A non-government entity
Keystone 65 Preferred Medical Only (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Keystone 65 Preferred Medical Only (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Keystone 65 Preferred Medical Only (HMO) in 2026, please refer to our full plan details page.
Keystone 65 Preferred Medical Only (HMO) is a HMO 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 2026.
It's important to know that Keystone 65 Preferred Medical Only (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Keystone 65 Preferred Medical Only (HMO).
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 Keystone 65 Preferred Medical Only (HMO), 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Keystone 65 Preferred Medical Only (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by Keystone 65 Preferred Medical Only (HMO).
Additional Benefits
The Keystone 65 Preferred Medical Only (HMO) plan offers robust medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and preventive services. For specialized care, members pay a $40 copay for specialists and a $150 copay for emergency room visits, both with no coinsurance. Inpatient hospital stays require a $275 daily copay for the first seven days and no copay thereafter, while outpatient hospital services carry a $375 copay. This plan also includes valuable supplemental benefits, providing routine dental, vision, and hearing exams with no copay and no coinsurance. Members can take advantage of a $250 annual allowance for eyewear and receive $30 every three months for over-the-counter items with no copay. Additionally, home health services and the first 20 days of a skilled nursing facility stay are covered with no copay.
Inpatient Hospital See details
Keystone 65 Preferred Medical Only (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 daily copay for days 1 to 7 and no copay for days 8 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Keystone 65 Preferred Medical Only (HMO) covers outpatient hospital services for a $375 copay and observation services for a $275 copay per stay, both with no coinsurance. Ambulatory surgical center services require a $150 copay with no coinsurance, while outpatient substance abuse sessions carry a $20 to $30 copay and blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Keystone 65 Preferred Medical Only (HMO) 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
Keystone 65 Preferred Medical Only (HMO) covers Medicare-approved ground and air ambulance services with a $180 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Keystone 65 Preferred Medical Only (HMO) covers emergency services with a $150 copay and urgently needed services with a $5 to $50 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Keystone 65 Preferred Medical Only (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Therapy services and routine podiatry require a $20 copay and no coinsurance, while chiropractic care is partially covered with routine visits costing $20 with no coinsurance and other chiropractic services not covered.
Preventive Services See details
Keystone 65 Preferred Medical Only (HMO) preventive services are partially covered with no copay and no coinsurance for covered services like annual physical exams and fitness benefits. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medication reconciliation, readmission prevention, 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
Keystone 65 Preferred Medical Only (HMO) covers hearing services with no deductible, offering Medicare-covered exams for a $40 copay and routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $499 to $799 and no coinsurance for up to two devices per year, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Keystone 65 Preferred Medical Only (HMO) partially covers vision services with no deductibles and no coinsurance, offering annual routine eye exams with no copay and other eye exams with a copay ranging from $0 to $40. Eyewear is covered with no copay up to a $250 annual maximum for one pair of contact lenses or eyeglasses, though separate eyeglass lenses, eyeglass frames, upgrades, and other eye exam services are not covered.
Dental Services See details
Keystone 65 Preferred Medical Only (HMO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance, plus routine exams, cleanings, and X-rays with no copay and no coinsurance. Non-covered services include fluoride treatments, orthodontics, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Keystone 65 Preferred Medical Only (HMO) with no copay, though prior authorization is required. Under this benefit, Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Keystone 65 Preferred Medical Only (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Keystone 65 Preferred Medical Only (HMO) with no copays, while coinsurance ranges from no coinsurance up to 20% depending on the item. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Keystone 65 Preferred Medical Only (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services, diagnostic procedures, and diagnostic radiological services, while outpatient X-rays require a $40 copay and therapeutic radiological services have a minimum copay of $85.
Home Health Services See details
Home Health Services are covered by Keystone 65 Preferred Medical Only (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Keystone 65 Preferred Medical Only (HMO) with no coinsurance and a $5 copay, though in practice only some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Keystone 65 Preferred Medical Only (HMO) covers skilled nursing facility services with no coinsurance, requiring prior authorization and 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
Keystone 65 Preferred Medical Only (HMO) partially covers other services, offering acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, and over-the-counter (OTC) items with no copay and no coinsurance up to $30 every three months. Meal benefits and nicotine replacement therapy are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved