Keystone 65 Focus Rx (HMO-POS): A Comprehensive and Affordable Health Plan

Summary
The Keystone 65 Focus Rx (HMO-POS) is a Medicare Advantage plan tailored for seniors seeking comprehensive healthcare coverage. The plan holds a stellar 4 out of 5-star rating for the 2024 plan year, demonstrating its commitment to quality and customer satisfaction. With a $0 monthly premium and medical deductible, this plan is designed to be accessible and budget-friendly while offering extensive benefits.

Click here to check your area just put in the zip code

Key Highlights

  • Monthly Premium: $0
  • Medical Deductible: $0
  • In-network Maximum Out-of-Pocket: $6,500
  • Drug Deductible: $0
  • Initial Coverage Limit: $5,030
  • Catastrophic Coverage Limit: $8,000

Benefit Details

Outpatient Care and Services

  • Acupuncture: A copayment of $15 for up to six visits annually ensures access to alternative therapies.
  • Additional Services:
    Copayments are waived for essential services like health education, fitness benefits, enhanced disease management, and medical nutrition therapy, making it easier for beneficiaries to access holistic healthcare.

Ambulance Services

  • In-Network: $230 copayment for ground and air ambulance services ensures affordable emergency transport within the network.
  • POS (Out-of-Network): 20% coinsurance applies to out-of-network ambulance services.

Chiropractic Services

  • In-Network: $15 copayment for Medicare-covered services and routine care, with a maximum of six routine care visits per year.
  • POS (Out-of-Network): 20% coinsurance for out-of-network services.

Dental Services

  • Preventive Dental: No copayment for oral exams, cleanings, and X-rays, making preventive care easily accessible every six months.
  • Comprehensive Dental:
    A combination of copayments and coinsurance ensures comprehensive dental care, with a maximum benefit of $2000 annually for non-Medicare covered services.

Diabetes Supplies and Services

  • In-Network: Coinsurance ranges from 0% to 20% for diabetic supplies, with $0 copayment for therapeutic shoes and inserts.
  • POS (Out-of-Network): 20% coinsurance for all covered services.

Diagnostic Tests, Lab, and Radiology Services

  • In-Network: Copayments range from $0 to $170, with prior authorization required for certain services.
  • POS (Out-of-Network): A 20% coinsurance applies to out-of-network services.

Doctor Office Visits

  • In-Network: $0 copayment for primary care office visits.
  • POS (Out-of-Network): 20% coinsurance for out-of-network primary care visits.

Doctor Specialty Visits

  • In-Network: $40 copayment for specialist visits.
  • POS (Out-of-Network): 20% coinsurance for out-of-network specialist visits.

Durable Medical Equipment

  • In-Network: 20% coinsurance for Medicare-covered equipment, with prior authorization required.
  • POS (Out-of-Network): 20% coinsurance for out-of-network services.

Emergency Care

  • Emergency Care: A flat copayment of $100 ensures predictable costs during emergencies.
  • Worldwide Coverage: Global emergency coverage is provided with a $100 copayment.

Hearing Services

  • In-Network: $0 copayment for routine hearing exams and $40 for Medicare-covered benefits, with coverage for hearing aids ranging from $699 to $999.
  • POS (Out-of-Network): 20% coinsurance for out-of-network exams.

Home Health Care

  • In-Network: $0 copayment for Medicare-covered services, providing vital support for seniors at home.
  • Prior Authorization Required: Ensures appropriate use of services.

Outpatient Mental Health Care

  • In-Network: Copayments of $30 and $20 for individual and group sessions, respectively.
  • POS (Out-of-Network): 20% coinsurance for all services.

Outpatient Prescription Drugs

  • In-Network: Coinsurance varies from 0% to 20% for Medicare Part B chemotherapy drugs and other covered medications.

Outpatient Rehabilitation Services

  • In-Network: $5 copayment for rehabilitation services like cardiac and pulmonary care.
  • POS (Out-of-Network): 20% coinsurance for out-of-network services.

Outpatient Services/Surgery

  • In-Network: Copayments for outpatient hospital services, observation, and ambulatory surgical centers ensure predictable costs.
  • POS (Out-of-Network): 20% coinsurance applies.

Outpatient Substance Abuse

  • In-Network: $30 and $20 copayments for individual and group sessions, respectively.
  • POS (Out-of-Network): 20% coinsurance for all services.

Over-the-Counter Items

  • In-Network: $0 copayment for over-the-counter items, with a $70 maximum benefit every three months.

Podiatry Services

  • In-Network: $25 copayment for both Medicare-covered and routine foot care, with a maximum of six visits annually.
  • POS (Out-of-Network): 20% coinsurance for out-of-network services.

Preventive Services and Wellness/Education Programs

  • In-Network: $0 copayment for a wide array of preventive services, including cancer screenings, immunizations, and wellness visits.
  • POS (Out-of-Network): 20% coinsurance for Medicare-covered preventive services.

Prosthetic Devices

  • In-Network: 20% coinsurance for Medicare-covered prosthetic devices and medical supplies.
  • POS (Out-of-Network): 20% coinsurance applies.

Renal Dialysis

  • In-Network: 20% coinsurance for Medicare-covered dialysis services.
  • POS (Out-of-Network): 20% coinsurance for out-of-network services.

Urgently Needed Care

  • Urgent Care: Copayment of $10 for retail clinic services and $40 for urgent care center services.
  • Worldwide Coverage: $100 copayment for global urgent coverage.

Vision Services

  • In-Network: $0 copayment for routine eye exams, with a $0 copayment for eyewear up to $250 annually.
  • POS (Out-of-Network): 20% coinsurance for out-of-network services.

Inpatient Care

Inpatient Hospital Care

  • In-Network:
    $210 per day for days 1-6, and $0 for days 7-90, ensuring predictable costs up to $1260 maximum.
  • POS (Out-of-Network):
    20% coinsurance applies for out-of-network stays.

Inpatient Mental Health Care

  • In-Network:
    $210 per day for days 1-6, and $0 for days 7-90, with a maximum out-of-pocket of $1260.
  • POS (Out-of-Network):
    20% coinsurance for psychiatric hospital stays.

Skilled Nursing Facility (SNF)

  • In-Network:
    $0 per day for days 1-20 and $203 per day for days 21-100.

Prescription Drug Benefits

Initial Coverage Level

  • Tier 1: Preferred Generics
    $0 preferred cost-share retail; $9 standard retail.
  • Tier 2: Generics
    $8 preferred cost-share retail; $20 standard retail.
  • Tier 3: Preferred Brand
    $47 copayment for both preferred and standard.
  • Tier 4: Non-Preferred Drug
    $100 copayment for both preferred and standard.
  • Tier 5: Specialty Tier
    33% coinsurance applies to all retail and mail-order services.

Gap Coverage Level

  • All Tiers:
    25% coinsurance applies to all drugs, ensuring predictable costs during the coverage gap.

Catastrophic Coverage Level

  • All Tiers:
    $0 copayment for all drugs after reaching the catastrophic coverage limit.

The Keystone 65 Focus Rx (HMO-POS) plan stands out for its comprehensive coverage, predictable costs, and wide range of benefits. With a focus on preventive care, routine services, and prescription drug coverage, this plan is an excellent choice for those seeking holistic and affordable healthcare coverage in their golden years.

Similar Posts