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Personal Choice 65 Achieve Rx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Personal Choice 65 Achieve 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 Achieve Rx (PPO) in 2026, please refer to our full plan details page.
Personal Choice 65 Achieve Rx (PPO) is a PPO plan offered by Independence Health Group, Inc. available for enrollment in 2026 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 Achieve 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 Achieve 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 Achieve 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.
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 a $375.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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 Achieve Rx (PPO) Medicare plan features an annual drug deductible of $375. For generic medications, members enjoy no copay for Tier 1 preferred generics and Tier 2 generics when filled through preferred pharmacies or standard mail order. If you use a standard pharmacy, Tier 1 drugs require a $9 copay and Tier 2 drugs require a $20 copay for a one-month supply. For brand-name and specialty medications, costs are structured as a percentage of the drug cost rather than a flat copayment. Tier 3 preferred brands require a 25% coinsurance, Tier 4 non-preferred drugs require a 30% coinsurance, and Tier 5 specialty drugs require a 28% coinsurance across all pharmacy options. This plan offers clear cost-saving opportunities through its preferred pharmacy and mail-order networks.
Additional Benefits
The Personal Choice 65 Achieve Rx (PPO) plan offers comprehensive medical coverage with no copay for primary care visits and a $55 copay for specialists, both with no coinsurance. Inpatient hospital stays require a $390 copay for days one through seven and no copay thereafter, while outpatient hospital services carry a $540 copay. Additionally, emergency room visits have a $130 copay, and urgent care services range from a $10 to $50 copay, with no coinsurance required for either. Routine dental, vision, and hearing exams are available with no copay, alongside a $250 annual allowance for eyewear and a $30 quarterly reimbursement for over-the-counter items. Home health services are covered with no copay or coinsurance, while skilled nursing facility stays feature no copay for the first 20 days followed by a $218 daily copay. Diagnostic lab services and preventive benefits are also covered with no copay or coinsurance, helping members manage their routine healthcare costs effectively.
Inpatient Hospital See details
Personal Choice 65 Achieve Rx (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $390 copay for days 1 to 7 and no copay for days 8 and beyond. Inpatient psychiatric care is also covered with no coinsurance, featuring a $330 copay for days 1 to 7 and no copay for days 8 to 90, though additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Personal Choice 65 Achieve Rx (PPO) covers outpatient services with no coinsurance, featuring a $540 copay for outpatient hospital services, a $390 copay per stay for observation services, and a $350 copay for ambulatory surgical center services. Outpatient substance abuse services require a $20 to $30 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Personal Choice 65 Achieve Rx (PPO) covers partial hospitalization services with a $30.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Personal Choice 65 Achieve Rx (PPO) covers Medicare-covered ground and air ambulance services with a $310 copay and no coinsurance, though prior authorization is required. While some transportation services are covered under the plan, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Personal Choice 65 Achieve Rx (PPO) with a $130 copay and no coinsurance, while urgently needed services require a copay of $10 to $50 and no coinsurance. Worldwide emergency and urgent care are also covered with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Personal Choice 65 Achieve Rx (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Other medical and therapy services are covered with no coinsurance and copays ranging from $0 to $55, though chiropractic services are only partially covered since other chiropractic services are not covered.
Preventive Services See details
Personal Choice 65 Achieve Rx (PPO) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. Sub-services that are not covered under this benefit include in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, additional smoking cessation, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Personal Choice 65 Achieve Rx (PPO) offers partially covered hearing services with no deductible and no coinsurance. Routine hearing exams (one per year) and fitting evaluations have no copay, while Medicare-covered exams require a $55 copay. Prescription hearing aids have a $699 to $999 copay for up to two devices per year, though over-the-counter, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Personal Choice 65 Achieve Rx (PPO) offers partially covered vision services, featuring eye exams with a $0 to $55 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $250 annual maximum. While routine exams, contact lenses, and eyeglasses are covered, other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under Personal Choice 65 Achieve Rx (PPO), with Medicare-covered dental requiring a $55 copay and no coinsurance, and preventive services like cleanings and exams requiring no copay and no coinsurance. Comprehensive services such as restorative care and implants are covered with no copay and 50% coinsurance up to a $1,000 annual maximum, while other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Personal Choice 65 Achieve Rx (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Personal Choice 65 Achieve Rx (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Personal Choice 65 Achieve Rx (PPO) with no copays and 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Diabetic supplies also carry no copay with coinsurance ranging from no coinsurance to 20%, and prior authorization is required.
Diagnostic and Radiological Services See details
Personal Choice 65 Achieve Rx (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services and diagnostic tests, while diagnostic radiological services have a $0 minimum copay, outpatient X-rays require a $40 copay, and therapeutic radiological services have an $85 minimum copay.
Home Health Services See details
Home Health Services are covered by the Personal Choice 65 Achieve Rx (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Personal Choice 65 Achieve Rx (PPO) with no coinsurance, featuring a $40 copay for standard cardiac rehabilitation and a $50 copay for intensive cardiac rehabilitation. Additionally, pulmonary rehabilitation services require a $35 copay, while supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) has a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Personal Choice 65 Achieve Rx (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Personal Choice 65 Achieve 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 or coinsurance up to a $30 quarterly reimbursement limit. Meal benefits and other additional services are not covered.
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