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Health plans comparison chart

This chart compares health plan benefits and estimated out-of-pocket costs for Independence Blue Cross in-network services – including doctor and hospital visits, specialty care, and prescription drugs. Deductible amounts shown are for individuals.

For more plan details, review each plan’s Summary of Benefits & Coverage – or use our guided shopping tool to get custom recommendations for the best health plan match, most affordable plan option, and what people like you tend to buy.

Click the + to expand that row for more details about the plan.

Plan name

Deductible

Primary care physician visit

Specialist visit

Inpatient hospital

Generic prescription

Keystone HMO Gold Proactive

Tier 1: $0
Tier 2: $0
Tier 3: $0

Tier 1: $15
Tier 2: $30
Tier 3: $45

Tier 1: $40
Tier 2: $60
Tier 3: $80

Tier 1: $350/day¹
Tier 2: $700/day¹
Tier 3: $1,100/day¹

$20 (all tiers)

Prescription drug

Generic: $20
Preferred brand: 40% with $100 copay max
Non-preferred drug: 50% with $300 copay max
Search for a drug

Plan details

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Keystone HMO Gold

$0

$35

$65

$750/day¹

$15

Prescription drug

Generic: $15
Preferred brand: 40% with $200 copay max
Non-preferred drug: 50% with $200 copay max
Search for a drug

Plan details

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Personal Choice^® PPO Gold

$0

$30

$65

$750/day¹

$15

Prescription drug

Generic: $15
Preferred brand: 40% with $200 copay max
Non-preferred drug: 50% with $200 copay max
Search for a drug

Plan details

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Personal Choice^® EPO Gold

$0

$35

$65

$750/day¹

$15

Prescription drug

Generic: $15
Preferred brand: 40% with $200 copay max
Non-preferred drug: 50% with $200 copay max
Search for a drug

Plan details

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Keystone HMO Silver Proactive

Tier 1: $0
Tier 2: $6,000
Tier 3: $6,000

Tier 1: $40
Tier 2: $60 no deductible
Tier 3: $70 no deductible

Tier 1: $80
Tier 2: $120 no deductible
Tier 3: $140 no deductible

Tier 1: $600/day¹
Tier 2: Subject to deductible and $900/day¹
Tier 3: Subject to deductible and $1,300/day¹

$20 no ded ($300 Rx ded for all prescription drugs except generic)

Prescription drug

Generic: $20 (all tiers; no deductible)
Preferred brand: $100 after deductible
Non-preferred drug: 50% after $300 deductible with $500 copay max
Search for a drug

Plan details

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Keystone HMO Silver Proactive Lite

Tier 1: $2,000
Tier 2: $6,500
Tier 3: $6,500

Tier 1: $50 no deductible
Tier 2: $60 no deductible
Tier 3: $70 no deductible

Tier 1: $100 no deductible
Tier 2: $120 no deductible
Tier 3: $140 no deductible

Tier 1: Subject to deductible and $600/day¹
Tier 2: Subject to deductible and $900/day¹
Tier 3: Subject to deductible and $1,300/day¹

$20 no ded ($300 Rx ded for all prescription drugs except generic)

Prescription drug

Generic: $20 (all tiers; no deductible)
Preferred brand: $100 after deductible
Non-preferred drug: 50% after $300 deductible with $500 copay max
Search for a drug

Plan details

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Keystone HMO Silver Proactive Select

Tier 1: $0
Tier 2: $6,000
Tier 3: $6,000

Tier 1: $40
Tier 2: $60 no deductible
Tier 3: $70 no deductible

Tier 1: $80
Tier 2: $120 no deductible
Tier 3: $140 no deductible

Tier 1: $600/day¹
Tier 2: Subject to deductible and $900/day¹
Tier 3: Subject to deductible and $1,300/day¹

$20 no ded ($300 Rx ded for all prescription drugs except generic)

Prescription drug

Generic: $20 (all tiers; no deductible)
Preferred brand: $100 after deductible
Non-preferred drug: 50% after $300 deductible with $500 copay max
Search for a drug

Plan details

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Keystone HMO Silver Proactive Basic

Tier 1: $2,500
Tier 2: $7,000
Tier 3: $7,000

Tier 1: $50 no deductible
Tier 2: $60 no deductible
Tier 3: $70 no deductible

Tier 1: $100 no deductible
Tier 2: $120 no deductible
Tier 3: $140 no deductible

Tier 1: Subject to deductible and $600/day¹
Tier 2: Subject to deductible and $900/day¹
Tier 3: Subject to deductible and $1,300/day¹

$20 no ded ($500 Rx ded for all prescription drugs except generic)

Prescription drug

Generic: $20
Preferred brand: 50% after $500 deductible with $400 copay max
Non-preferred drug: 50% after $500 deductible with $500 copay max
Search for a drug

Plan details

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Benefits chart
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Keystone HMO Silver Proactive Value

Tier 1: $1,500
Tier 2: $6,000
Tier 3: $6,000

Tier 1: $40 no deductible
Tier 2: $60 no deductible
Tier 3: $70 no deductible

Tier 1: $80 no deductible
Tier 2: $120 no deductible
Tier 3: $140 no deductible

Tier 1: Subject to deductible and $600/day¹
Tier 2: Subject to deductible and $900/day¹
Tier 3: Subject to deductible and $1,300/day¹

$20 no ded ($300 Rx ded for all prescription drugs except generic)

Prescription drug

Generic: $20 (all tiers; no deductible)
Preferred brand: $100 after $300 deductible
Non-preferred drug: 50% after $300 deductible with $500 copay max
Search for a drug

Plan details

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Keystone HMO Silver

$3,000

$35 no deductible

$70 no deductible

30% after deductible

$20 no deductible

Prescription drug

Generic: $20 no deductible
Preferred brand: 50% after deductible with $300 copay max
Non-preferred drug: 50% after deductible with $400 copay max
Search for a drug

Plan details

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Keystone HMO Silver Basic

$4,500

$40 no deductible

$80 no deductible

50% after deductible

$20 no deductible (integrated with medical ded)

Prescription drug

Generic: $20 no deductible (integrated with medical ded)
Preferred brand: 50% after deductible with $300 copay max
Non-preferred drug: 50% after deductible with $400 copay max
Search for a drug

Plan details

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Personal Choice^® PPO Silver

$3,000

$30 no deductible

$70 no deductible

25% after deductible

$20 no deductible (integrated with medical deductible)

Prescription drug

Generic: $20 no deductible
Preferred brand: 50% after deductible with $300 copay max
Non-preferred drug: 50% after deductible with $400 copay max
Search for a drug

Plan details

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Keystone HMO Bronze

$7,400

$75 no deductible

$150 no deductible

Subject to deductible and $700/day¹

$25 no deductible (integrated with medical deductible)

Prescription drug

Generic: $25 no deductible (integrated with medical deductible)
Preferred brand: 50% after deductible with $300 copay max
Non-preferred drug: 50% after deductible with $400 copay max
Search for a drug

Plan details

Summary of Benefits and Coverage
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Personal Choice^® PPO Bronze

$6,000

$50 no deductible

50% after deductible

25% after deductible

$25 no deductible (integrated with medical deductible)

Prescription drug

Generic: $25 no deductible (integrated with medical deductible)
Preferred brand: 50% after deductible
Non-preferred drug: 50% after deductible
Search for a drug

Plan details

Summary of Benefits and Coverage
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Personal Choice^® EPO Bronze Reserve

$7,050

0% after deductible

0% after deductible

0% after deductible

0% after deductible (integrated with medical deductible)

Prescription drug

Generic: 0% after deductible (integrated with medical deductible)
Preferred brand: 0% after deductible
Non-preferred drug: 0% after deductible
Search for a drug

Plan details

Summary of Benefits and Coverage
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Personal Choice^® EPO Bronze Basic

$8,700

Visits 1-3: $20 no deductible
Visits 4+: 0% after deductible

0% after deductible

0% after deductible

$25 no deductible (integrated with medical deductible)

Prescription drug

Generic: $25 no deductible (integrated with medical deductible)
Preferred brand: 0% after deductible
Non-preferred drug: 0% after deductible
Search for a drug

Plan details

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Personal Choice^® EPO Catastrophic

$8,700

Visits 1-3: $50 no deductible
Visits 4+: 0% after deductible

0% after deductible

0% after deductible

0% after deductible (integrated with medical deductible)

Prescription drug

Generic: 0% after deductible (integrated with medical deductible)
Preferred brand: 0% after deductible
Non-preferred drug: 0% after deductible
Search for a drug

Plan details

Summary of Benefits and Coverage
Benefits chart
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Legend

= Most popular plans
FutureScripts Pharmacy network includes more than 68,000 pharmacies.
HSA – This plan is compatible with a health savings account.
Low-cost Generics are available at an even lower cost than standard generics.

Mandatory Generics – If you get a brand name drug when a generic is available, you pay the difference in cost plus the brand name cost-sharing. Choosing generics saves you money.
Off-exchange only – Plan can only be purchased through Independence directly and is not available on Pennie.

On-exchange only – Plan is only available for purchase through Pennie.
Preferred Pharmacy network means your coverage is available at more than 58,000 pharmacies.

¹ Amount shown reflects copay per day. There is a maximum of 5 copays per admission.