Jefferson Health Plans

What Jefferson Health Plans does

Jefferson Health Plans is the marketing name for products of Health Partners Plans, Inc., a not-for-profit Pennsylvania-licensed Managed Care Organization founded in 1984 and serving more than 370,000 members across Pennsylvania and New Jersey. It operates as the payor arm of the Jefferson Enterprise, alongside Jefferson Health and Thomas Jefferson University, following Jefferson's November 2021 acquisition of Health Partners Plans. The portfolio comprises four core insurance products: Jefferson Health Plans EverWell (Medicaid for individuals with limited financial resources), Jefferson Health Plans CHIP (low- or no-cost coverage for Pennsylvania children under 19), Jefferson Health Plans Medicare Advantage (13 HMO, PPO, and D-SNP plans with embedded Part D, dental, vision, flex cards, and SilverSneakers), and Jefferson Health Plans Individual and Family Plans (ACA marketplace products distributed via the Pennie marketplace). A unified system-wide rebrand completed on June 1, 2026 brought all four product lines under the single Jefferson Health Plans identity.

The technology and operations stack centers on the Health Trio Provider Portal and Health Trio Connect member portal for eligibility, claims, prior authorizations, and member self-service, supplemented by the MHK platform for prior authorizations, CMS-mandated FHIR-based interoperability APIs (Patient Access, Provider Directory, Formulary), electronic claims submission, and real-time eligibility transactions via Optum and Smart Data Solutions. Provider-facing workflows incorporate InterQual medical necessity criteria, Eviti Connect for autoimmune specialty drug authorizations, Cotiviti and Zelis for post-payment and inpatient bill review, HHAeXchange for home health EVV compliance, and Let'sGetChecked for in-home screening kits. Member and community engagement is supported by Community Wellness Centers in West Philadelphia, Wissahickon, and (coming soon) Lehigh Valley Schuylkill, alongside telehealth, SilverSneakers, and care management programs such as Baby Partners maternity coordination.

The business model is recurring per-member-per-month capitation across government-sponsored and ACA lines. Revenue is generated through state Medicaid and CHIP capitation payments from the Pennsylvania Department of Human Services, CMS Medicare Advantage capitation, and ACA marketplace premiums distributed via Pennie. Go-to-market is hybrid: direct-to-consumer enrollment via website and member services phone lines, broker and licensed sales agent relationships for Individual/Family and Medicare, provider referrals from the Jefferson Health clinical network, and state agency enrollment systems for Medicaid/CHIP. Member segments include Medicaid, CHIP, Medicare-eligible seniors, and ACA-qualified individuals and families, served through a provider network of 10,000+ doctors for Medicare and 13,000+ providers for Individual/Family plans.

Name

Jefferson Health Plans

Legal name

Health Partners Plans, Inc.

Website

https://jeffersonhealthplans.com

Company type

Private

Founded year

1984

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Jefferson Health Plans is a not-for-profit Pennsylvania-licensed managed care organization serving more than 370,000 Medicaid, CHIP, Medicare Advantage, and Individual/Family plan members across Pennsylvania and New Jersey as the payor arm of the Jefferson Enterprise.

Ownership category

akta.pro rank

Product category

Health Insurance (Managed Care)

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

MA Prescription Drug Plans (MA-PD) (HLAEACAF)

akta.pro secondary industry

Employer Wellness & Population Health Programs (HLAEAAAH)

Keywords

• Managed care organization
• Medicaid health plans
• Medicare advantage plans
• Childrens health insurance
• Individual family coverage

Headquarters

HQ city

Philadelphia

HQ country

United States

HQ region

North America

Offices4 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Government Program Premiums: Revenue from government health insurance programs including Medicaid, CHIP, and Medicare Advantage. Health Partners Plans, Inc. serves more than 370,000 members through these government-funded programs.
2. Individual and Family Plan Premiums: ACA marketplace plans for individuals and families not covered through employer, Medicaid, Medicare, or CHIP. Enrolled through Pennie marketplace.

Pricing tiers

Go-to-market motion2 records

Distribution channels5 records

Marketing channels7 records

Core offering

Jefferson Health Plans is a not-for-profit managed care organization that underwrites and administers government-sponsored and ACA marketplace health insurance products for individuals and families across Pennsylvania and New Jersey. Its portfolio includes Medicaid (EverWell), CHIP, Medicare Advantage (HMO, HMO-DSNP, PPO), and Individual and Family Plans, serving more than 370,000 members through provider networks, care management programs, and community wellness initiatives.

Product overview

Jefferson Health Plans is a not-for-profit managed care organization offering a comprehensive portfolio of health coverage products under a unified Jefferson Health Plans brand. The portfolio consists of four core insurance products: Jefferson Health Plans Medicare Advantage (HMO, HMO-DSNP, PPO plans for seniors), Jefferson Health Plans EverWell (Medicaid coverage for individuals with limited financial resources), Jefferson Health Plans CHIP (Children's Health Insurance Program for Pennsylvania children under 19), and Jefferson Health Plans Individual and Family Plans (ACA marketplace coverage). These core products are complemented by value-added programs including Baby Partners maternity coordination, Care Management programs, Wellness Rewards incentive programs, Community Wellness Centers offering fitness and health education, telehealth services, and provider-facing portals (Health Trio Provider Portal, Jefferson Provider Portal) for administrative functions. The organization serves more than 370,000 members across Pennsylvania and New Jersey, operating as part of the Jefferson Enterprise alongside Thomas Jefferson University and Jefferson Health.

Differentiator

Problem solved

Functional benefit

Products and services

• Jefferson Health Plans EverWell (Medicaid) Medicaid managed care plan (formerly Health Partners Plans Medicaid) for Pennsylvania individuals and families with limited financial resources. Provides comprehensive health coverage with $0 copays for covered services and prescriptions, enhanced vision, dental, and hearing benefits, and access to the Jefferson Health Plans provider network. Available through the Pennsylvania Department of Human Services.
• Jefferson Health Plans CHIP Children's Health Insurance Program providing coverage for Pennsylvania children under 19 who are uninsured and not eligible for Medicaid. Features low or no copays for doctor visits, free fitness center memberships, prescription drug coverage, vision (eye exams and glasses), dental care, and community programming. Available in all Pennsylvania counties.
• Jefferson Health Plans Medicare Advantage Medicare Advantage plans offered as HMO, HMO-DSNP, and PPO options, providing benefits beyond Original Medicare including dental, vision, hearing, prescription drug coverage, flex cards, SilverSneakers fitness benefit, and the Wellness Rewards program. Available in Pennsylvania and New Jersey with 13 plan options and a network of 10,000+ doctors and specialists.
• Jefferson Health Plans Individual and Family Plans ACA marketplace health insurance plans for individuals and families not covered through an employer, Medicaid, Medicare, or CHIP. Plans offer $0 primary care visits with Tier 1 providers, $0 medical deductible options, low-cost prescriptions, and access to a network of more than 13,000 providers with no referrals required. Enrolled through the Pennie.com marketplace.

Quantifiable outcome

• Nearly 12,000 new Medicare Advantage customers added during open enrollment - biggest annual gain
• +2 more outcomes

Named customers4 records

Segments4 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration19 records

Feature4 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• PacifycoreStrategic or Co-development Partner · 17 March 2026New partnership providing lactation and doula services to expand pregnancy and postpartum support. Includes in-person labor and delivery doula support, up to 12 prenatal/postpartum visits, and 24/7 virtual lactation support. Partnership shown to reduce ED visits, lower NICU admissions, and improve prenatal care adherence.
• LabcorpcoreTechnology or Integration · 1 January 2026Labcorp joined provider network effective January 1, 2026 alongside Quest and Health Network Labs. 230+ laboratory draw sites throughout Pennsylvania and New Jersey, expanding member access to over 650 laboratory sites.
• Optum Behavioral HealthcoreTechnology or Integration · 17 October 2025Beginning January 1, 2026, members enrolled in CHIP, Medicare Advantage, and Individual and Family Plans will receive behavioral health benefits through Optum Behavioral Health.
• Lehigh Valley Health NetworkcoreStrategic or Co-development PartnerAcquisition of Lehigh Valley Health Network influenced Jefferson Health Plans' Medicare Advantage growth in the region, contributing to increased enrollment in Pennsylvania, especially in the Philadelphia region, New Jersey, and Lehigh Valley.
• Sharing ExcessminorStrategic or Co-development PartnerPartnership for monthly fresh food pop-ups at Community Wellness Centers, providing fresh produce, nutrition education, and SNAP benefits assistance.
• Jefferson Collaborative for Health EquitycoreStrategic or Co-development PartnerHealth education programs delivered through the Jefferson Collaborative for Health Equity including Nutrition Education, Tobacco Cessation, Hypertension Management, and Diabetes Self-Management.
• Eviti ConnectcoreTechnology or IntegrationPartnership with NantHealth for Eviti Connect autoimmune diseases platform enabling real-time prior authorization for drugs used to treat autoimmune diseases.
• Quest DiagnosticscoreTechnology or IntegrationLab services provider for non-STAT outpatient laboratory services with extensive draw sites in Pennsylvania and New Jersey.

Scale indicators8 records

Recent moves7 records

Expansion highlights7 records

Broad incumbents

• Humana: Major national Medicare Advantage carrier with strong PA and NJ presence. Competes for MA members in Jefferson Health Plans' core service area and is a key benchmark on MA Stars and supplemental benefits.
• Cigna Healthcare: Large national health insurer with Medicare Advantage and ACA offerings in the mid-Atlantic region. Competes with Jefferson Health Plans for individual and senior members in PA/NJ.
• Aetna (CVS Health): National carrier offering Medicare Advantage, ACA, and Medicaid products, including through CVS Health retail and care delivery assets. Competes across Jefferson Health Plans' product portfolio in PA and NJ.
• UnitedHealthcare: Largest U.S. health insurer with broad Medicare Advantage, Medicaid, and ACA footprints in PA and NJ. Competes in the same government and individual segments as Jefferson Health Plans at a much larger national scale.

Direct peers

• AmeriHealth Caritas: National Medicaid managed care organization with a strong Pennsylvania presence. Competes directly with Jefferson Health Plans EverWell for Pennsylvania Medicaid contracts and members.
• UPMC Health Plan: Integrated health plan of UPMC offering Medicare Advantage, Medicaid (UPMC for You), ACA, and commercial coverage across PA. A direct competitor in government programs with a similarly integrated provider model.
• Independence Blue Cross: Philadelphia-based regional health insurer offering commercial, Medicare, and ACA plans in PA. Closest direct competitor to Jefferson Health Plans, particularly in the Greater Philadelphia and Southeastern PA markets.
• Geisinger Health Plan: Pennsylvania-based integrated health plan offered by Geisinger, with Medicare Advantage, ACA, and Medicaid products. Directly comparable vertically integrated regional MCO competing in central and northeastern PA.
• Highmark Blue Cross Blue Shield: Major PA-based Blues carrier offering Medicare Advantage, ACA, and commercial plans across Pennsylvania. Competes head-to-head with Jefferson Health Plans in MA, ACA, and group segments, and is closely tied to Allegheny Health Network.
• Capital Blue Cross: Pennsylvania-licensed Blues plan serving central PA with commercial, Medicare, and ACA products. A regional peer that competes with Jefferson Health Plans in overlapping PA geographies.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/jeffhealthplans
• YouTubeyoutube.com/@jeffersonhealthplans
• Facebookfacebook.com/jeffersonhealthplans
• LinkedInlinkedin.com/company/jefferson-health-plans
• Instagraminstagram.com/jeffersonhealthplans

Compliance10 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Subsidiaries4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Jefferson Health Plans