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Reminder of changes to our Medicare Advantage plans for 2018 

January 4, 2018    

As previously communicated, Independence is offering five Medicare Advantage plans in 2018: Keystone 65 Focus HMO, Keystone 65 Preferred HMO, Keystone 65 Select HMO, Personal Choice 65SM PPO, and the new Keystone 65 Basic HMO.

Below are a few of the plans’ features.

Observation stays

For all five Independence Medicare Advantage plans, outpatient observation stays are covered. However, the copayment for observation stays will be assessed when a patient visits the emergency room and is kept for an extended period before release. As a reminder, hospitals and critical access hospitals must provide the Medicare Outpatient Observation Notice (MOON) to beneficiaries in Original Medicare (fee-for-service) and Medicare Advantage enrollees who receive observation services as an outpatient for more than 24 hours.

Referrals are no longer needed to see a specialist!

As of January 1, 2018, members in our Medicare Advantage HMO plans will no longer need referrals to see a specialist. We encourage our members to continue to see their primary care physician for coordination of care.

Benefit features

The Keystone 65 HMO and Personal Choice 65 PPO plans will continue to offer the following in 2018:

  • Six routine chiropractic visits and six routine podiatric visits (copayments vary by plan);
  • Standard glasses or contact lenses are covered in full when obtained through a participating provider following cataract surgery (one pair per surgery). However, coverage will not apply to upgraded frames and/or lenses, such as bifocals and progressive lenses;
  • Coverage for urgently needed care at both network retail pharmacy clinics and stand-alone urgent care centers;
  • Enrollment in a SilverSneakers® Fitness program at no extra cost;
  • Routine hearing benefits through TruHearing®, which include: one routine exam and two fitting evaluations per year; and one hearing aid per ear each year with a $699 copayment per ear for a standard hearing aid or $999 copayment per ear for a premium hearing aid, when provided by TruHearing. Note: Keystone 65 Basic, Keystone 65 Select, and Keystone 65 Focus members must have selected the optional supplemental benefits, Choice Program, to be covered under TruHearing.

Copayments

Please note the following regarding copayments for prescription medications:

  • Tier 1 and 2 prescriptions (which include most generic drugs) will have lower copayments when they are filled at a preferred pharmacy.
  • Tier 3, 4, and 5 prescriptions (which include brand-name, specialty, and high-cost generic drugs) will have the same copayments at both preferred and standard pharmacy locations.
  • The lower copayments will be available through FutureScripts® Secure, our mail-order pharmacy, as well as at both local and national chain preferred pharmacies. These include CVS, Giant, Target, ShopRite, Walmart, Sam’s Club, Wegmans, and select independent pharmacies. For an up-to-date list of preferred pharmacies, members can use the Find a Doctor tool.
  • In addition to offering lower, preferred pharmacy copayments, FutureScripts Secure will continue to provide 90-day supplies for just two times the copayment (i.e., members pay only two copayments instead of three).
Please note the following regarding continued savings on medical copayments:
  • Members will be charged one copayment per day for Medicare-covered diagnostic radiology services received at the same location on the same day. These include X-rays and advanced imaging services. The highest copayment will apply.
  • The one copayment per day policy will apply for multiple rehabilitation services received on the same day at the same location. These include physical therapy, occupational therapy, and speech therapy.
  • For inpatient hospital stays, members will not be charged a “per-day” copayment for the day of discharge.

For more information

For more information on Independence Medicare Advantage plans, members can call 1-800-645-3965 for Keystone 65 HMO or 1-888-718-3333 for Personal Choice 65 PPO.

You can also find additional articles related to our Medicare Advantage plans in the Products section.


Tivity Health and SilverSneakers are registered trademarks or trademarks of Tivity Health, Inc., and/or its subsidiaries and/or affiliates in the USA and/or other countries. © 2017 Tivity Health, Inc. All rights reserved.

TruHearing is a registered trademark of TruHearing, Inc., an independent company.

FutureScripts Secure is an independent company that provides pharmacy benefit management services.





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