Personal Choice 65 Rx (PPO)

Pennsylvania Medicare Advantage Plan (2024 Plan)


Monthly Premium

Your Cost
$247
by Independence Blue Cross

Additional Coverage

HearingVisionDental

Overall Government Star Rating

 4.5
out of 5 stars

Ready to Enroll Online?


Plan Name
Personal Choice 65 Rx (PPO)
Insurance Carrier
Independence Blue Cross
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
PPO

Personal Choice 65 Rx (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Pennsylvania and offered by the health insurance company Independence Blue Cross. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$247
Annual Deductible
$0
Max Out-of-Pocket
$5,000
Primary doctor visit
$0 copay
Specialist visit
$35 copay per visit
ER visit
$100 copay per visit (always covered)
Ambulance
$175 copay

Personal Choice 65 Rx (PPO) has a monthly premium cost of $247 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $8,950 In and Out-of-network $5,000 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Personal Choice 65 Rx (PPO) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Personal Choice 65 Rx (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Personal Choice 65 Rx (PPO) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Personal Choice 65 Rx (PPO) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Personal Choice 65 Rx (PPO) received an overall government quality rating of 4.5 stars out of 5 stars.

Personal Choice 65 Rx (PPO) performed better than Pennsylvania’s State average overall quality score of 4.2 stars.

This Plan’s 5-star Gov’t Quality Score
Pennsylvania State Average Score
Overall Government 5 Star Quality Rating
 4.5
 4.2
Summary rating of health plan quality
 4.5
 4.1
Staying healthy: screenings, tests, & vaccines
 4
 3.7
Managing chronic (long term) conditions
 3
 3.7
Member experience with health plan
 4
 4.1
Member complaints & changes in the health plan's performance
 5
 4.1
Health plan customer service
 4
 4.2
Summary rating of drug plan quality
 4.5
 4.1
Drug plan customer service
 3
 3.5
Member complaints & changes in the drug plan's performance
 5
 4.3
Member experience with the drug plan
 4
 4.2
Drug safety & accuracy of drug pricing
 4
 3.7

The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.

Personal Choice 65 Rx (PPO) received 4.5 stars for its health plan quality score which is better than the Pennsylvania State average health plan quality score of 4.1 stars.

Personal Choice 65 Rx (PPO) received 4.5 stars for its drug plan quality score which is better than the Pennsylvania State average drug plan quality score of 4.1 stars.


Monthly Premium
$247
Health Portion of Premium
$139
Drug Portion of Premium
$108
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$8,950 In and Out-of-network
$5,000 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes
Doctor Lookup Link

Doctor Services

Primary doctor visit
In-network: $0 copay
Out-of-network: 30% coinsurance per visit
Specialist visit
In-network: $35 copay per visit
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0 copay
Out-of-network: 30% coinsurance
Lab services
In-network: $0 copay
Out-of-network: 30% coinsurance
Diagnostic radiology services (like MRI)
In-network: $0-175 copay
Out-of-network: 30% coinsurance
Outpatient x-rays
In-network: $40 copay
Out-of-network: 30% coinsurance
Emergency care
$100 copay per visit (always covered)
Urgent care
$5-60 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $240 per day for days 1 through 6
$0 per day for days 7 through 90
$0 per day for days 90 and beyond
Out-of-network: 30% per stay
Outpatient hospital coverage
In-network: $300 copay per visit
Out-of-network: 30% coinsurance per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: 30% per stay

Preventive services

Preventive services
In-network: $0 copay
Out-of-network: 30% coinsurance

Ambulance

Ground ambulance
In-network: $175 copay
Out-of-network: $175 copay

Therapy services

Occupational therapy visit
In-network: $20 copay
Out-of-network: 30% coinsurance
Physical therapy & speech & language therapy visit
In-network: $20 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $20 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy with a psychiatrist
In-network: $30 copay
Out-of-network: 30% coinsurance
Outpatient group therapy visit
In-network: $20 copay
Out-of-network: 30% coinsurance
Outpatient individual therapy visit
In-network: $30 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: 30% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$9.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$0 copay

Brand-name drugs :
$0 copay

Generic$20.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: 30% coinsurance

Hearing

Hearing exam
In-network: $35 copay
Out-of-network: 30% coinsurance
Fitting/evaluation
In-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All types
In-network: $499-799 copay
Out-of-network: $499-799 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: 80% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 80% coinsurance
Fluoride treatment
Not covered
Dental x-rays
In-network: $0 copay
Out-of-network: 80% coinsurance

Comprehensive dental

Non-routine services
Not covered
Diagnostic services
Not covered
Restorative services
In-network: 20% coinsurance
Out-of-network: 80% coinsurance
Endodontics
In-network: 20% coinsurance
Out-of-network: 80% coinsurance
Periodontics
In-network: 20% coinsurance
Out-of-network: 80% coinsurance
Extractions
In-network: 20% coinsurance
Out-of-network: 80% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: 40% coinsurance
Out-of-network: 80% coinsurance

Vision

Routine eye exam
In-network: $0 copay
Out-of-network: 80% coinsurance
Contact lenses
In-network: $0 copay
Out-of-network: 80% coinsurance
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: 80% coinsurance
Eyeglass frames (only)
Not covered
Eyeglass lenses (only)
Not covered
Upgrades
Not covered

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Ready to Enroll Online?

Please Support Our Sponsor

Advertisement

Medicare Health Plans

Get Advice & Sign Up Help

TTY 711

Speak with a Licensed Insurance Agent

Mon-Fri: 8am - 11pm ET
Sat-Sun: 8am - 11pm ET

Medicare65quote

  • Medicare Advantage Plans
  • Medicare Prescription Drug Plans
  • Medicare Supplement Insurance Plans

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! See www.medicare65quote.com for our Third-Party Marketing Organization disclaimer.

Related Articles
Best Pennsylvania Medicare Advantage Health Insurance Companies for 2024

In this article we rank Pennsylvania Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.

Read more →