Independence is offering Keystone 65 Focus RX HMO, Keystone 65 Preferred HMO, Keystone 65 Select HMO,
and Personal Choice 65SM PPO members several ways to save on many of their copayments for prescription drugs,
diabetic supplies, diagnostic radiology services, rehabilitation services, and inpatient hospital stays next year.
Lower, preferred pharmacy copays
Starting in 2017, Medicare Advantage members can take advantage of lower copays for many prescriptions filled at
preferred pharmacies. Here’s how it works:
- Tier 1 and 2 prescriptions (which include most generic drugs) will have lower copays when they are filled at a
preferred pharmacy. Many generic drugs have been added to Tier 1, which means they will be eligible for these
new, lower copays.
- Tier 3, 4, and 5 prescriptions (which include brand-name, specialty, and high-cost generic drugs) will have the
same copays at both preferred and standard pharmacy locations.
The lower copays 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, and
select independent pharmacies. For an up-to-date list of preferred pharmacies, members can use the Find a Provider tool.
Note: In addition to offering lower, preferred pharmacy copays, FutureScripts Secure will continue to provide 90-day supplies for just two times the copay (i.e., members pay only two copays instead of three).
Fewer copays means more savings
Medicare Advantage members will now be able to
save three ways on copays:
- They will be charged just one copay 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 copay will apply.
- The same one copay 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” copay for the day of
$0 copays on preferred diabetic supplies
In 2017, Independence Medicare Advantage members
must use diabetic test strips and a glucose monitor
from the preferred manufacturer brands Accu-Chek®
and OneTouch®. These brands will be covered at $0
copayment. All other manufacturer brands will not be
covered by Keystone 65 HMO plans. For Personal
Choice 65 PPO, an out-of-network coinsurance will apply.
If their current glucose monitor does not work with either
of these brands, they can obtain a new glucose monitor at
no additional cost.
Please note that all other brands of test strips and glucose
monitors will no longer be covered by the Keystone 65
HMO plans. Diabetic members will receive a separate
mailing with details.
Test strips can be purchased from either a network
pharmacy or durable medical supplier. The $0 copay on
Accu-Chek and OneTouch test strips will apply at both
preferred and standard pharmacies.
Note: The plans will continue to provide a $0 copay on all
brands of lancets and solutions.
Other plan features
The Keystone 65 HMO and Personal Choice 65
PPO plans will continue to offer the following
- Six routine chiropractic visits and six routine
podiatric visits (copays vary by plan);
- Standard glasses or contact lenses are covered
in full following cataract surgery (one pair per surgery) – 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 copay per ear for a standard hearing aid or $999 copay per ear
for a premium hearing aid, when provided by TruHearing. (Keystone 65 Select and Keystone 65 Focus members
must have the optional supplemental benefit, Choice Program, to be covered under TruHearing.);
New for 2017: Some of the hearing aids offered through TruHearing will now feature Bluetooth® technology.
If you have any questions, please contact your Network Coordinator.
FutureScripts and FutureScripts Secure are independent companies that provide pharmacy benefit management services.
SilverSneakers is a registered trademark of Healthways, Inc. and/or its subsidiaries, independent companies. ©2016 Healthways, Inc.
All rights reserved.
TruHearing is a registered trademark of TruHearing, Inc., an independent company.