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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 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 Chester, Delaware, Montgomery 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 $152.00. 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)
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Drug Coverage
The Personal Choice 65 Rx (PPO) plan has an "Enhanced Alternative" drug benefit type with no deductible. In the initial coverage phase, you'll pay no copay for preferred generic drugs at a preferred pharmacy or through the mail. For standard generic drugs, you'll pay 25% coinsurance, and for preferred brand drugs, you'll pay 50% coinsurance. For non-preferred drugs, you will pay 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Personal Choice 65 Rx (PPO) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay, while outpatient services have a copay depending on the type of service. Primary care, preventive care, and routine hearing and vision exams often have no copay. The plan includes coverage for ambulance services, emergency services, and mental health services with copays. Dental services cover a variety of procedures, with copays or coinsurance applying. Other covered services include home health, home infusion, and durable medical equipment, with some services requiring coinsurance or prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for 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, while Additional Days for Inpatient Hospital-Acute have no copay for days 91-999. Inpatient Hospital Psychiatric services have the same cost sharing as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered with a $300 copay. Ambulatory Surgical Center (ASC) Services have a $150 copay, while outpatient blood services have no copay. Individual sessions for outpatient substance abuse have a copay between $30 and $30, and group sessions have a copay between $20 and $20.
Partial Hospitalization See details
Partial Hospitalization is covered under the Personal Choice 65 Rx (PPO) plan, with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Personal Choice 65 Rx (PPO) plan. Ground and Air Ambulance Services have a $175 copay, and there is no coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the Personal Choice 65 Rx (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $5 and $55. Worldwide Emergency Coverage and Worldwide Urgent Coverage also have a $125 copay, but 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, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, and physician specialist services with a $35 copay. Mental health specialty services have a $30 copay for individual sessions and a $20 copay for group sessions, while podiatry services and other health care professional visits have a copay between $20 and $35. The plan also covers psychiatric services, physical therapy, speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $5 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services with varying copays. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visits are also covered with no copay. Home-based palliative care, support for caregivers of enrollees, and fitness benefits are also covered with no copay. Health education, medical nutrition therapy, and remote access technologies have no copay. In-home safety assessments, personal emergency response systems, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, 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
The Personal Choice 65 Rx (PPO) plan covers hearing exams for a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $499 and $799 depending on the type.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$35, and routine eye exams with no copay. Eyewear is covered with a combined maximum plan benefit of $250 per year, and you are limited to one pair of contact lenses or eyeglasses 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 treatment have no copay, but have limitations on the number of visits and/or the time between visits. Orthodontic services are covered with a $1,500 maximum benefit per year. Restorative services and Endodontics have a 20% coinsurance, while Prosthodontics (removable), implant services, and Prosthodontics (fixed) have a 40% coinsurance. Oral and Maxillofacial Surgery is covered with a 20-40% coinsurance. Maxillofacial Prosthetics and orthodontics are not covered.
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 have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Personal Choice 65 Rx (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with a 20% coinsurance and authorization required, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $175, Therapeutic Radiological Services have a copay of $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 Rx (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered. Therefore, the plan does not cover 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. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $20 copay, limited to 6 treatments per year, and over-the-counter items with a maximum benefit of $30 every three months. 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, and Self-Directed Personal Assistance Services are not covered.
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