Keystone 65 Basic Rx (HMO)
Available to residents of Philadelphia County, PA for 2026. Contract H3952, plan 055, segment 0.
Plan details
| Monthly drug premium | $0.00 |
|---|---|
| Drug deductible | $0.00 |
| Plan type | Medicare Advantage |
| Contract / plan | H3952-055-0 |
| Offered by | Independence Blue Cross |
| Parent organization | Independence Health Group, Inc. |
| Formulary drugs | 3,432 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 4 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 4 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H3952 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | 25% |
| Tier 4 | 42% |
| Tier 5 | 33% |
Also available in 4 other PA counties
Plan facts come from the CMS quarterly prescription drug plan public use files.