Independence will soon introduce Keystone 65 Focus Rx HMO (Keystone 65 Focus), a new Medicare Advantage HMO benefit product for 2016. Keystone 65 Focus uses a defined-network with more than 23,000 participating providers in southeastern Pennsylvania. Keystone 65 Focus members will enjoy the same 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.
The following hospitals are participating in the Keystone 65 Focus network. 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 below for non-emergency services.
- 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
Keystone 65 Focus benefits
||Keystone 65 Focus Rx HMO*
|Monthly plan premium
||Philadelphia and Bucks County
||Chester, Delaware, and Montgomery County
|Medical with Choice Program
|Medical with Rx
|Medical with Rx and Choice Program
||Defined network of physicians, ancillary providers, and hospitals
|Primary care physician (PCP) visits
||$75 copay (not waived if admitted)
||$20 in-network urgent care centers ($10 for PCP; $40 for specialist) (not waived if admitted to the hospital)
||Emergency care and urgently needed care are covered worldwide, $75 copay per visit (not waived if admitted)
|Routine chiropractic services
||$20 copay per visit (up to 6 visits per year)
|Routine podiatry services
||$40 copay per visit (up to 6 visits per year)
||$150 copay per ambulatory surgical center visit
$250 copay per outpatient hospital facility visit
||$150 per day for days 1 – 4; $600 maximum per stay; unlimited days per admission
|Preventive dental and vision care
||Available only with the Choice Program option: $10 copay for dental exam and cleaning once every 6 months; $10 copay for a routine eye exam and up to $100 allowance for eyewear every 2 years
||Available only with the Choice Program option: $40 copay for a routine hearing exam. Hearing aid benefit copay of $699 (standard) or $999 (premium) per hearing aid (one per ear per year)
|Out-of-pocket maximum for 2016
|Prescription drugs (optional coverage)
||No deductible for brand prescription drugs
No deductible for generic tier 1 and tier 2 drugs
||$2 preferred generic
$47 preferred brand
$100 non-preferred brand
33% coinsurance specialty drug
|Initial coverage limit
||$3,310 in total drug cost
||Member pays 58% of generic drug costs and 45% of brand name drug costs until he or she reaches $4,850
||Member pays the greater of $2.95 generic and $7.40 brand or 5% coinsurance after reaching $4,850 catastrophic trigger
|Mail order (90-day supply)
||$4 preferred generic
$94 preferred brand
$200 non-preferred brand
33% coinsurance specialty drug
*All Keystone 65 HMO members must use in-network hospitals and physicians with the exception of emergent or urgently needed care. Referrals are required for most services.
†For urgently needed care received outside the United States, the emergency room copayment will apply.
Your participation status for the Keystone 65 Focus defined network
We recently mailed providers in our Keystone 65 HMO network eligibility criteria and their participation status for Keystone 65 Focus. If you have any questions about the eligibility criteria or another aspect of the Keystone 65 Focus defined network, please refer to the frequently asked questions on our website. If you still have questions after reviewing this information, please email us.
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.
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