Independent Health's
Medicare Family Choice® HMO-SNP
Please note: Our Family Choice plan is for people residing in a participating nursing home or assisted living facility. Learn More about Family Choice Eligibility.

Here is an outline of some of the specific changes in your current plan for 2017.

View the following documents for a complete list of plan changes and 2017 plan benefits:
2016 2017
Monthly Premium $37 (There may be no cost to you if you qualify for Medicaid.) $41 (There may be no cost to you if you qualify for Medicaid.)
Primary Copay Covered in full Covered in full
Specialty Copay Covered in full Covered in full
Inpatient Hospital Copay $100 copay per admission $100 copay per admission
Outpatient Surgery $50 copay 10% coinsurance
Lab Copay* $0 $0
X-Ray Copay $0 general X-ray/
$0 advanced radiology
10% coinsurance
Worldwide Emergency and Urgent Care $50/Covered in Full $35 / $0
Vision** $0 routine eye exam
$100 coverage limit routine eyewear
$20 routine eye exam
$100 coverage limit routine eyewear
Skilled Nursing Facility $0 copay per day (days 1-100) $0
Part D Prescription Benefit Tier 1/2/3/4/5 No deductible.
$4 / $15 / 25% / 25% / 33% to initial coverage limit of $3,310.
No deductible.
$4 / $15 / 25% / 25% / 33% to initial coverage limit of $3,700.

View our 2017 Medicare Advantage Plans




Disclaimers
Independent Health is a Medicare Advantage organization with a Medicare contract offering HMO, HMO-SNP, HMO-POS and PPO plans. Enrollment in Independent Health depends on contract renewal. *Member pays 20% for genetic testing. Benefits vary by plan. **Applicable copays may apply for these benefits. Member must use EyeMed providers in order to take advantage of these benefits. Refer to the Evidence of Coverage for complete details. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments and restrictions may apply. Benefits, premiums and/or copayments may change on January 1 of each year. The provider network may change at any time. You will receive notice when necessary.

This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care requirement and resides in a participating nursing home for 90 days or more. Or, members must qualify for an institutional level of care as defined by the state of New York. Must be a resident of a participating assisted living facility located in Western New York, and not live outside the affiliated facility for more than 30 days. Independent Health’s Medicare Family Choice HMO-SNP has been approved by the National Committee for Quality Assurance (NCQA), a non-profit organization dedicated to improving health care quality until December 31, 2017. You must continue to pay your Medicare Part B premium.
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Y0042_C5683 Approved
Last Updated: 11/17/2016