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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 2025, 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 4.5 out of 5 stars in 2025.
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 $9.50. 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) plan has a $0 deductible. In the initial coverage phase, you will pay different amounts for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and standard mail order, while standard generic drugs have 25% coinsurance at both preferred and standard pharmacies, and standard mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan also offers a Part D premium reduction for those who qualify for the low-income subsidy.
Additional Benefits
The Keystone 65 Focus Rx (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays, and no copays for many preventive services. The plan also provides coverage for primary care, specialist visits, and mental health services with copays ranging from $0 to $30. Additional benefits include hearing, vision, and dental services with copays and coinsurance, as well as coverage for home health, skilled nursing, and ambulance services. The plan also covers home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-6, there is a $210 copay, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Keystone 65 Focus Rx (HMO-POS) plan. Outpatient hospital services and observation services have a $325 copay, while Ambulatory Surgical Center (ASC) services have a $200 copay. Individual and group sessions for outpatient substance abuse have a copay of $30 and $20 respectively. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Keystone 65 Focus Rx (HMO-POS) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $230 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Keystone 65 Focus Rx (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay and no coinsurance. Urgently Needed Services have a copay between $10 and $40 and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Keystone 65 Focus Rx (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and specialist services with a $30 copay. The plan also covers mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $5 copay.
Preventive Services See details
The Keystone 65 Focus Rx (HMO-POS) plan covers preventive services including an annual physical exam with no copay. It also covers additional preventive services, including health education, Medical Nutrition Therapy (MNT), Home-Based Palliative Care, Support for Caregivers of Enrollees, and Fitness Benefit, all with no copay. Kidney Disease Education Services and other preventive services are covered with no copay for services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System (PERS), 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, and Telemonitoring 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 have a $30 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) have a copay between $699 and $999. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$30, and eyewear with a combined maximum benefit of $250 per year. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Keystone 65 Focus Rx (HMO-POS) plan covers Medicare Dental Services with a $30 copay, and other dental services including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment with no copay. The plan also covers restorative services, endodontics, periodontics, prosthetic services, implant services, and oral and maxillofacial surgery, all with varying coinsurance, and orthodontic services with a $2,000 maximum benefit. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by this plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Keystone 65 Focus Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Keystone 65 Focus Rx (HMO-POS) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, as well as Diabetic Equipment with varying coinsurance and copay amounts depending on the specific supply or service. Diabetic Therapeutic Shoes/Inserts have no copay, and Diabetic Supplies have no coinsurance.
Diagnostic and Radiological Services See details
For the Keystone 65 Focus Rx (HMO-POS) plan, diagnostic and radiological services are covered. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $160, Therapeutic Radiological Services have a minimum copay of $60, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Keystone 65 Focus Rx (HMO-POS) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Keystone 65 Focus Rx (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Keystone 65 Focus Rx (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
The Keystone 65 Focus Rx (HMO-POS) plan covers acupuncture with a $15 copay for up to 6 treatments per year, and over-the-counter items with a maximum benefit of $70 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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