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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 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 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 $15.00. 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 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or standard mail order services. If you choose a standard pharmacy, Tier 1 drugs require a $9 copay for a one-month supply, while Tier 2 drugs carry a $20 copay. For brand-name and specialty medications, cost-sharing is structured as a coinsurance percentage rather than a flat copay. You will pay 25% coinsurance for Tier 3 preferred brand drugs, 37% coinsurance for Tier 4 non-preferred drugs, and 33% coinsurance for Tier 5 specialty drugs. These coinsurance rates remain the same whether you fill your prescription at a preferred pharmacy, standard pharmacy, or via standard mail order.
Additional Benefits
The Keystone 65 Focus Rx (HMO-POS) plan offers affordable routine care, featuring no copays for primary care physician visits, preventive services, and routine annual eye and hearing exams. Specialist visits require a $30 copay, while emergency room visits carry a $130 copay with no coinsurance. For hospital care, inpatient stays require a $275 daily copay for days 1 to 7 followed by no copay, while outpatient hospital services require a $350 copay. Additional benefits include preventive dental services with no copay and comprehensive dental coverage up to a $1,500 annual maximum with 20% to 40% coinsurance. Members also benefit from a $250 annual eyewear allowance and a $60 quarterly over-the-counter allowance with no copays. Furthermore, home health services and the first 20 days of skilled nursing facility care are covered with no copay.
Inpatient Hospital See details
Keystone 65 Focus Rx (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 to 7 and no copay for days 8 through 90. Prior authorization is required, and while unlimited additional days for acute stays are covered at no copay, 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 and no coinsurance.
Partial Hospitalization See details
Keystone 65 Focus Rx (HMO-POS) covers partial hospitalization services with a $30.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Keystone 65 Focus Rx (HMO-POS) covers ground and air ambulance services with a $260 copay and no coinsurance, though prior authorization is required and the copay is not waived upon hospital admission. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Emergency services under Keystone 65 Focus Rx (HMO-POS) are covered 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, though worldwide emergency transportation is not covered.
Primary Care See details
Keystone 65 Focus Rx (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Other services like physical therapy, mental health, and podiatry have copays ranging from $0 to $30 and no coinsurance, though chiropractic benefits are only partially covered since other chiropractic services are not covered.
Preventive Services See details
Keystone 65 Focus Rx (HMO-POS) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physical exams and diabetes self-management training. However, some sub-services are not covered, including personal emergency response systems (PERS), weight management programs, alternative therapies, and in-home safety assessments.
Hearing Services See details
Keystone 65 Focus Rx (HMO-POS) covers hearing exams and fittings with no coinsurance, featuring no copay for routine annual exams and fittings, and a $30 copay for Medicare-covered exams. Prescription hearing aids are partially covered with no coinsurance and a copay of $699 to $999 for up to two aids per year, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Keystone 65 Focus Rx (HMO-POS) provides partially covered vision services with no coinsurance or deductibles, offering one routine eye exam per year with no copay, though other eye exam services are not covered. Eyewear is covered with no copay up to a $250 annual limit for one pair of contact lenses or eyeglasses, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Keystone 65 Focus Rx (HMO-POS) offers partially covered dental services, excluding other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics. Medicare-covered dental has a $30 copay and no coinsurance, preventive care has no copay and no coinsurance, and comprehensive services require no copay and 20% to 40% coinsurance up to a $1,500 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Keystone 65 Focus Rx (HMO-POS) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Keystone 65 Focus Rx (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Keystone 65 Focus Rx (HMO-POS) covers medical equipment with no copay for durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes and inserts. A 20% coinsurance applies to DME, prosthetics, and medical supplies, while diabetic supplies carry a coinsurance of 0% (no coinsurance) to 20%.
Diagnostic and Radiological Services See details
Keystone 65 Focus Rx (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Outpatient lab services, diagnostic procedures, and diagnostic radiology are available with no copay, while outpatient X-rays require a $30 copay and therapeutic radiological services carry a copay starting at $85.
Home Health Services See details
Home Health Services are covered by Keystone 65 Focus Rx (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Keystone 65 Focus Rx (HMO-POS) provides Cardiac Rehabilitation Services with no coinsurance, and although some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Keystone 65 Focus Rx (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Keystone 65 Focus Rx (HMO-POS) provides partial coverage for other services, which includes acupuncture for a $15.00 copay and no coinsurance for up to 6 treatments per year, and over-the-counter items with no copay and no coinsurance up to a $60.00 quarterly limit. Meal benefits are not covered under this plan.
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