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Keystone 65 Liberty Medical Only (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Keystone 65 Liberty Medical Only (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Keystone 65 Liberty Medical Only (HMO) in 2026, please refer to our full plan details page.
Keystone 65 Liberty Medical Only (HMO) is a HMO plan offered by Independence Health Group, Inc. available for enrollment in 2025 to people living in Philadelphia, Bucks, 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 Liberty Medical Only (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Keystone 65 Liberty Medical Only (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 Liberty Medical Only (HMO), 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 $120.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by Keystone 65 Liberty Medical Only (HMO).
Additional Benefits
Keystone 65 Liberty Medical Only (HMO) offers affordable essential healthcare coverage, including primary care physician visits with no copay and specialist visits for a $55 copay. For hospital care, inpatient stays require a $370 daily copay for days 1 through 6, followed by no copay for days 7 through 90, while outpatient services carry no copay and a 20% coinsurance. Emergency room visits are covered with a $130 copay, and urgent care visits range from a $15 to $50 copay. This plan also features valuable supplemental benefits, including routine eye exams, preventive dental care, and home health services all with no copay. Comprehensive dental is available with a 20% to 40% coinsurance up to a $2,000 annual limit, and routine hearing exams feature no copay, with hearing aids requiring a copay between $699 and $999. Members can also take advantage of a $30 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Keystone 65 Liberty Medical Only (HMO) with no coinsurance, requiring a $370 daily copay for days 1 through 6 and no copay for days 7 through 90 for both acute and psychiatric stays. Prior authorization is required, and while unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Keystone 65 Liberty Medical Only (HMO) covers outpatient services, offering outpatient hospital and ambulatory surgical center services with no copay and a 20% coinsurance. Outpatient substance abuse services require no coinsurance and feature a $30 copay for individual sessions or a $20 copay for group sessions, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Keystone 65 Liberty Medical Only (HMO) covers partial hospitalization services with a $30.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Keystone 65 Liberty Medical Only (HMO) covers ground and air ambulance services with a $280 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are partially covered by Keystone 65 Liberty Medical Only (HMO), offering emergency room visits for a $130 copay and no coinsurance, and urgent care for a $15 to $50 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
Keystone 65 Liberty Medical Only (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $55 copay and no coinsurance. Additional benefits like physical therapy ($45 copay) and mental health sessions ($20 to $30 copay) also feature no coinsurance, though chiropractic benefits are only partially covered as other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Keystone 65 Liberty Medical Only (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and kidney disease education. However, the plan does not cover in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, in-home support, additional smoking cessation, telemonitoring, home safety modifications, or counseling.
Hearing Services See details
Keystone 65 Liberty Medical Only (HMO) covers hearing services with no coinsurance, featuring a $55 copay for Medicare-covered exams, and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Keystone 65 Liberty Medical Only (HMO) features partially covered vision services with no coinsurance, offering one routine eye exam per year with no copay, though other eye exam services are not covered. Eyewear is also partially covered with no copay up to a $250 annual combined maximum for contact lenses or eyeglasses, while individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Keystone 65 Liberty Medical Only (HMO) partially covers dental services, offering Medicare-covered dental for a $55 copay and no coinsurance, and preventive care like cleanings and x-rays with no copay and no coinsurance. Comprehensive options such as restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery are covered with no copay and 20% to 40% coinsurance up to a $2,000 annual limit, though orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Keystone 65 Liberty Medical Only (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Keystone 65 Liberty Medical Only (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Keystone 65 Liberty Medical Only (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance, subject to prior authorization. Diabetic equipment is also covered with prior authorization, featuring no copay for therapeutic shoes or inserts, and no coinsurance to 20% coinsurance for diabetic supplies from specified manufacturers.
Diagnostic and Radiological Services See details
Keystone 65 Liberty Medical Only (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members pay no copay for diagnostic procedures, lab services, and diagnostic radiological services, but will pay a $50 copay for outpatient X-rays and a copay starting at $85 for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Keystone 65 Liberty Medical Only (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Keystone 65 Liberty Medical Only (HMO) offers Cardiac Rehabilitation Services with no coinsurance, but in practice, some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Keystone 65 Liberty Medical Only (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copayment for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Keystone 65 Liberty Medical Only (HMO) partially covers other services, offering acupuncture with 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 $30.00 quarterly limit. Meal benefits and other supplemental services are not covered under this plan.
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