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Personal Choice 65 Elite Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Elite 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 Elite Rx (PPO) in 2025, please refer to our full plan details page.
Personal Choice 65 Elite 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 Elite 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 Elite 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 Elite Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.60. 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 $10000.00 (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 $10000.00 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 Elite Rx (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. Preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly premium will be $16.60.
Additional Benefits
The Personal Choice 65 Elite Rx (PPO) plan offers a variety of benefits with varying costs. This plan covers inpatient hospital stays with a $525 copay per admission, and outpatient services with copays ranging from $0 to $250. You'll also find coverage for ambulance services, primary care visits with no copay, and preventive services like annual physical exams with no copay. Additional benefits include coverage for hearing and vision services, with copays and limitations on eyewear. Dental services are covered with no copay for oral exams, x-rays, and cleanings, and coinsurance for restorative services. The plan also covers home health services with no copay, and offers coverage for home infusion, dialysis, and medical equipment with coinsurance or copays.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $525 copay per admission. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, offered by the Personal Choice 65 Elite Rx (PPO) plan, include coverage for all outpatient hospital services, with a $250 copay, and observation services, with a $250 copay. Ambulatory Surgical Center (ASC) Services have a $150 copay. Outpatient substance abuse services have 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 under the Personal Choice 65 Elite Rx (PPO) plan, with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Personal Choice 65 Elite Rx (PPO) plan. Both ground and air ambulance services have a $225 copay, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency coverage, are covered under the Personal Choice 65 Elite Rx (PPO) plan. Emergency services have a $100 copay, urgently needed services have a copay between $5 and $45, and worldwide emergency coverage and worldwide urgent coverage both have a $100 copay; worldwide emergency transportation is not covered.
Primary Care See details
Personal Choice 65 Elite Rx (PPO) covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, and mental health specialty services with a $20-30 copay. The plan also covers podiatry services with a $25 copay, other health care professional services with a $0-30 copay, psychiatric services with a $20-30 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a $0-30 copay, and opioid treatment program services with a $5 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and also cover additional preventive services with no copay for services like Health Education, Home-Based Palliative Care, Support for Caregivers of Enrollees, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System (PERS), 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, 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 Elite Rx (PPO) plan covers hearing exams with a $30 copay, and routine hearing exams with no copay. The plan also covers fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) with a copay between $399 and $699. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
Vision services include eye exams, with a copay of $0-$30, and eyewear, including contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered. Eyewear has a combined maximum benefit of $250 per year.
Dental Services See details
The Personal Choice 65 Elite Rx (PPO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, and fluoride treatment with no copay. Orthodontic services have a maximum benefit of $3,000 per year. Restorative services, endodontics, periodontics, implant services, and prosthodontics (fixed and removable) are covered with 20% to 40% coinsurance, while oral and maxillofacial surgery is covered with 20% to 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 by the Personal Choice 65 Elite Rx (PPO) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
The Personal Choice 65 Elite Rx (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance, while Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275.00, Therapeutic Radiological Services have a copay of at least $75.00, and Outpatient X-Ray Services have a copay of $35.00.
Home Health Services See details
Home Health Services are covered by Personal Choice 65 Elite Rx (PPO) 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 by the Personal Choice 65 Elite Rx (PPO) plan, but the specific services are not covered. The plan has a copay for some Cardiac Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Personal Choice 65 Elite Rx (PPO) plan, with prior authorization required. 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 for SNF are not covered.
Other Services See details
The Personal Choice 65 Elite Rx (PPO) plan covers acupuncture with a $15 copay per visit, up to 6 treatments per year, and also covers over-the-counter items with a maximum benefit of $125 every three months. This plan does not cover meal benefits, or several other services including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more.
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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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