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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 2025, 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 2025.
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 $164.00. 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 $5750.00 (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 $5750.00 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 Plus Rx (PPO)
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Drug Coverage
The Personal Choice 65 Plus Rx (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred mail 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, the monthly premium is reduced from $68.70 to $20.30.
Additional Benefits
The Personal Choice 65 Plus Rx (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays require a $250 copay, while outpatient services have copays ranging from $30 to $275. The plan provides coverage for primary care with no copay for primary care physician visits and a $15 copay for chiropractic, occupational therapy, physical therapy, and speech-language pathology services. Preventive services, vision exams, dental services, and home health services are covered with no copay. Emergency services have a $110 copay, and ambulance services have a $150 copay. Hearing exams and hearing aid fitting/evaluation have no copay, but prescription hearing aids have a copay between $499 and $799.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you pay a $250 copay per admission or stay. For Additional Days for Inpatient Hospital-Acute, there is no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $275 copay, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with a $225 copay, and Outpatient Substance Abuse Services with a copay of $30 for individual sessions and $20 for group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Personal Choice 65 Plus 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 by the Personal Choice 65 Plus Rx (PPO) plan. Ground and Air Ambulance Services have a $150 copay, and there is no coinsurance; however, 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 Plus Rx (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay and no coinsurance, while Urgently Needed Services have a copay between $5 and $45 and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care coverage includes no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services and Routine Chiropractic Care (up to 6 visits per year), a $15 copay for Occupational Therapy Services, no copay for Physician Specialist Services, and a $30 copay for Individual Sessions for Mental Health Specialty Services and a $20 copay for Group Sessions. Additionally, this plan has a $15 copay for Podiatry Services (up to 6 visits per year), no copay for Other Health Care Professional visits, a $30 copay for Individual Sessions for Psychiatric Services and a $20 copay for Group Sessions. Physical Therapy and Speech-Language Pathology Services have a $15 copay, and Additional Telehealth Benefits range from no copay to a $15 copay, while Opioid Treatment Program Services have a $5 copay.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Additional services like Health Education, Medical Nutrition Therapy, Home-Based Palliative Care, Support for Caregivers of Enrollees, and Fitness Benefits are covered with no copay. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Some services, like In-Home Safety Assessment, Personal Emergency Response System, 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, In-Home Support Services, 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
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay, while prescription hearing aids (all types) have a copay between $499 and $799. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with no copay, and eyewear benefits with a combined maximum of $250 per year. Eyeglasses (lenses and frames) and contact lenses are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Personal Choice 65 Plus Rx (PPO) plan covers dental services with no copay for Medicare dental services, oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and adjunctive general services. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and implant services have no coinsurance. Orthodontic services have a maximum plan benefit of $1500 per year. 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, and 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 Plus Rx (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
The Personal Choice 65 Plus Rx (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, and the coinsurance is 20% for Medicare-covered items. 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, including diagnostic procedures/tests and lab services, are covered with no copay. Diagnostic Radiological Services have a maximum copay of $150, Therapeutic Radiological Services have a copay of at least $80, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered under the Personal Choice 65 Plus 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 Plus Rx (PPO) plan. The plan does not cover any of the Cardiac Rehabilitation Services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Personal Choice 65 Plus Rx (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture with a $15 copay per visit, up to 6 treatments per year, and over-the-counter (OTC) items, with a maximum benefit of $30 every three months. The plan does not cover meal benefits, 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, or Self-Directed Personal Assistance Services.
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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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