Independence has introduced Keystone 65 Focus Rx HMO (Keystone 65 Focus), a new Medicare Advantage benefit product for 2016. Keystone 65 Focus is a defined-network benefit product with more than 23,000 participating providers in southeastern Pennsylvania. Keystone 65 Focus members will enjoy similar benefits as with broader-network Medicare Advantage HMO benefit products, while taking advantage of lower premiums and out-of-pocket costs due to their more defined network of providers.
As a reminder, the following hospitals are participating in the Keystone 65 Focus network:
- Abington Health
- – Abington Memorial Hospital
- – Lansdale Hospital
Community Health Systems
- – Brandywine Hospital
- – Chestnut Hill Hospital
- – Jennersville Regional Hospital
- – Phoenixville Hospital
- – Pottstown Memorial Medical Center
Grand View Hospital
Holy Redeemer Hospital and Medical Center
Main Line Hospitals, Inc.
- – Bryn Mawr Hospital
- – Lankenau Medical Center
- – Paoli Hospital
- – Riddle Hospital
St. Luke's Health System
Thomas Jefferson University Hospital, Inc.
- – Methodist Hospital
- – Thomas Jefferson University Hospital
Please note that if an Independence-participating hospital does not appear on this list, it means the hospital is not participating in the Keystone 65 Focus network. Members who choose Keystone 65 Focus for their health care coverage should only be referred to the hospitals listed above for their health care. Providers participating in the Keystone 65 Focus network can be found using the online provider directory.
Capitation arrangements for Keystone 65 Focus
The following capitation arrangements apply for the Keystone 65 Focus benefit product:
- Radiology and physical therapy services. Radiology and physical therapy services will not be capitated. Keystone 65 Focus members must be directed to a participating provider in the Keystone 65 Focus network. These services will be reimbursed on a fee-for-service basis for the Keystone 65 Focus benefit product. Referral requirements still apply.
- Laboratory services. Laboratory services will remain capitated, and Keystone 65 Focus members must be directed to their primary care physician's capitated laboratory outpatient provider.
Look for more detailed information regarding capitation arrangements for the Keystone 65 Focus benefit product in the December 2015 edition of Partners in Health UpdateSM.
For more information
Refer to the article Keystone 65 Focus Rx HMO, our new Medicare Advantage benefit product for detailed information about Keystone 65 Focus. If you have Medicare patients who are interested in learning more about Keystone 65 Focus, please have them contact Customer Service toll-free at 1-800-645-3965 (TTY/TDD: 711), 8 a.m. to 8 p.m., seven days a week. Please keep in mind that providers must remain neutral when assisting patients with enrollment decisions. Any discussions with patients should be an objective assessment of the patient's needs and potential options.
If you have any questions about Keystone 65 Focus, including the eligibility criteria for participation in the defined network, please refer to the frequently asked questions on our website.