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Personal Choice 65 Plus Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Plus 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 Plus Rx (PPO) in 2026, please refer to our full plan details page.
Personal Choice 65 Plus Rx (PPO) is a PPO plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Philadelphia, Bucks, Chester, Montgomery, Delaware. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Personal Choice 65 Plus 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 Plus 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 Plus Rx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $214.00. 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 $6300.00 (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 $6300.00 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 Plus 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 and Tier 2 drugs carry a $20 copay for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays across all pharmacy types. Tier 3 preferred brands require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 38% coinsurance. Tier 5 specialty drugs require a 33% coinsurance for a one-month, two-month, or three-month supply.
Additional Benefits
The Personal Choice 65 Plus Rx (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copay and no coinsurance for primary care and specialist doctor visits. For hospital care, members pay a $400 copay per admission for inpatient stays and a $310 copay for outpatient hospital services, both with no coinsurance. Emergency care is also accessible, with a $130 copay for emergency room visits and urgently needed care starting at a $5 copay. This plan also includes valuable supplemental benefits, providing routine dental, vision, and hearing services with no copays or coinsurance, subject to specific annual coverage limits. For specialized medical needs, home health services are covered with no copay, while durable medical equipment and dialysis services require no copay and a 20% coinsurance. Additionally, members can take advantage of preventive care and annual physicals with no copay or coinsurance.
Inpatient Hospital See details
Personal Choice 65 Plus Rx (PPO) covers inpatient acute and psychiatric hospital stays with a $400 copay per admission, no coinsurance, and prior authorization required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute stay days are included with no copay.
Outpatient Services See details
Personal Choice 65 Plus Rx (PPO) covers outpatient hospital and observation services with a $310 copay and no coinsurance, and ambulatory surgical center services with a $225 copay and no coinsurance. Outpatient substance abuse services have no coinsurance and a copay of $20 for group sessions or $30 for individual sessions, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Personal Choice 65 Plus Rx (PPO) plan with a $30.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Personal Choice 65 Plus Rx (PPO) covers Medicare-covered ground and air ambulance services with a $200 copay and no coinsurance, requiring prior authorization with copays not waived upon hospital admission. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Personal Choice 65 Plus Rx (PPO) partially covers emergency services with no coinsurance, featuring a $130 copay for emergency services and a $5 to $50 copay for urgently needed services. Worldwide emergency and urgent care are also covered with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits are covered under Personal Choice 65 Plus Rx (PPO) with no copay and no coinsurance for primary care and specialist visits, while physical and occupational therapies require a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, as other chiropractic services are not covered. Mental health, psychiatric, podiatry, and opioid treatments are also covered with no coinsurance and copays ranging from $5 to $30.
Preventive Services See details
Preventive Services are partially covered by Personal Choice 65 Plus Rx (PPO) with no copay and no coinsurance for covered benefits like annual physicals, fitness benefits, and health education. However, several services are not covered, including in-home safety assessments, personal emergency response systems, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are covered by Personal Choice 65 Plus Rx (PPO) with no deductible, featuring no copay and no coinsurance for Medicare-covered exams, one routine hearing exam annually, and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $499 to $799 for up to two aids per year, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Personal Choice 65 Plus Rx (PPO), offering one routine eye exam and one pair of eyeglasses or contact lenses per year with no copays or coinsurance. A combined annual maximum benefit of $250 applies to eyewear, but other eye exams, separate eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the Personal Choice 65 Plus Rx (PPO) plan with no copay and no coinsurance for covered services, up to a $1,000 yearly maximum. Sub-services that are not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Personal Choice 65 Plus Rx (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Personal Choice 65 Plus Rx (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Personal Choice 65 Plus Rx (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and coinsurance ranging from no coinsurance up to 20%, subject to prior authorization and manufacturer limitations.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Personal Choice 65 Plus Rx (PPO) with no coinsurance, although prior authorization is required. Diagnostic procedures, tests, and lab services have no copay, while outpatient x-rays require a $30 copay, therapeutic radiology has a minimum $85 copay, and diagnostic radiology copays start at $0.
Home Health Services See details
Home Health Services are covered under Personal Choice 65 Plus Rx (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Personal Choice 65 Plus Rx (PPO) plan with no coinsurance. Members will pay a $5 copay for services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease.
Skilled Nursing Facility (SNF) See details
Personal Choice 65 Plus Rx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Personal Choice 65 Plus Rx (PPO) covers acupuncture with a $15 copay and no coinsurance for up to 6 treatments per year, alongside over-the-counter (OTC) items with no copay and no coinsurance up to a $30 limit every three months. Meal benefits and other additional services are not covered under this plan.
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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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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