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Personal Choice 65 Medical Only (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Medical Only (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 Medical Only (PPO) in 2026, please refer to our full plan details page.
Personal Choice 65 Medical Only (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 Medical Only (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Personal Choice 65 Medical Only (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 Medical Only (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Personal Choice 65 Medical Only (PPO).
Additional Benefits
The Personal Choice 65 Medical Only (PPO) plan offers comprehensive medical coverage with no copays for primary care visits, preventive services, and home health care. For hospital stays, members pay a daily copay of $270 for the first six days of inpatient care and no copay thereafter, while outpatient hospital services require a $350 copay. Emergency care is available with a $130 copay, and specialist visits range from a $5 to $40 copay, with no coinsurance required for these services. This plan also includes valuable specialty benefits, featuring no copays for routine vision and hearing exams, alongside a $250 annual eyewear allowance and hearing aid coverage. Dental benefits include no copays for preventive services and a 20% to 40% coinsurance for comprehensive care up to a $1,500 yearly limit. Diagnostic services, medical equipment, and dialysis are also covered, typically requiring no copays and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Personal Choice 65 Medical Only (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $270 daily copay for days 1 to 6 and no copay for days 7 to 90. Additional acute days are covered with no copay, though non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Personal Choice 65 Medical Only (PPO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital services, a $270 copay per stay for observation services, and a $200 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 copay for individual sessions and a $20 copay for group sessions with no coinsurance, while outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
Personal Choice 65 Medical Only (PPO) covers partial hospitalization services with a $30.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Personal Choice 65 Medical Only (PPO) covers Medicare-approved 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 under this plan.
Emergency Services See details
Personal Choice 65 Medical Only (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a copay of $5 to $50 and no coinsurance. Worldwide emergency and urgent services are partially covered with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Personal Choice 65 Medical Only (PPO) covers primary care physician services with no copay and no coinsurance, while additional services like specialist visits, therapy, and mental health care have copays ranging from $5.00 to $40.00 and no coinsurance. Chiropractic care is partially covered, offering up to 6 routine visits per year for a $15.00 copay and no coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Personal Choice 65 Medical Only (PPO) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physical exams and health education. Non-covered services include in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, smoking cessation, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Personal Choice 65 Medical Only (PPO), featuring routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $40 copay and no coinsurance. Prescription hearing aids require a copay of $499 to $799 with no coinsurance, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Personal Choice 65 Medical Only (PPO) covers annual routine eye exams with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual maximum for one pair of contact lenses or eyeglasses, but individual frames, lenses, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Personal Choice 65 Medical Only (PPO), with Medicare-covered dental requiring a $40 copay and no coinsurance, and preventive services available with no copay and no coinsurance. Comprehensive dental services feature no copay and 20% to 40% coinsurance up to a $1,500 annual maximum, though other diagnostic dental, other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Personal Choice 65 Medical Only (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Personal Choice 65 Medical Only (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Personal Choice 65 Medical Only (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and coinsurance ranging from 0% to 20%, though prior authorization and manufacturer limits may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Personal Choice 65 Medical Only (PPO) with no coinsurance, though prior authorization is required. There is no copay for diagnostic tests, lab services, and diagnostic radiological services, while outpatient X-rays cost a $40 copay and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
Home health services are covered by Personal Choice 65 Medical Only (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Personal Choice 65 Medical Only (PPO) plan with no copay and no coinsurance. However, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Personal Choice 65 Medical Only (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with additional days not covered.
Other Services See details
Personal Choice 65 Medical Only (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 every three months. Meal benefits, nicotine replacement therapy, and certain other services are not covered.
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