A non-government entity
Personal Choice 65 Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Rx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Personal Choice 65 Rx (PPO) in 2025, please refer to our full plan details page.
Personal Choice 65 Rx (PPO) is a PPO plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Bucks, Philadelphia Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Personal Choice 65 Rx (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Personal Choice 65 Rx (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Personal Choice 65 Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $192.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Personal Choice 65 Rx (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Personal Choice 65 Rx (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and standard mail order, while standard generic drugs have 25% coinsurance at both preferred and standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D premium will be reduced to $12.80.
Additional Benefits
The Personal Choice 65 Rx (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. The plan also covers primary care visits, preventive services, and routine hearing and vision exams with no copay. Dental services, including oral exams and cleanings, are covered with no copay, while other services have coinsurance. Additional benefits include ambulance, emergency, and home health services with copays or no copays, as well as coverage for durable medical equipment, diagnostic services, and skilled nursing facility stays with copays or coinsurance. The plan also provides coverage for acupuncture and over-the-counter items. However, certain services like cardiac rehabilitation, private duty nursing, and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $240 copay for days 1-6 and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you pay a $240 copay for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $300 copay, observation services with a $300 copay, and ambulatory surgical center services with a $150 copay. Outpatient substance abuse services are covered with a copay of $30 for individual sessions, and $20 for group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Personal Choice 65 Rx (PPO) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Personal Choice 65 Rx (PPO) plan. All Ambulance Services require prior authorization and have a $175 copay for both ground and air ambulance services, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Personal Choice 65 Rx (PPO) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a copay between $5 and $55 with no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Personal Choice 65 Rx (PPO) plan covers primary care physician services with no copay, while chiropractic services have a $20 copay. Occupational therapy services have a $20 copay, and specialist services have a $35 copay. Mental health, podiatry, other health care professional, psychiatric services, and opioid treatment services have varying copays. Physical therapy and speech-language pathology services have a $20 copay, and additional telehealth benefits have a copay between $0 and $35.
Preventive Services See details
The Personal Choice 65 Rx (PPO) plan covers preventive services, including an annual physical exam with no copay, and covers additional preventive services like Home-Based Palliative Care, and Support for Caregivers of Enrollees with no copay. This plan also covers services like Health Education, Fitness Benefit, Enhanced Disease Management, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
The Personal Choice 65 Rx (PPO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $499 and $799, while prescription hearing aids for inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services include eye exams with a copay of $0-$35, and coverage for routine eye exams with no copay. Eyewear is covered up to a combined maximum of $250 per year for both in-network and out-of-network services, while contact lenses and eyeglasses (lenses and frames) are each limited to one per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and other dental services with no maximum plan benefit coverage. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered with no copay. Restorative Services, Endodontics, Periodontics, and Implant Services have a 20% - 40% coinsurance, while Prosthodontics (removable and fixed) has a 40% coinsurance. Oral and Maxillofacial Surgery is covered with a coinsurance between 20% and 40%. Orthodontic Services and Maxillofacial Prosthetics are covered with a maximum benefit of $1500 per year, but Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Personal Choice 65 Rx (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment, including Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with no copay, and lab services with no copay. Diagnostic Radiological Services have a copay up to $175, Therapeutic Radiological Services have a copay of $80 or more, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Personal Choice 65 Rx (PPO) plan with no copay and no coinsurance, although additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Personal Choice 65 Rx (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Personal Choice 65 Rx (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Personal Choice 65 Rx (PPO) plan covers acupuncture with a $20 copay for up to 6 treatments per year, and over-the-counter items with a maximum benefit of $30 every three months. Meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved