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Medicare Advantage plans: What’s new for 2017 

October 3, 2016    

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:

  1. 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.
  2. 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.
  3. For inpatient hospital stays, members will not be charged a “per-day” copay for the day of discharge.

$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 in 2017:

  • 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.

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