Keystone 65 HMO

Overview

Enroll in a plan

Medicare Advantage plans designed to fit your needs
Everyone’s insurance needs are different. This is why there are six different Medicare Advantage plans for you to choose from. No matter what type of coverage you are looking for — Keystone 65 HMO has the plan for you.

Keystone 65 Select HMO plan options


Keystone 65 Select HMO	Medical-only coverage
Keystone 65 Select HMO with Choice Program	Medical coverage + hearing, dental, and vision coverage

Keystone 65 Select Rx HMO	Medical coverage + prescription drug coverage

Keystone 65 Select Rx HMO with Choice Program	Medical coverage + hearing, dental, and vision coverage + prescription drug coverage

Keystone 65 Preferred HMO plan options


Keystone 65 Preferred HMO	Medical coverage (includes hearing, dental, and vision)
Keystone 65 Preferred Rx HMO	Medical coverage (includes hearing, dental, and vision) + prescription drug coverage

With any of the Keystone 65 HMO plans:

You choose a primary care physician (PCP) from your plan's provider network.
- Please note that Keystone 65 Select HMO and Keystone 65 Preferred HMO have different provider networks.
Your PCP arranges referrals to the other doctors, hospitals, and health care services you need within the network.
There is no need to submit claim forms for most services: simply show your Keystone 65 HMO ID card when you obtain medical services.

All Keystone 65 HMO plans include:

comprehensive medical coverage with virtually no paperwork;
routine medical exams, screenings, and preventive care;
access to an extensive network of more than 1,900 primary care physicians, 27,000 specialist sites, and 70 hospitals;
access to health resources and wellness programs;
help managing chronic conditions, such as asthma, diabetes, and COPD;
If you choose a plan with prescription drug coverage:
- You’ll have the convenience of paying just one premium each month for both your medical and drug coverage.
- You may go to thousands of pharmacies within the network and simply present your Keystone 65 HMO card. Learn more about prescription drug coverage.
If you choose a plan with hearing, dental, and vision coverage:
- You’re covered for routine dental exams and cleanings every six months.
- You’re also covered for vision and hearing services — and can get reimbursements for eyewear and hearing aids.

Contact Us

Prospective members can call 1-877-393-6733 (1-877-219-5457 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. However, please be aware that on weekends and holidays from February 15 through October 14, your call may be sent to an answering machine.
Members can call 1-800-645-3965 (1-888-857-4816 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. However, please be aware that on weekends and holidays from February 15 through October 14, your call may be sent to an answering machine.
Send us an email.
Prospective members can mail any inquiries to P.O. Box 13713, Philadelphia, PA 19101-3713.
Members can mail any inquiries to P.O. Box 7799, Philadelphia, PA 19101-7799

Summary of Benefits

For details of covered services, copays, and deductibles for the Keystone 65 HMO plans, see the ibxmedicare.com Summary of Benefits Y0041_H3952_KS12_03a CMS Approved 09082011.

You must continue to pay your Medicare Part B premium.

The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1, 2013. Members may enroll in the plan during specific times of the year. Contact the plan for more information. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits, as well as limitations, copayments, and restrictions. Members must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don�t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

Medicare beneficiaries may enroll in Keystone 65 HMO, Personal Choice 65 PPO, or Select Option PDP through the CMS Medicare Online Enrollment Center located at www.medicare.gov.

You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Keystone 65 HMO or Personal Choice 65 PPO will be responsible for the costs.

Please contact Keystone 65 HMO or Personal Choice 65 PPO Customer Service for more information.

Website last updated: 3/6/12
Y0041_HM_12_300a Pending CMS Approval