Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Personal Choice 65 Achieve Rx, 2027

H3909Contract020Plan

PPO · 5 counties in Pennsylvania

Run by QCC Insurance Company (contract H3909), sold as Independence Blue Cross, owned by Independence Health Group, Inc.

Renews for 2027

2026 star rating, contract H3909: 4 of 5

Personal Choice 65 Achieve Rx (H3909-020) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $9,850 ($6,750 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit	$6,750	$9,850	up $3,100
Drug deductible	$375	$700	up $325
Specialist visit	$55 copay	$60 copay	up $5
Emergency room	$130 copay	$115 copay	down $15
Hospital stay, in network	$390 a day for days 1–7, then $0 a day for days 8–90	$435 a day for days 1–5, then $0 a day for days 6–90	up $225for a 5-day stay
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Ground ambulance, in network	$310 copay	$300 copay	down $10
Comprehensive dental, yearly limit	$1,000 a year	not offered	dropped
Eyewear, yearly limit	$250 a year	not offered	dropped
Over-the-counter items, yearly	$120 a year	not offered	dropped
Drug tier 3, preferred brand	25% of the cost	24% of the cost	down 1 point
Drug tier 4, non-preferred drug	30% of the cost	25% of the cost	down 5 points
Drug tier 5, specialty tier	28% of the cost	25% of the cost	down 3 points
8 lines do not change
Monthly premium	$0	$0	no change
Part B premium reduction, monthly	none	none	no change
Primary care visit	$0 copay	$0 copay	no change
Medical deductible, in network	none	none	no change
Hearing aids, yearly limit for both ears	not offered	not offered	no change
Counties served	5	5	no change
Drug tier 1, preferred generic	$9	$9	no change
Drug tier 2, generic	$20	$20	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$9	$9	$0
Tier 2	Generic	$20	$20	$0
Tier 3	Preferred Brand	25% of the cost	24% of the cost	24% of the cost
Tier 4	Non-Preferred Drug	30% of the cost	25% of the cost	25% of the cost
Tier 5	Specialty Tier	28% of the cost	25% of the cost	25% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 77 plans open to everyone are sold for 2027, this one included. Against the others, 60 plans have a lower out-of-pocket limit, 16 the same. On the premium, 44 the same, 32 a higher one.

Out-of-pocket limits of the 77 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0001 plan

$4,000 to under $6,00012 plans

$6,000 to under $8,00036 plans

$8,000 to $10,000 (this plan)28 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 5 counties: $0 a month and $9,850.

Pennsylvania

Bucks Chester Delaware Montgomery Philadelphia

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H3909-020
Legal name of the contract: QCC Insurance Company
Sold as: Independence Blue Cross
Parent company: Independence Health Group, Inc.
Plan type: PPO
2026 star rating of the contract: 4 of 5 overall; health plan 4 of 5, drug plan 4.5 of 5
Members, September 2026: 13,462
Plan website, as filed with CMS: www.ibxmedicare.com

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Montgomery, PAWhere most of its members live; premiums and limits side by side
Every Independence Blue Cross plan for 2027Its contracts, counties and plans that end
The other 3 plans of contract H3909Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.