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Upcoming Medicare Advantage HMO and PPO benefit changes  

October 1, 2015    

Effective January 1, 2016, there will be several changes to our current Medicare Advantage HMO and PPO plans, including the introduction of a new plan — Keystone 65 Focus Rx HMO (Keystone 65 Focus). The Keystone 65 Focus plan offers members an affordable option with a $0 premium in Philadelphia and Bucks counties, and $25 premium in Chester, Delaware, and Montgomery counties. Please refer to the article Keystone 65 Focus Rx HMO, our new Medicare Advantage benefit product for detailed information about this new plan.

The Keystone 65 Basic Rx HMO plan will be discontinued on December 31, 2015. Current members of the Keystone 65 Basic plan have two options this Annual Election Period:

  1. Do nothing and be automatically enrolled into the Keystone 65 Select Rx HMO plan.
  2. Enroll into a new plan by completing a Plan Change Form.

Additionally, highlights for 2016 include:

  • reduced Maximum Out of Pocket (MOOP) across all Independence Medicare Advantage plans;
  • new routine chiropractic and routine podiatry benefits;
  • reduced copay for cardiac and pulmonary rehabilitation services;
  • new hearing aid program through TruHearing®;
  • two Medicare Advantage plans with a $0 drug deductible;
  • minimal increases in premiums;
  • reduced monthly premium for Choice Program.
  • Medicare Advantage HMO and PPO members should have already received their 2016 Annual Notice of Changes/ Evidence of Coverage. They will have until December 7, 2015, to make any changes to their health care plans.

    The following tables highlight some of the Medicare Advantage HMO and PPO benefits changes for 2016.

    Medicare Advantage HMO and PPO monthly plan premiums

    Plan type Keystone 65 Focus HMO Keystone 65 Select HMO Keystone 65 Preferred HMO Person
    Medical only Not available Philadelphia/Bucks: $12 Chester/Delaware/ Montgomery: $37 Philadelphia/Bucks: $145 Chester/Delaware/ Montgomery: $204 Philadelphia/Bucks: $165
    Medical with Choice Program (hearing, dental, vision)Not available Philadelphia/Bucks: $18 Chester/Delaware/ Montgomery: $43 Not available Not available
    Medical with Rx Philadelphia/Bucks: $0 Chester/Delaware/ Montgomery: $25 Philadelphia/Bucks: $36 Chester/Delaware/ Montgomery: $75 Philadelphia/Bucks: $199 Chester/Delaware/ Montgomery: $272 Philadelphia/Bucks: $251 Chester/Delaware/ Montgomery: $134
    Medical with Rx and Choice Program Philadelphia/Bucks: $6 Chester/Delaware/ Montgomery: $31 Philadelphia/Bucks: $42 Chester/Delaware/ Montgomery: $81 Not available Not available

    Medicare Advantage HMO and PPO benefits highlights

    Service category Keystone 65 Focus HMO Keystone 65 Select HMO Keystone 65 Preferred HMO Personal Choice 65<sup>SM</sup> PPO
    Maximum out of pocket (MOOP)$5,700 in network $5,500 in network $4,000 in network $6,200 in network, $10,000 combined in network and out of network
    Cardiac and pulmonary rehabilitation (referral required)$5 copay $5 copay $5 copay $5 copay
    Routine chiropractic, up to 6 visits (referral required)*$20 copay$20 copay$20 copay$20 copay
    Routine podiatry, up to 6 visits (referral required)*$40 copay $45 copay $40 copay $40 copay
    Hearing servicesWith Choice Program - $40 copay once every 3 years. Hearing aid copay, $699 (standard) or $999 (premium) (one aid per ear per year) through TruHearing. Includes $0 copay for fitting and evaluation. With Choice Program - $40 copay once every 3 years. Hearing aid copay, $699 (standard) or $999 (premium) (one aid per ear per year) through TruHearing. Includes $0 copay for fitting and evaluation. $40 copay once every 3 years. Hearing aid copay, $699 (standard) or $999 (premium) (one aid per ear per year) through TruHearing. Includes $0 copay for fitting and evaluation. $40 copay once every 3 years. Hearing aid copay, $699 (standard) or $999 (premium) (one aid per ear per year) through TruHearing. Includes $0 copay for fitting and evaluation.
    SilverSneakers®Included IncludedIncluded Included
    Prescription drug deductible$0 (all tiers) $320 (tiers 3-5) $0 (all tiers) $320 (tiers 3-5)
    Primary care physician visits$10 copay per visit $20 copay per visit $5 copay per visit $15 copay per visit
    Specialist visits $40 copay per visit $45 copay per visit $40 copay per visit $40 copay per visit
    Emergency room (U.S. and worldwide)$75 copay per visit (not waived if admitted) $75 copay per visit (not waived if admitted) $75 copay per visit (not waived if admitted) $75 copay per visit (not waived if admitted)
    Urgent care center $20 copay (not waived if admitted to the hospital) $30 copay (not waived if admitted to the hospital) $20 copay (not waived if admitted to the hospital) $20 copay (not waived if admitted to the hospital)
    Outpatient surgery$150 copay per visit for ambulatory surgical centers (ASC); $250 copay per visit for outpatient hospital facility $150 copay per visit for ASCs; $400 copay per visit for outpatient hospital facility $125 copay per visit for ASCs; $400 copay per visit for outpatient hospital facility $150 copay per visit for ASCs; $400 copay per visit for outpatient hospital facility
    Inpatient hospital$150 per day for days 1 – 4 ($600 per stay maximum) per admission $290 per day for days 1 – 6 ($1,740 per stay maximum) per admission $240 per day for days 1 – 6 ($1,440 per stay maximum) per admission $900 per admission; unlimited days per admission
    Dental, vision, hearing (non- Medicare covered) Benefits available for additional $6 per month in plan premiums through the Choice Program Benefits available for additional $6 per month in plan premiums through the Choice Program Dental: $20 copay for exams and cleanings once every 6 months
    Vision: $40 copay once every 2 years; covered up to $100 every 2 years for eyewear
    Hearing: $40 copay once every 3 years; hearing aid copay of $699 (standard) or $999 (premium) per hearing aid per year
    Dental and vision not covered. Routine hearing is now covered for 2016 through TruHearing
    *This is addition to Medicare covered services.

    Contact your Network Coordinator if you have any questions.

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

    SilverSneakers is a registered mark of Healthways, Inc., an independent company.





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