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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 Chester, Delaware, Montgomery 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 $187.00. 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 coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or standard mail order. If you choose a standard pharmacy, Tier 1 drugs carry a $9 copay for a one-month supply, while Tier 2 drugs require a $20 copay. For higher-tier medications, costs shift to a coinsurance model across all pharmacy types. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 33% coinsurance. This structure ensures clear, predictable cost-sharing depending on your specific medication needs and pharmacy choice.
Additional Benefits
The Personal Choice 65 Rx (PPO) plan offers comprehensive medical coverage with no copay for primary care physician visits and a $40 copay for specialist appointments. For hospital care, inpatient stays require a $270 daily copay for days one through six followed by no copay, while outpatient hospital services carry a $350 copay. Emergency care is also highly accessible, featuring a $130 copay for emergency room visits and a $195 copay for ambulance services with no coinsurance. Essential routine services are well covered, including annual physical exams and preventive dental care with no copay. Routine vision and hearing exams also require no copay, with the plan offering up to $250 annually for eyewear and coverage for prescription hearing aids. Additionally, members benefit from home health services with no copay and a quarterly $30 allowance for over-the-counter items.
Inpatient Hospital See details
Personal Choice 65 Rx (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a $270 daily copay for days 1 through 6, followed by no copay for days 7 through 90. While unlimited additional acute days are covered with no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Personal Choice 65 Rx (PPO) covers outpatient hospital services with a $350 copay and no coinsurance, observation services with a $270 copay per stay and no coinsurance, and ambulatory surgical center services with a $200 copay and no coinsurance. Outpatient substance abuse services are covered with no coinsurance and a $30 copay for individual sessions or a $20 copay for group sessions, while outpatient blood services have no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Personal Choice 65 Rx (PPO) with a $30.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Personal Choice 65 Rx (PPO) covers ground and air ambulance services with a $195 copay and no coinsurance, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered under the Personal Choice 65 Rx (PPO) plan with a $130 copay and no coinsurance, and urgently needed services are covered with a $5 to $50 copay and no coinsurance. Worldwide emergency services are partially covered with a $130 copay and no coinsurance for emergency and urgent care, but worldwide emergency transportation is not covered.
Primary Care See details
Personal Choice 65 Rx (PPO) offers primary care physician services with no copay and specialist visits for a $40 copay, both with no coinsurance. Other covered services feature no coinsurance with copays ranging from $0 to $40, though chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Personal Choice 65 Rx (PPO) offers partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, health education, and fitness benefits. However, several sub-services are not covered, such as in-home safety assessments, personal emergency response systems, telemonitoring, and weight management programs.
Hearing Services See details
Personal Choice 65 Rx (PPO) covers hearing services with no deductible, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $499 to $799 copay and no coinsurance for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription types are not covered.
Vision Services See details
Vision services are partially covered by Personal Choice 65 Rx (PPO) with no deductibles, no coinsurance, a copay of up to $40 for eye exams (no copay for one annual routine exam), and no copay for eyewear up to a $250 annual limit. One pair of contact lenses or eyeglasses is covered yearly, but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Personal Choice 65 Rx (PPO) partially covers dental services, excluding other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics. Medicare-covered dental services require a $40 copay and no coinsurance, while covered preventive care has no copay and no coinsurance, and comprehensive services have no copay and 20% to 40% coinsurance up to a $1,500 annual limit.
Home Infusion bundled Services See details
Personal Choice 65 Rx (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance of no coinsurance up to 20%, while Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Personal Choice 65 Rx (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Personal Choice 65 Rx (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and 20% coinsurance. Diabetic therapeutic shoes are covered with no copay, while diabetic supplies feature no coinsurance to 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Personal Choice 65 Rx (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic tests, lab services, and diagnostic radiology services have no copay, while outpatient X-rays require a $40 copay and therapeutic radiology services have a minimum copay of $85.
Home Health Services See details
Home health services are covered under the Personal Choice 65 Rx (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Personal Choice 65 Rx (PPO) covers some cardiac rehabilitation services with a $5 copay and no coinsurance. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Personal Choice 65 Rx (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is needed. Patients pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Personal Choice 65 Rx (PPO) provides coverage for select other services, featuring acupuncture with a $15 copay and no coinsurance for up to 6 treatments yearly, and over-the-counter (OTC) items with no copay and no coinsurance up to $30 every three months. Meal benefits and other additional services are not covered under this plan.
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