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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 Chester, Delaware, Montgomery. 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 $10.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $9.30. 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 for prescription drugs. In the initial coverage phase, you'll pay varying costs depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred and mail-order pharmacies, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Keystone 65 Focus Rx (HMO-POS) plan offers a range of benefits with varying costs. Hospital stays have a copay of $210 for days 1-6, and then no copay for the remainder of the stay. Outpatient services and emergency services have copays, while primary care visits, preventive services, and home health services have no copay. The plan also covers hearing, vision, and dental services, with copays for exams and services. Medical equipment and supplies are covered with some coinsurance, and prescription hearing aids are covered with a copay. The plan also covers home infusion, dialysis, and other services, with a mix of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-6, the copay is $210, and for days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. For outpatient hospital and observation services, there is a $325 copay, while ambulatory surgical center services have a $200 copay. Outpatient blood services have no copay, individual outpatient substance abuse sessions have a $30 copay, and group outpatient substance abuse sessions have a $20 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 under the Keystone 65 Focus Rx (HMO-POS) plan. Both Medicare-covered 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $10-40 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Keystone 65 Focus Rx (HMO-POS) plan offers primary care services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $20 copay. Additionally, the plan covers physician specialist services with a $30 copay, mental health specialty services with a copay between $20 and $30, and podiatry services with a $25 copay. The plan also covers other health care professional services with a copay between $0 and $30, psychiatric services with a copay between $20 and $30, and physical therapy and speech-language pathology services with a $20 copay. Finally, the plan covers additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $5 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services that may include copays for services like health education. Kidney disease education, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids are not covered, and 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 coverage 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 with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, and fluoride treatment with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable, and fixed), implant services, and oral and maxillofacial surgery are covered with 20% to 40% coinsurance, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Keystone 65 Focus Rx (HMO-POS) plan. This includes coverage for Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Keystone 65 Focus Rx (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Keystone 65 Focus Rx (HMO-POS) plan. Durable Medical Equipment has no copay and a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. For Diabetic Supplies, there is no coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered, with a copay for Medicare-covered diagnostic procedures, tests, and lab services. 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 copay of at most $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. However, 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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Keystone 65 Focus Rx (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture has a $15 copay, and OTC items are covered up to $70 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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