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Introducing a new PCP-tiered benefit for 2019 

September 24, 2018    

Independence is offering Keystone 65 Basic HMO, Keystone 65 Focus HMO-POS, Keystone 65 Preferred HMO, and Keystone 65 Select HMO individual members a new Preferred primary care physician (PCP) benefit in 2019. This new benefit will allow members to visit one of the hundreds of preferred PCPs in our network and pay nothing out of pocket.

Our Medicare Advantage HMO and HMO-POS network PCPs have been categorized into one of two benefit tiers:

  • Preferred. Members will pay $0 cost-sharing for PCP visits.
  • Standard. Members will pay the same cost-sharing for PCP visits as 2018.

Note: There will be no PCP copayment increases for 2019 for our Medicare Advantage HMO plans.

In October, a new identifier will be added to our Find a Doctor tool to assist members in locating a Preferred PCP. However, the $0 cost-sharing will not be effective until January 1, 2019.

Preferred PCPs were sent a separate letter by mail notifying them of their placement in the preferred tier. Providers in this tier were selected if they met minimum quality performance metrics and currently participate in a Facilitated Health Network (FHN) or Value-Based contract with Independence that contains both upside and downside incentives for 2019. Providers can confirm their tier placement in the Find a Doctor tool after October 1, 2018.

Additional information about this new benefit will be communicated in future Partners in Health UpdateSM articles.

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