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Personal Choice 65 Prime Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Prime 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 Prime Rx (PPO) in 2025, please refer to our full plan details page.
Personal Choice 65 Prime Rx (PPO) is a PPO plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Philadelphia, Bucks, Chester, Delaware, Montgomery. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Personal Choice 65 Prime 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 Prime 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 Prime Rx (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. Additionally, this plan comes with a Part B Premium reduction of $9.10. You must continue to pay paying your reduced 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 $11300.00 (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 $11300.00 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 Prime Rx (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies or mail order, while standard generic drugs have 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Personal Choice 65 Prime Rx (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, and outpatient services have copays that range from $0 to $350. This plan includes coverage for primary care with no copay, along with hearing, vision, and dental services. It also offers coverage for home health services, and skilled nursing facilities with a copay.
Inpatient Hospital See details
Inpatient hospital services are covered, with a $250 copay for days 1-7 and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, have a $350 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay. Outpatient Substance Abuse Services include individual sessions with a $30 copay, and group sessions with a $20 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Personal Choice 65 Prime Rx (PPO) plan, and requires prior authorization. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Personal Choice 65 Prime Rx (PPO) plan. Ground and Air Ambulance Services have a $240 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services include coverage for emergency services, urgently needed services, and worldwide emergency services. Emergency services have a $100 copay and no coinsurance. Urgently needed services have a copay between $10 and $45, with no coinsurance. Worldwide emergency coverage and worldwide urgent coverage have a $100 copay, with no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
The Personal Choice 65 Prime Rx (PPO) plan covers primary care physician services with no copay and chiropractic services with a $15 copay. Occupational therapy services have a $25 copay, and physician specialist services have a $30 copay. Mental health specialty services, including individual and group sessions, have a copay of $30 and $20, respectively. Podiatry services have a $25 copay, while other health care professional services have a copay between $0 and $30. Psychiatric services, including individual and group sessions, have a copay of $30 and $20, respectively. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $30. Opioid treatment program services have 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. This plan does not cover in-home safety assessments, personal emergency response systems, 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 benefits, telemonitoring services, home and bathroom safety devices and modifications, counseling services, and additional sessions of smoking and tobacco cessation counseling. The plan also covers home-based palliative care, support for caregivers of enrollees, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
The Personal Choice 65 Prime Rx (PPO) plan covers hearing exams with a $30 copay. Routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, and all types are covered with a copay between $699 and $999, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $30, 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 are covered, including Medicare Dental Services with a $30 copay, and other dental services such as oral exams with no copay. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery have a 10% coinsurance. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Personal Choice 65 Prime Rx (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, and the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Personal Choice 65 Prime Rx (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, and diagnostic radiological services with a copay of at most $200.00, therapeutic radiological services with a copay of at most $60.00, and outpatient X-ray services with a $40.00 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Personal Choice 65 Prime Rx (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 covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac Rehabilitation Services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Personal Choice 65 Prime Rx (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Under the Personal Choice 65 Prime Rx (PPO) plan, acupuncture has a $15 copay, and over-the-counter items are covered up to $70 every three months. Other services, including meal benefits, are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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