a2: 30% coinsurance; 18b1: 30% coinsurance; 18c: 30% coinsurance
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Transportation
In: 10b(NMC): $0 cost share · Out: Not separately reported
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Fitness & wellness
In: Fitness Benefit: Not applicable · Out: Not separately reported
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Over-the-counter allowance
In: Over-the-Counter (OTC) Items: $0 cost share · Out: 13b: 30% coinsurance
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Meals
In: Meal Benefit: Not applicable · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-networkPrimary Care Physician Services: $0 cost share
Out-of-network7a: 30% coinsurance
Specialist
In-networkPhysician Specialist Services: 0%–20% coinsurance
Out-of-network7d: 30% coinsurance
Preventive care
In-networkAnnual Physical Exam: Not applicable; Kidney Disease Education Services: $0 cost share; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share
Out-of-network14d: 30% coinsurance; 14e1: 30% coinsurance; 14e2: 30% coinsurance; 14e4: 30% coinsurance; 14e5: 30% coinsurance; 14a: 30% coinsurance
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-networkDiagnostic Procedures/Tests: 20% coinsurance
Out-of-network8a1: 30% coinsurance
Laboratory services
In-networkNot separately reported
Out-of-network8a2: 30% coinsurance
X-rays & standard imaging
In-networkOutpatient X-Ray Services: 20% coinsurance
Out-of-network8b3: 30% coinsurance
MRI, CT & PET imaging
In-networkDiagnostic Radiological Services: 20% coinsurance
Out-of-network8b1: 30% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkUrgently Needed Services: 20% coinsurance
Out-of-networkNot separately reported
Emergency room
In-network$115 copay
Out-of-networkNot separately reported
Ground ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Air ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient hospital
In-networkOutpatient Hospital Services: 20% coinsurance; Observation Services: 20% coinsurance
Out-of-network9a1: 30% coinsurance; 9a2: 30% coinsurance
Outpatient surgery / ASC
In-networkAmbulatory Surgical Center (ASC) Services: 20% coinsurance
Out-of-network9b: 30% coinsurance
Recovery & therapy5 benefits
Home health
In-network$0 cost share
Out-of-network30% coinsurance
Skilled nursing facility
In-networkSkilled nursing facility: $0 cost share
Out-of-networkSkilled nursing facility: Tier 1: 30% coinsurance for days 1–999; 30% coinsurance
Cardiac & pulmonary rehabilitation
In-networkCardiac Rehabilitation Services: 20% coinsurance; Intensive Cardiac Rehabilitation Services: 20% coinsurance; Pulmonary Rehabilitation Services: 20% coinsurance; SET for PAD Services: 20% coinsurance; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-network3-1: 30% coinsurance; 3-2: 30% coinsurance; 3-3: 30% coinsurance; 3-4: 30% coinsurance
Occupational therapy
In-networkOccupational Therapy Services: $0 cost share
Out-of-network7c: 30% coinsurance
Physical & speech therapy
In-networkPhysical Therapy and Speech-Language Pathology Services: $0 cost share
Out-of-network7i: 30% coinsurance
Behavioral health2 benefits
Mental health services
In-networkPartial Hospitalization Program: 20% coinsurance; Individual Sessions for Mental Health Specialty Services: 20% coinsurance; Group Sessions for Mental Health Specialty Services: 20% coinsurance; Individual Sessions for Psychiatric Services: 20% coinsurance; Group Sessions for Psychiatric Services: 20% coinsurance; Inpatient psychiatric hospital: Tier 1: $1,300 per stay
Out-of-network5a: 30% coinsurance; 7e1: 30% coinsurance; 7e2: 30% coinsurance; 7h1: 30% coinsurance; 7h2: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: $1,300 per stay
Substance use treatment
In-networkIntensive Outpatient Program Services: 20% coinsurance; Individual Sessions for Outpatient Substance Abuse: 20% coinsurance; Group Sessions for Outpatient Substance Abuse: 20% coinsurance
Out-of-network5b: 30% coinsurance; 9c1: 30% coinsurance; 9c2: 30% coinsurance
Specialty care2 benefits
Podiatry
In-networkPodiatry Services: 20% coinsurance
Out-of-network7f: 30% coinsurance; 7f_2: 30% coinsurance
Chiropractic
In-networkChiropractic Services: 20% coinsurance
Out-of-network7b: 30% coinsurance
Supplemental benefits7 benefits
Dental
In-networkMedicare Dental Services: 20% coinsurance
Out-of-network16a: 30% coinsurance
Vision
In-networkEye Exams: 20% coinsurance; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: $0 cost share
Out-of-network17a: 30% coinsurance; 17a1: 30% coinsurance; 17b: 30% coinsurance; 17b1: 30% coinsurance; 17b2: 30% coinsurance; 17b3: 30% coinsurance; 17b4: 30% coinsurance; 17b5: 30% coinsurance
Hearing
In-networkHearing Exams: 20% coinsurance; Prescription Hearing Aids (all types): $0 cost share; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable; OTC Hearing Aids: $0 cost share
Out-of-network18a: 30% coinsurance; 18a1: 30% coinsurance; 18a2: 30% coinsurance; 18b1: 30% coinsurance; 18c: 30% coinsurance
Transportation
In-network10b(NMC): $0 cost share
Out-of-networkNot separately reported
Fitness & wellness
Not applicableIn-networkFitness Benefit: Not applicable
Out-of-networkNot separately reported
Over-the-counter allowance
In-networkOver-the-Counter (OTC) Items: $0 cost share
Out-of-network13b: 30% coinsurance
Meals
Not applicableIn-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · CMS reports no Part B premium reduction for this plan.
Maximum out-of-pocket (MOOP)
In-network$9,850
Combined in + out$14,800
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Annual health deductible
$0
Combined network deductible
Not separately reported
Part D premium
$18.80 / month
Network & referrals
Local PPO · Referrals: Required for some services · Out-of-network coverage: Yes
Prescription drugs0 tiers
Part D deductible
$700 / year
Using this plan
Understand H9942-001-000
Plain-language context built from this plan’s 2027 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
Longevity Health Plan (PPO I-SNP) is a 2027 Local PPO offered by Longevity Health Plan in New Jersey (partial). The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. Referrals are required for some services.
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
- Primary Care Physician Services: $0 cost share
- Specialist
- Physician Specialist Services: 0%–20% coinsurance
- Laboratory services
- Not separately reported
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- Diagnostic Procedures/Tests: 20% coinsurance
- MRI, CT & PET imaging
- Diagnostic Radiological Services: 20% coinsurance
- Outpatient hospital
- Outpatient Hospital Services: 20% coinsurance; Observation Services: 20% coinsurance
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $115 copay
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.
Part B premium reduction (“giveback”)
A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports no Part B premium reduction for this plan.
Availability
Who can enroll
- Service area
- New Jersey (partial) (NJ)
- Plan type
- Local PPO
- Special Needs Plan
- Institutional
- Contract / plan
- H9942-001
- Coverage year
- 2027
This is a Institutional; enrollment requires the plan's specific eligibility criteria as well as residence in its 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.
DentalMedicare Dental Services: 20% coinsurance
VisionEye Exams: 20% coinsurance; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: $0 cost share
HearingHearing Exams: 20% coinsurance; Prescription Hearing Aids (all types): $0 cost share; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable; OTC Hearing Aids: $0 cost share
Over-the-counter allowanceOver-the-Counter (OTC) Items: $0 cost share
Transportation10b(NMC): $0 cost share
Plan-specific answers
Frequently asked questions
Where is H9942-001-000 available?
Longevity Health Plan (PPO I-SNP) is listed for New Jersey (partial) (NJ). This is a Institutional; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.
What is the in-network maximum out-of-pocket limit for H9942-001-000?
The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $9,850. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H9942-001-000?
The listed consolidated Part C and Part D premium is $18.80 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H9942-001-000?
The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.
Does H9942-001-000 report extra benefits?
Yes. CMS reports dental, vision, hearing, over-the-counter allowance, transportation. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2027
Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.
Plan context
Where H9942-001-000 fits
- Full CMS plan ID
H9942-001-000- Contract
H9942- Base plan code
H9942-001- Segment
000- Carrier
- Longevity Health Plan
- Plan type
- Local PPO
- Service area
- New Jersey (partial) (NJ)
County/service-area foundation
CMS service-area entries
Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.
- Atlantic, NJ
- Bergen, NJ
- Burlington, NJ
- Camden, NJ
- Cape May, NJ
- Essex, NJ
- Gloucester, NJ
- Hudson, NJ
- Hunterdon, NJ
- Mercer, NJ
- Middlesex, NJ
- Monmouth, NJ
6 additional service-area entries are retained in the data record.
Exact county navigation
Counties with exact segment geography
These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.
Show 18 county links
New Jersey
- Atlantic County, New Jersey
- Bergen County, New Jersey
- Burlington County, New Jersey
- Camden County, New Jersey
- Cape May County, New Jersey
- Essex County, New Jersey
- Gloucester County, New Jersey
- Hudson County, New Jersey
- Hunterdon County, New Jersey
- Mercer County, New Jersey
- Middlesex County, New Jersey
- Monmouth County, New Jersey
- Morris County, New Jersey
- Ocean County, New Jersey
- Passaic County, New Jersey
- Somerset County, New Jersey
- Union County, New Jersey
- Warren County, New Jersey
About this code
What H9942-001-000 identifies
H9942-001-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H9942-001, H9942 001, or the compact full CMS ID H9942001000 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.