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Medicare Advantage · HMO
Independence Blue Cross
Plan year 2026

Keystone 65 Liberty Medical Only H3952-059 (HMO)

4.0 · 2026 Star Rating · source: CMS · Ratings are updated annually
Monthly premium
$0
+ your Part B premium
Max out-of-pocket
$6,750
in-network annual cap
Primary care
$0
per visit copay
Specialist
$55
per visit
This plan includes a Part B giveback, which lowers what you pay for your Medicare Part B premium by up to $120 a month. Depending on how you pay Part B, the reduction may appear in your Social Security payment or on your Part B bill. That is up to $1,440 a year. Processing can take time; confirm the amount and timing with the plan.
This plan does not include Part D drug coverage
Before enrolling, confirm how your prescriptions will be covered. Whether you can add a standalone Part D plan depends on the Medicare Advantage plan type; pairing one with most MA HMO or PPO plans can disenroll you from Medicare Advantage. A gap in creditable drug coverage may lead to a Part D late enrollment penalty later.

Part D late enrollment penalty

If you go 63 days or more in a row after your Part D initial enrollment period without Part D or other creditable prescription drug coverage, you may owe a penalty if you join Part D later. The penalty is 1% of the national base beneficiary premium ($38.99 in 2026) for each full uncovered month. It is added to your monthly Part D premium for as long as you have Part D, and the base premium can change each year.

Who this type of plan may fit

MA-Only plans are generally considered by people who already have creditable prescription drug coverage, such as coverage from the VA, TRICARE, or a current or former employer or union. Your coverage provider—not this page—must tell you whether your current drug coverage is creditable.

Before you enroll
  • Find your current plan's annual Notice of Creditable Coverage or ask its benefits administrator.
  • Confirm in this plan's official documents whether adding a standalone drug plan is allowed.
  • Do not drop existing drug coverage until you understand how the change affects both coverages.
Review the creditable coverage checklist

Your costs at a glanceIn-network, for the 2026 plan year

Drug coverage
Not included
Inpatient hospital
Days 1-6: $370/day, Days 7-90: $0/day, then $0/day
no limit on covered hospital days
Inpatient mental health
Days 1-6: $370/day, Days 7-90: $0/day
Outpatient surgery
20%
Emergency room
$130
Urgent care
$15
–$50

What's included, and what it's actually worth6 benefits included. Tap any card for the detail

Part B giveback

$120/month
DetailsThis plan includes a Part B giveback, which lowers what you pay for your Medicare Part B premium by up to $120 a month.
Processing can take time; confirm the amount and timing with the plan.

Hearing

$699–$999copay per hearing aid
Details$699–$999 copay per hearing aid
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$250/yr eyewear allowance
Eyewear allowance$250/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

OTC allowance

$30/quarter OTC allowance
Prepaid card$30/quarter OTC allowance
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$55 copay
In-network$55 copay per visit
Inpatient Hospital$370/day, days 1–6
In-networkDays 1-6: $370/day, Days 7-90: $0/day, then $0/day
Benefit limitNone — additional covered days are unlimited
Outpatient Surgery20%
In-network20% per procedure
Mental HealthDays 1-6: $370/day, Days 7-90: $0/day
Inpatient psychiatricDays 1-6: $370/day, Days 7-90: $0/day
Fitness$0 fitness benefit
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors you added

Our take

Where this plan shines

This plan has a $0 monthly premium.
See your primary doctor for $0.
Highly rated by CMS (4 stars).

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
The specialist copay ($55) is on the higher side — worth comparing if you see specialists often.
Network restriction — you’ll need to use in-network providers except in emergencies.
Limited coverage while traveling outside the plan’s service area.
Does not include prescription drug coverage — confirm whether you can keep other creditable coverage or pair this plan with a standalone Part D plan.
Late enrollment penalty risk if you go without creditable drug coverage for 63+ days.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Summary of Benefits (PDF)
Download the plan's official Summary of Benefits document
Check Your Doctors
See if your doctors accept this plan
Documentos en español
Llame al (877)393-6733 (TTY: 711) para solicitar documentos en español

Helpful next steps

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We do not offer every plan available in your area. Currently we represent a limited number of organizations which offer a limited number of products in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.

Every year, Medicare evaluates plans based on a 5-star rating system. Star ratings are based on 2026 data and may change annually.

Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of plan-approved items. Unused amounts will expire at the end of the month or quarter.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

The standard Part B premium for 2026 is $202.90. Monthly reduction on Medicare Part B premium varies and may be subject to processing delays and may not be immediate.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

  1. The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
  2. The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.

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