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Frequently Asked Questions
Personal Choice 65SM
1. How does Personal Choice 65 differ from a Medicare supplement?
2. Will I have separate payments for my medical and Part D drug coverage?
3. If I choose the medical-only option, can I join a different Medicare drug plan?
4. Do I have to choose a primary care physician?
5. How does the cost-sharing work?
6. Why is it recommended that I confirm that services are covered and medically necessary for certain out-of-network services?
7. I travel a lot. What if I have an emergency?
8. How do I know if the medications I take are covered?
9. What resources do you have for managing health conditions like asthma?
10. Do I have to file claims with Personal Choice 65?
11. What if I have Personal Choice 65 coverage through my employer?
12. How can I get more information?
13. Can I get an information packet sent to me in the mail?
14. Do I qualify for low-income subsidy?
top of page1. How does Personal Choice 65 differ from a Medicare supplement?
Personal Choice 65 gives you the same flexibility in choosing your own doctors as a supplemental policy would. However, you get more coverage than a Medicare supplement.
2. Will I have separate payments for my medical and Part D drug coverage?
No. When you join Personal Choice 65 Standard Rx, your monthly plan premium provides coverage for most of the health care services you may need plus generic and brand-name drugs. However, you must continue to pay your Medicare Part A, if applicable, and Part B premiums to Medicare.
3. If I choose the medical-only option, can I join a different Medicare drug plan?
No. If you enroll in a Medicare Advantage plan with prescription drug coverage such as Personal Choice 65, you must get Medicare prescription drug coverage through the plan.
4. Do I have to choose a primary care physician?
No. You're free to use the doctors and specialists you want — in and out of the Personal Choice 65 network—without having to go through a primary care physician or getting a referral. Keep in mind that our network is extensive (more than 22,000 physicians and specialists,), but you always have the option to seek care outside the network.
5. How does the cost-sharing work?
Your costs are lower when you use in-network providers . If you use services outside the network, you share more of the cost (30% coinsurance after a $500 annual deductible). Prior authorization is recommended for certain services outside of the network.
6. Why is it recommended that I confirm that services are covered and medically necessary for certain out-of-network services?
If the plan determines that the services are not covered benefits or are not medically necessary, then the services may not be covered. You may be responsible for the charges.
7. I travel a lot. What if I have an emergency?
You're covered for emergency care, urgent care, or dialysis anywhere in the U.S. — at the in-network benefit level. Even if it is not an emergency, you may use out-of-network doctors and hospitals at any time; you will just have to pay more than if you used an in-network provider.
8. How do I know if the medications I take are covered?
Review the formulary, the list of drugs covered by the plan, on this website. We’ve been able to negotiate special prices with drug companies for the medications in our formulary. Savings are passed on to you when your prescriptions are filled by our network pharmacies.
9. What resources do you have for managing health conditions like asthma?
If you have asthma, diabetes, or another chronic condition, you can get the one-on-one support you need to manage your health through ConnectionsSM Health Management Programs. You'll have access to a Health Coach you can talk to any time of day or night, seven days a week.
10. Do I have to file claims with Personal Choice 65?
With our automatic claims filing, there is virtually no paperwork for you to worry about. In most cases, you simply present your Personal Choice 65 ID card. Out-of-network services may require minimal paperwork.
11. What if I have Personal Choice 65 coverage through my employer?
If you have coverage through your former or current employer, Health and Welfare Fund, or Association Group, your benefits may vary. Call toll-free at 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week for more information.
12. How can I get more information?
Feel free to call us toll-free at 1-877-393-6733 (TTY/TDD: 1-877-219-5457), 8 a.m. to 8 p.m., seven days a week. You can also request a home visit or attend one of our seminars at a location near you (check our calendar for dates). For accommodations for persons with special needs, or to make a reservation, call the number above.
13. Can I get an information packet sent to me in the mail?
Yes. Submit an online request to receive an information packet in the mail.
14. Do I qualify for low-income subsidy?
If you have limited income and resources, you may qualify for low-income subsidy. When you join Personal Choice 65, Medicare will tell us how much extra help you are getting. Then we will let you know the amount you will pay. If you qualify, your drug costs will also be lower.
You can see if you qualify for a low-income subsidy by calling:
- 1-800-MEDICARE (1-800-633-4227) (TTY/TDD: 1-877-486-2048), 24 hours a day/7 days a week
- Pennsylvania Office of Medical Assistance Programs (Medicaid) at 1-717-787-1870
- The Social Security Administration at 1-800-772-1213 (TTY/TDD: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday