Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H3909-018-000

Personal Choice 65 Plus Rx (PPO) · Independence Blue Cross · Philadelphia, Bucks, Chester, Montgomery, Delaware

Compact plan code: H3909018000

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Personal Choice 65 Plus Rx (PPO)

H3909-018-000 Philadelphia, Bucks, Chester, Montgomery, Delaware Local PPO
Open in quick lookup
01

In-network

Inpatient hospital

Per admission $400 per stay
Plan-listed inpatient copay $400
02

Emergency transport

Ambulance

Ground · in-network$200 copay
Air · in-network$200 copay
03

Emergency services

Emergency room

$130 copay

04

Medical maximum

Maximum out-of-pocket

In-network$4,201
Combined in + out$6,300
05

Skilled care at home

Home health

In-network$0 copay
Out-of-network35% coinsurance
06

Monthly cost

Premium & giveback

Part C premium$132.80 / month
Consolidated C + D$214 / month

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release. Quick-reference values should be confirmed in current official plan documents.

PBP benefits ↗ Landscape data ↗

Same CMS contract

H3909-001-000 Personal Choice 65 Rx (PPO) Bucks, Philadelphia Counties · Local PPO H3909-007-000 Personal Choice 65 Medical Only (PPO) Bucks, Philadelphia Counties · Local PPO H3909-009-000 Personal Choice 65 Rx (PPO) Chester, Delaware, Montgomery Counties · Local PPO H3909-020-000 Personal Choice 65 Achieve Rx (PPO) Philadelphia, Bucks, Chester, Montgomery, Delaware · Local PPO H3909-801-000 Personal Choice 65 Group Medical Only (PPO) National · Local PPO H3909-802-000 Personal Choice 65 Group Rx (PPO) National · Local PPO

About this code

What H3909-018-000 identifies

H3909-018-000 is a Contract Year 2026 Medicare plan segment code. The compact form H3909018000 refers to the same normalized contract, plan, and segment shown on this page.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.