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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 2026, 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 2026.
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 $227.00. 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 $9900.00 (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 $9900.00 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:
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Drug Coverage
The Personal Choice 65 Rx (PPO) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately without any upfront out-of-pocket deductible costs. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling prescriptions through a preferred pharmacy or standard mail order. Using a standard pharmacy for these generic tiers increases your cost to a $9 copay for Tier 1 and a $20 copay for Tier 2 for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than set copays. Tier 3 preferred brand drugs require a 25% coinsurance payment across preferred, standard, and standard mail-order pharmacies. Tier 4 non-preferred drugs and Tier 5 specialty tier drugs both carry a 33% coinsurance rate for all pharmacy options.
Additional Benefits
The Personal Choice 65 Rx (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs. You will pay no copay and no coinsurance for primary care visits, preventive care, and home health services, while specialist visits require a $40 copay. For hospital care, there is no coinsurance, but you will pay a $270 daily copay for the first six days of an inpatient stay and a $350 copay for outpatient hospital services. Essential everyday benefits like routine hearing exams and preventive dental care are available with no copay. The plan also features a $250 annual eyewear allowance, a $30 quarterly over-the-counter item allowance, and comprehensive dental coverage with 20% to 40% coinsurance. Emergency medical needs are covered with a $130 copay and no coinsurance, which includes worldwide emergency and urgent care.
Inpatient Hospital See details
Personal Choice 65 Rx (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $270 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional acute hospital days are covered at no copay, room upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Personal Choice 65 Rx (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $350 copay, observation services for a $270 copay per stay, and ambulatory surgical center services for a $200 copay. Outpatient substance abuse services require a $20 to $30 copay, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Personal Choice 65 Rx (PPO) plan with a $30.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Personal Choice 65 Rx (PPO) covers Medicare-covered ground and air ambulance services with a $195 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Personal Choice 65 Rx (PPO) with a $130 copay and no coinsurance, while urgently needed services require a $5 to $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Personal Choice 65 Rx (PPO) covers primary care physician services and select telehealth benefits with no copay and no coinsurance. Other outpatient services feature no coinsurance but require copays, including $40 for specialists, $25 for physical and occupational therapy, and $15 for podiatry and routine chiropractic care, though other chiropractic services are not covered.
Preventive Services See details
Personal Choice 65 Rx (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and diabetes self-management. However, several services are not covered, including in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, extra smoking cessation, telemonitoring, home modifications, and counseling.
Hearing Services See details
Personal Choice 65 Rx (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $799 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Personal Choice 65 Rx (PPO) offers partially covered vision services, featuring eye exams with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also partially covered with no copay and no coinsurance up to a $250 annual limit, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Personal Choice 65 Rx (PPO), offering Medicare-covered dental for a $40 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive services feature no copay and 20% to 40% coinsurance up to a $1,500 annual maximum, though other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Personal Choice 65 Rx (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may apply. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Personal Choice 65 Rx (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Personal Choice 65 Rx (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required. Covered DME, prosthetics, and medical supplies feature no copay and 20% coinsurance, while diabetic therapeutic shoes have no copay, and diabetic supplies carry no copay and no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Personal Choice 65 Rx (PPO) with no coinsurance, though prior authorization is required. There is no copay for diagnostic procedures, lab services, and diagnostic radiological services, while outpatient X-rays require a $40 copay and therapeutic radiological services require a copay of at least $85.
Home Health Services See details
Home health services are covered by Personal Choice 65 Rx (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Personal Choice 65 Rx (PPO) plan with no coinsurance and a $5 copay per service. This copayment applies to cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Personal Choice 65 Rx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Personal Choice 65 Rx (PPO) partially covers other services, offering acupuncture with a $15.00 copay and no coinsurance for up to 6 treatments per year, and over-the-counter (OTC) items with no copay and no coinsurance up to $30.00 quarterly. Meal benefits and nicotine replacement therapy are not covered under this plan.
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