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Personal Choice 65^SM PPO

A Medicare Advantage Preferred Provider Organization (PPO) Plan

• Overview |
• How the Plan Works |
• Summary of Benefits |
• Evidence of Coverage |
• Frequently Asked Questions |
• Eligibility Requirements |
• Prescription Drug Benefit Resources |
• Manuals, Guides, and Forms |
• Enroll

Personal Choice 65 PPO gives you the freedom to go to any doctor or hospital in the U.S. — without a referral. You’ll get more coverage than Original Medicare and a Medicare supplement. You’ll pay less — or nothing at all — for preventive care. You can enroll in Personal Choice 65 PPO if you live in the service area which includes Bucks and Philadelphia counties in Pennsylvania.

Personal Choice 65 PPO provides:

• No referrals
• Virtually no paperwork
• No requirement to select a primary care physician
• Coverage in or out of network
• Routine medical exams and screenings
• Extensive network of more than 22,000 area physicians and specialists
• Access to health resources and wellness programs
• Help managing chronic conditions, such as asthma, diabetes, and COPD

Personal Choice 65 PPO offers two plan options:

	Personal Choice 65 PPO
Medical-Only Plan	$225 monthly premium No Part D coverage
Medical plus prescription drug	$261.20 monthly premium

How the Plan Works
Summary of Benefits
Evidence of Coverage
Frequently Asked Questions
Eligibility Requirements
Prescription Drug Benefit Resources
Manuals, Guides, and Forms
Enroll in Personal Choice 65 PPO

For More Information

• Request an information packet through the mail.
• Request a home visit with a marketing representative.
• Attend a free informational meeting. For accommodations for persons with special needs, or to make a reservation, 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.

Contact Us

Call us toll-free, 8 a.m. to 8 p.m., seven days a week.
Members: 1-888-718-3333 (TTY/TDD: 1-888-857-4816).
Non-members: 1-877-393-6733 (TTY/TDD: 1-877-219-5457).

Email
Send us an email.

Questions about Medicare? Visit the Medicare Learning Center.

Need extra help with health plan and drug costs?

If you have limited income and resources, you may qualify for low-income subsidy. When you join Personal Choice 65 PPO, 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: 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: 1-800-325-0778), 7 a.m. to 7 p.m., Monday through Friday

Benefits, formulary, pharmacy, network, premium, and/or copays may change on January 1, 2011. Please contact Independence Blue Cross for details.