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Keystone 65 Preferred Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Keystone 65 Preferred Rx (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 Rx (HMO) in 2026, please refer to our full plan details page.
Keystone 65 Preferred Rx (HMO) is a HMO plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Bucks, Philadelphia Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Keystone 65 Preferred Rx (HMO) 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 Keystone 65 Preferred Rx (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 Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $188.00. 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 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:
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Drug Coverage
The Keystone 65 Preferred Rx (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront costs. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay for one-, two-, or three-month supplies when using a preferred pharmacy or standard mail order. If you use a standard pharmacy, Tier 1 drugs have a $9 copay and Tier 2 drugs have a $20 copay for a one-month supply. For higher-tier medications, costs are structured as coinsurance rather than flat copays across preferred, standard, and mail-order pharmacies. Tier 3 preferred brands require a 25% coinsurance, Tier 4 non-preferred drugs carry a 35% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance. These percentage-based costs apply equally to one-, two-, and three-month supplies.
Additional Benefits
The Keystone 65 Preferred Rx (HMO) plan provides comprehensive healthcare coverage with predictable out-of-pocket costs and no coinsurance for most medical services. Members benefit from no copay for primary care visits, preventive services, and home health care, while specialist visits require a $40 copay. For hospital care, inpatient stays carry a $275 daily copay for the first seven days with no copay thereafter, and emergency room visits have a flat $150 copay. Supplemental benefits are a major highlight of this plan, offering no copay for routine dental, vision, and hearing exams, plus up to $250 annually for eyewear. Diagnostic labs and outpatient blood services also feature no copay, while durable medical equipment and dialysis services require a coinsurance of up to 20%. Additionally, the plan includes a $30 quarterly allowance for over-the-counter health items with no copay.
Inpatient Hospital See details
Keystone 65 Preferred Rx (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a $275 daily copay for days 1-7, followed by no copay for days 8 through 90. Unlimited additional acute days are covered at no copay, but non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Keystone 65 Preferred Rx (HMO) with no coinsurance, featuring copays of $375 for outpatient hospital services, $275 per stay for observation services, and $150 for ambulatory surgical center services. Outpatient substance abuse services require a $20 to $30 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization is covered by Keystone 65 Preferred Rx (HMO) with a $30.00 copay and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Keystone 65 Preferred Rx (HMO) covers ground and air ambulance services with a $180 copay and no coinsurance, requiring 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 Rx (HMO) covers emergency services with a $150 copay and urgently needed services with a $5 to $50 copay, with no coinsurance required for either service. Worldwide emergency and urgent care are also covered with a $150 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Keystone 65 Preferred Rx (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Therapy, podiatry, and mental health services have copays ranging from $20 to $40 with no coinsurance, while chiropractic care is partially covered since other chiropractic services are not covered.
Preventive Services See details
Keystone 65 Preferred Rx (HMO) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness benefits, and screenings. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, telemonitoring, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, in-home support, post-discharge medication reconciliation, readmission prevention, wigs, smoking cessation, counseling, and home safety modifications.
Hearing Services See details
Hearing services are covered by Keystone 65 Preferred Rx (HMO) with no coinsurance, featuring a $40 copay for Medicare-covered exams and no copay for routine annual exams and hearing aid evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $499 and $799, though over-the-counter (OTC), inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Vision services are partially covered by Keystone 65 Preferred Rx (HMO) with no deductibles or coinsurance, featuring no copay for annual routine eye exams and up to a $40 copay for other exams. Eyewear is covered with no copay up to a $250 annual maximum for one pair of contact lenses or eyeglasses, though individual eyeglass lenses, frames, upgrades, and other eye exam services are not covered.
Dental Services See details
Keystone 65 Preferred Rx (HMO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance. Preventive services like oral exams, cleanings, and x-rays are covered with no copay and no coinsurance, but fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Keystone 65 Preferred Rx (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Keystone 65 Preferred Rx (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Keystone 65 Preferred Rx (HMO) with no copays, though coinsurance ranges from 0% to 20% depending on the item. Covered benefits—including durable medical equipment, prosthetics, medical supplies, and diabetic equipment—generally require prior authorization and carry up to a 20% coinsurance with no copays.
Diagnostic and Radiological Services See details
Keystone 65 Preferred Rx (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for lab services, diagnostic procedures, and diagnostic radiological services, while outpatient X-rays have a $40 copay and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
Keystone 65 Preferred Rx (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Keystone 65 Preferred Rx (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Keystone 65 Preferred Rx (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required for admission, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Keystone 65 Preferred Rx (HMO) partially covers other services, offering acupuncture with a $20.00 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 a $30 limit every three months. Meal benefits and other additional services are not covered.
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