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Keystone 65 Focus Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Keystone 65 Focus Rx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Keystone 65 Focus Rx (HMO-POS) in 2026, please refer to our full plan details page.
Keystone 65 Focus Rx (HMO-POS) is a HMO-POS plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Philadelphia, Bucks. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Keystone 65 Focus Rx (HMO-POS) 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 Focus Rx (HMO-POS).
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 Focus Rx (HMO-POS), 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. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $6750.00 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 Focus Rx (HMO-POS) Medicare plan features a $0 prescription drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay when filled through 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 brand-name and specialty medications, your costs are based on coinsurance regardless of the pharmacy type you choose. Tier 3 preferred brand drugs require a 25% coinsurance, and Tier 4 non-preferred drugs require a 37% coinsurance. Specialty medications in Tier 5 carry a 33% coinsurance for all available supply lengths.
Additional Benefits
The Keystone 65 Focus Rx (HMO-POS) plan offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance. For example, members pay no copay for primary care visits, preventive services, routine vision and hearing exams, and home health care. When copays do apply for major services, they are clearly defined, such as a $275 copay for days one through seven of inpatient hospital stays and a $130 copay for emergency room visits, both with no coinsurance. Specialist visits, therapies, and mental health services require low copays ranging from $5 to $30 and no coinsurance. Routine dental care is available with no copay, while comprehensive dental services are covered up to a $1,500 annual limit with no copay and 20% to 40% coinsurance. Additionally, the plan includes practical extras like an over-the-counter item benefit of up to $60 every three months with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Keystone 65 Focus Rx (HMO-POS) with no coinsurance, requiring a $275 copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Keystone 65 Focus Rx (HMO-POS) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital services and a $275 copay per stay for observation services. Ambulatory surgical center services require a $235 copay with no coinsurance, while outpatient substance abuse sessions have a $20 to $30 copay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Keystone 65 Focus Rx (HMO-POS) with a $30.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Keystone 65 Focus Rx (HMO-POS), offering ground and air ambulance services with a $260 copay and no coinsurance. However, transportation services to plan-approved or health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered by Keystone 65 Focus Rx (HMO-POS) with a $130 copay and no coinsurance, while urgently needed services require a $10 to $50 copay and no coinsurance. Worldwide emergency and urgent services are partially covered with a $130 copay and no coinsurance, as worldwide emergency transportation is not covered.
Primary Care See details
Keystone 65 Focus Rx (HMO-POS) covers primary care physician visits with no copay and no coinsurance, while specialists, therapies, and mental health services require copays ranging from $5 to $30 and no coinsurance. Chiropractic services are partially covered, offering up to six routine visits per year with a $15 copay and no coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive Services under Keystone 65 Focus Rx (HMO-POS) are partially covered with no copay and no coinsurance for covered services, including annual physical exams, fitness benefits, and health education. However, several supplemental services are not covered, such as in-home safety assessments, weight management programs, alternative therapies, and personal emergency response systems.
Hearing Services See details
Keystone 65 Focus Rx (HMO-POS) covers Medicare-covered hearing exams with a $30 copay and routine hearing exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two devices per year, while inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Keystone 65 Focus Rx (HMO-POS) with no deductibles or coinsurance. Routine eye exams (one per year) and eyewear (one pair of contact lenses or eyeglasses per year, up to a $250 annual limit) are covered with no copay, but other eye exams, individual eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Keystone 65 Focus Rx (HMO-POS) offers partially covered dental services, featuring Medicare-covered dental for a $30 copay and no coinsurance, alongside preventive care with no copay and no coinsurance. Comprehensive services are covered up to a $1,500 annual limit with no copay and 20% to 40% coinsurance, though orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Keystone 65 Focus Rx (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while 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 under Keystone 65 Focus Rx (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Keystone 65 Focus Rx (HMO-POS) covers durable medical equipment, prosthetics, and diabetic supplies with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Keystone 65 Focus Rx (HMO-POS) 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 $30 copay and therapeutic radiological services have a copayment starting at $85.
Home Health Services See details
Keystone 65 Focus Rx (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required. This benefit ensures you can receive necessary medical care in your home at no additional cost.
Cardiac Rehabilitation Services See details
Keystone 65 Focus Rx (HMO-POS) covers cardiac rehabilitation services with no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Keystone 65 Focus Rx (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Under this plan, you 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
Keystone 65 Focus Rx (HMO-POS) partially covers other services, including acupuncture with a $15 copay and no coinsurance for up to six treatments per year, and over-the-counter items with no copay and no coinsurance up to $60 every three months. Meal benefits are not covered under this plan.
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