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Personal Choice 65 Saver Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Saver 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 Saver Rx (PPO) in 2025, please refer to our full plan details page.
Personal Choice 65 Saver 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 Saver 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 Saver 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 Saver 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 $96.00. 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 Saver Rx (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs at a preferred pharmacy, you will have no copay, but for standard generic drugs, you will pay 23% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Personal Choice 65 Saver Rx (PPO) plan offers a range of benefits beyond standard Medicare coverage. It includes inpatient hospital stays with a copay, and outpatient services with coinsurance. The plan also covers emergency services, primary care, preventive services, hearing exams and hearing aids, vision services, dental services, and home health services. This plan provides additional coverage for services such as ambulance, partial hospitalization, and some diagnostic and radiological services, all with varying copays or coinsurance. Notably, the plan has a $0 copay for many services, including preventive services, and covers certain hearing and vision services, along with some dental services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-5, there is a $375 copay, and days 6-90 have no copay; an out-of-pocket maximum of $1875 applies. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services and observation services, both with a 20% coinsurance, as well as ambulatory surgical center services with a 20% coinsurance. Outpatient substance abuse services are covered with a $30 copay for individual sessions and a $20 copay for group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Personal Choice 65 Saver Rx (PPO) plan, but requires prior authorization. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $260 copay for both ground and air ambulance services, and 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 by the Personal Choice 65 Saver Rx (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a copay between $15 and $45; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have a $10 copay, Chiropractic Services have a $15 copay for routine care, Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a $50 copay. Mental Health Specialty Services has copays of $30 for individual sessions and $20 for group sessions. Podiatry Services have a $25 copay for routine foot care, and Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth benefits have a copay between $10 and $50, while Opioid Treatment Program Services have a $5 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar services, annual physical exams with no copay, and additional preventive services with a copay for specific services. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services includes Hearing Exams and Prescription Hearing Aids. Hearing Exams have a $50 copay, and Routine Hearing Exams have no copay. Prescription Hearing Aids (all types) have a copay between $699 and $999. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, as well as OTC Hearing Aids, are not covered.
Vision Services See details
The Personal Choice 65 Saver Rx (PPO) plan covers vision services, including eye exams with a copay of $0-$50. Eyewear is covered, including contact lenses, with a combined maximum plan benefit of $250 every year. Eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
The Personal Choice 65 Saver Rx (PPO) plan covers dental services, including Medicare dental services with a $50 copay, and other dental services such as oral exams and dental x-rays with no copay. Restorative services, endodontics, periodontics, prosthodontics, and implant services are covered with 20-40% coinsurance. Orthodontic services are covered up to a maximum of $1,500 per year. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 Saver Rx (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, have no copay, while Diagnostic Radiological Services have a copay of up to $285, Therapeutic Radiological Services have a copay of at most $80, and Outpatient X-Ray Services have a $40 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered under the Personal Choice 65 Saver 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 not covered by the Personal Choice 65 Saver Rx (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The "Personal Choice 65 Saver Rx (PPO)" plan covers acupuncture with a $15 copay for up to 6 treatments per year, and also covers over-the-counter items with a maximum benefit of $30 every three months. The plan does not cover meal benefits, dual eligible SNPs, 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.
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