Alyssa Lane
Keystone First VIP Choice (HMO D-SNP) is a Medicare Advantage Special Needs Plan offered by VISTA Health Plan Inc. in Southeastern Pennsylvania. It is a health insurance company that provides managed care plan services for Pennsylvania Medical Assistance (Medicaid) and Medicare recipients. Medicare beneficiaries may also enrol in Keystone 65 HMO, Keystone 65 HMO-POS, Personal Choice 65SM PPO, or Select Option PDP through the CMS Medicare Online Enrollment Center.
| Characteristics | Values |
|---|---|
| Keystone First VIP Choice | A Medicare Advantage Special Needs Plan by VISTA Health Plan Inc. |
| A health insurance company that provides managed care plan services for Pennsylvania Medical Assistance (Medicaid) and Medicare recipients | |
| Offers PPO, HMO-POS, and HMO Medicare Advantage plans with a Medicare contract | |
| Monthly premium of $48.40, including Part C and D premiums but excluding Part B premium | |
| After yearly out-of-pocket drug costs reach $2,000, Medicare Part D covered drugs are free | |
| Not connected with or endorsed by the U.S. Government or the federal Medicare program | |
| Medicare beneficiaries may also enroll in Keystone 65 HMO, Keystone 65 HMO-POS, Personal Choice 65 PPO, or Select Option PDP |
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What You'll Learn
Keystone First VIP Choice (HMO D-SNP)
The plan provides cost-sharing for drugs, with the Low-Income Subsidy (LIS) or "Extra Help" program assisting those with Medicare in lowering prescription drug costs. After paying the $590 drug deductible, you will enter the initial coverage phase, where you will pay for drugs in each tier until your total drug costs reach $2,000. Once you reach this amount, you will enter the next coverage phase.
In addition to drug coverage, Keystone First VIP Choice (HMO D-SNP) offers a range of benefits. These benefits may vary based on carrier and location, and specific plan details can be found on the MedicareAdvantageRX.com website.
To find a healthcare provider within the Keystone First network, you can utilize their online tools to search for primary care practitioners (PCP), hospitals, dental providers, pharmacies, and more.
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Keystone First and Medicare
Keystone First is a medical assistance (Medicaid and Medicare) managed care health plan. It is based in southeastern Pennsylvania and focuses on low-income residents in counties including Bucks, Chester, Delaware, Montgomery, and Philadelphia. The company is a subsidiary of Independence Blue Cross and currently serves over 400,000 residents in the area. Keystone First was founded by the Sisters of Mercy in 1982 as the Mercy Health Plan. In 2015, Keystone First was rated among the "top Medicaid plans in Pennsylvania".
Keystone First offers a range of services to its members, including regular eye exams, a texting program for pregnant women called Keys to Your Care, and initiatives for issues like gun safety, teen dating violence, and food insecurity. Some Keystone plans do not include coverage for "anesthesia without prior authorization" for dental care, and prescription eyeglasses or contact lenses are not covered for clients over the age of 21.
The Keystone First VIP Choice plan serves dual-eligible special needs individuals who are on both Medicare and Medicaid. This plan provides links to external websites for the convenience of users in locating information and services of interest. However, Keystone First VIP Choice does not control or endorse any information, products, or services available on these linked sites. Users should exercise caution when visiting linked sites, as Keystone First VIP Choice cannot guarantee the security of any personal information disclosed.
In terms of medication coverage, the Pennsylvania Department of Human Services (DHS) made changes in 2020 to the way some medicines are covered under Pennsylvania Medical Assistance (Medicaid) health plans. All health plans were required to move to a statewide preferred drug list (PDL). Members with questions about this change can contact Keystone First's Member Services for more information.
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Keystone 65 Plans
HMO plans require members to use doctors and hospitals within their network. Out-of-network emergency care is covered for medically necessary services. The Keystone 65 Focus HMO-POS plan offers an annual point-of-service maximum that can be used for out-of-network care, but in-network care will be more affordable.
The Keystone 65 HMO plan offers a $0 copay for in-network primary care physicians (PCPs), and members do not need a referral to see a specialist. Dental benefits are underwritten by Keystone Health Plan East and administered by United Concordia Companies, Inc. Vision benefits are also offered by Keystone Health Plan East and administered by Davis Vision.
Medicare beneficiaries can enrol in Keystone 65 plans through the CMS Medicare Online Enrollment Center. For questions about Keystone 65 plans, members can call the Member Help Team at 1-800-645-3965 (TTY/TDD: 711) daily from 8 am to 8 pm.
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Keystone First Medicaid
Keystone First is a medical assistance programme based in southeastern Pennsylvania. It is a Medicaid and Medicare managed care health plan that focuses on low-income residents in counties including Bucks, Chester, Delaware, Montgomery, and Philadelphia. The programme currently serves over 400,000 residents in the area and was founded by the Sisters of Mercy in 1982 as the Mercy Health Plan. Keystone First is a subsidiary of Independence Blue Cross.
In 2015, Keystone First was rated among the "top Medicaid plans in Pennsylvania". The programme covers regular eye exams for clients but does not include prescription eyeglasses or contact lenses for individuals over the age of 21. Some Keystone plans do not cover "anaesthesia without prior authorisation" for dental care.
Keystone First offers a special texting programme called Keys to Your Care for members who are pregnant. This programme is brought by Bright Start®, the Keystone First maternity programme. Keystone First also offers a resource centre called Healthy Families, Safe Communities for members and providers, which includes initiatives on gun safety, teen dating violence, and food insecurity.
The Pennsylvania Department of Human Services (DHS) made changes in 2020 to the way that some medicines are covered by Keystone First. All Pennsylvania Medical Assistance (Medicaid) health plans were required to move to a statewide preferred drug list (PDL). Members with questions about this change can call Member Services at 1-800-521-6860 (TTY 1-800-684-5505).
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Keystone First and Temple Health
Keystone First is a health insurance company that provides managed care plan services for Pennsylvania Medical Assistance (Medicaid) and Medicare recipients. Temple Health is a healthcare provider with a long-standing commitment to the health of its community.
Temple Health and Keystone First have a contract agreement wherein Temple Health hospitals and physician offices remain in-network for all Keystone First patients. This means that Keystone First covers care at Temple Health hospitals and doctors' offices. However, in 2024, the two parties underwent negotiations on reimbursement rates, which threatened to disrupt the care of thousands of patients.
Temple Health notified its patients that their care might no longer be covered if a new contract agreement was not reached with Keystone First by the summer deadline. The previous contract was set to expire on July 31, 2024. If no agreement was reached, Temple Health providers and facilities would no longer be participating providers for Keystone First patients beginning August 1, 2024.
Fortunately, Temple Health and Keystone First reached a new contract agreement, avoiding any disruption to patient care. The new agreement includes higher insurance reimbursements for delivered healthcare services, taking into account the significant cost increases that healthcare providers bear. Under the new agreement, Temple Health hospitals and physicians remain in-network for Keystone First patients, ensuring continued access to quality healthcare services.
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Frequently asked questions
Keystone First VIP Choice (HMO D-SNP) is a Medicare Advantage Special Needs Plan by VISTA Health Plan Inc.
The monthly premium is $48.40. This includes your Part C and D premiums but does not include your Part B premium.
You can sign up for the Keystone First VIP Choice plan by calling 1-877-354-4611 or TTY 711.
Keystone First is a health insurance company that provides managed care plan services for Pennsylvania Medical Assistance (Medicaid) and Medicare recipients. Keystone 65 Plans are offered by Independence Blue Cross Medicare (IBX) and include PPO, HMO-POS, and HMO Medicare Advantage plans.
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