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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 2025, 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 2025.
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 $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 Medical Only (PPO)
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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 a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $240 for the first six days, and then no copay for the remainder of the stay. Outpatient services, primary care, and preventive services are covered, with some services having no copay. The plan also includes coverage for ambulance, emergency, and hearing services, with copays ranging from $20 to $175. Vision and dental services are included with copays and coinsurance, and the plan also covers home health services with no copay. However, the plan does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $240 copay for days 1-6 and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will also pay a $240 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $300 copay, observation services with a $300 copay, ambulatory surgical center (ASC) services with a $150 copay, and outpatient substance abuse services with a $30-$30 copay for individual sessions and a $20-$20 copay for group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Personal Choice 65 Medical Only (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, with a $175 copay for both Medicare-covered ground and air ambulance services, and no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under this plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a copay between $5 and $55. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Personal Choice 65 Medical Only (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, specialist services with a $35 copay, mental health specialty services with a copay of $20-$30, podiatry services with a $20 copay, other health care professional services with a $0-$35 copay, psychiatric services with a $20-$30 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$35 copay, and opioid treatment program services with a $5 copay. Routine chiropractic care and routine foot care are limited to 6 visits per year.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, and annual physical exams with no copay. Additional preventive services, including Health Education, Medical Nutrition Therapy, Home-Based Palliative Care, Support for Caregivers of Enrollees, 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, are covered with no copay. However, services such as In-Home Safety Assessment, Personal Emergency Response System, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services includes 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) are covered with a copay between $499 and $799, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a copay of $0 to $35, and eyewear with a combined maximum benefit of $250 per year. Contact lenses and eyeglasses (lenses and frames) are covered, but 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, Oral Exams with no copay, Dental X-Rays with no copay, Prophylaxis (Cleaning) with no copay, Fluoride Treatment with no copay, Restorative Services with 20% coinsurance, Endodontics with 20% coinsurance, Periodontics with 20% coinsurance, Prosthodontics, removable with 40% coinsurance, Implant Services with 40% coinsurance, Prosthodontics, fixed with 40% coinsurance, and Oral and Maxillofacial Surgery with 20-40% coinsurance; Maxillofacial Prosthetics and Orthodontics are not covered. Orthodontic Services have a maximum benefit of $1,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Personal Choice 65 Medical Only (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, and Diabetic Supplies have between 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, lab services, and radiological services are covered. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $175, Therapeutic Radiological Services have a copay of at least $80, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered under the Personal Choice 65 Medical Only (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Personal Choice 65 Medical Only (PPO) plan. The plan does not cover any Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Personal Choice 65 Medical Only (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture with a $20 copay, and Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $30 every three months. The plan does not cover Meal Benefit, 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, or Self-Directed Personal Assistance Services.
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