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.
Participating hospitals
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
-
Aria Health
-
Community Health Systems
- – Brandywine Hospital
- – Chestnut Hill Hospital
- – Jennersville Regional Hospital
- – Phoenixville Hospital
- – Pottstown Memorial Medical Center
-
Doylestown Hospital
|
-
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
Service category
|
Keystone 65 Focus
Rx HMO* |
Monthly plan
premium |
|
Philadelphia and Bucks County |
Chester, Delaware, and Montgomery County
|
Medical only |
N/A |
N/A |
Medical with Choice Program |
N/A |
N/A |
Medical with Rx |
$0 |
$25 |
Medical with Rx and Choice Program |
$6 |
$31 |
Network |
Defined network of physicians, ancillary providers, and
hospitals |
Primary care physician (PCP) visits |
$10 copay |
Specialist visits |
$40 copay |
Emergency care |
$75 copay (not waived if admitted) |
Urgent care† |
$20 in-network urgent care centers ($10 for PCP; $40 for
specialist) (not waived if admitted to the hospital) |
Worldwide coverage† |
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) |
Outpatient surgery |
$150 copay per ambulatory surgical center visit $250 copay
per outpatient hospital facility visit |
Inpatient hospital |
$150 per day for days 1 – 4; $600 maximum per stay;
unlimited days per admission |
Fitness program |
SilverSneakers® |
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 |
Hearing services |
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 |
$5,700 |
Prescription
drugs (optional coverage) |
Deductible |
No deductible for brand prescription drugs No deductible
for generic tier 1 and tier 2 drugs |
Copay |
$2 preferred generic $15 generic $47 preferred
brand $100 non-preferred brand 33% coinsurance specialty drug |
Initial coverage limit |
$3,310 in total drug cost |
Coverage gap |
Member pays 58% of generic drug costs and 45% of brand name
drug costs until he or she reaches $4,850 |
Catastrophic |
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 $30 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.
SilverSneakers is a registered mark of Healthways, Inc.,
an independent company.