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Keystone 65 Preferred Medical Only (HMO) Medicare Advantage Plan H3952-008 • 2027 • Philadelphia County, PA

CMS Rating: ☆☆☆☆☆ (4.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$4450.00In-network
Part B Giveback
Not offered
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
Philadelphia County, PA
Local Enrollment
108 beneficiaries in Philadelphia County
Last update:

Keystone 65 Preferred Medical Only (HMO) Introduction

Keystone 65 Preferred Medical Only is a Medicare Advantage HMO plan offered by Independence Blue Cross. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $4450.00 in-network maximum out-of-pocket. CMS Plan ID H3952-008 identifies this plan.

You must live in Philadelphia County, Pennsylvania to enroll in this plan. CMS reports 108 beneficiaries enrolled in this plan in Philadelphia County. For assistance with this plan, new members can call (877)393-6733 (TTY 711).

Compare Similar Plans in Philadelphia County

Compare this plan with the two most-enrolled HMO plans available in Philadelphia County, Pennsylvania. Enrollment is based on CMS local enrollment data.

HMO plan comparison for Philadelphia County, Pennsylvania
Plan Detail Keystone 65 Preferred Medical Only Keystone 65 Basic Rx Humana Total Complete
CMS Plan ID H3952-008-0 H3952-055-0 H6622-037-0
Local Enrollment 108 13,816 4,961
Monthly Premium $0.00 $15.00 $0.00
Medical Deductible $0.00 $0.00 $0.00
Maximum Out-of-Pocket $4,450.00 $9,500.00 $8,200.00
Part B Giveback Not offered Not offered Not offered
Primary Care $0 copay $0 copay $0 copay
Specialist $40 copay $35 copay $35 copay
Part D Deductible Not Applicable $700.00 $700.00
CMS Star Rating 4.0 4.0 4.0
Dental $0 copay $0 copay $0 copay
Vision $0 copay $0 copay $0 copay
Hearing $0 copay Not covered $0 copay

Want to explore more options? Browse all Medicare Advantage plans in Philadelphia County, or compare Medicare Advantage plans across Pennsylvania, including premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

Cost-sharing for Keystone 65 Preferred Medical Only includes out-of-pocket expenses for covered healthcare services. The following tables provide a summary of typical in-network out-of-pocket costs for plan H3952-008.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H3952-008-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $40 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0-$40 copay
Routine chiropractic
In-network: $20 copay
Fitness benefits
Coming soon
Health education
In-network: $0 copay
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0-$250 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $40 copay
Diagnostic tests and procedures
In-network: $0 copay

Emergency and Urgent Care Services

Emergency room care
$150 copay
Worldwide emergency care
Coming soon
Urgent care
$5-$50 copay
Inpatient hospital care
Tier 1
$275 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Ground ambulance
In-network: $200 copay

Mental Health Services

Outpatient individual therapy
In-network: $30 copay
Outpatient group therapy
In-network: $20 copay
Inpatient psychiatric hospital care
Tier 1
$275 per day for days 1-7
$0 per day for days 8-90
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $20 copay
Occupational therapy
In-network: $20 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: 0%-20% coinsurance
Durable medical equipment
In-network: 0%-20% coinsurance
Prosthetics
In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Dental x-rays
In-network: $0 copay
Cleaning
In-network: $0 copay
Periodontics
Not covered
Endodontics
Not covered
Restorative services
Not covered
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
Not covered

Vision Services

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglass frames only
Not covered
Eyeglass lenses only
Not covered
Eyeglasses (frames & lenses)
In-network: $0 copay
Upgrades
Not covered

Hearing Services

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Prescription hearing aids
In-network: $499-$799 copay
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
In-network: $0 copay
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by Keystone 65 Preferred Medical Only as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H3952)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H3952
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆
Medicare Advantage Plan Availability

Keystone 65 Preferred Medical Only is available to eligible Medicare beneficiaries residing in Philadelphia County, Pennsylvania, including communities such as Philadelphia, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Independence Blue Cross (official source) http://www.ibxmedicare.com October 4, 2026
CMS.gov Medicare Advantage Plan Fact Sheet 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Compare Original Medicare & Medicare Advantage 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.