2021 Medicare Plans

2021 Benefits at a Glance

Review Independent Health’s 2021 Medicare Advantage Plans with our 2021 Benefits at a Glance tool. Learn More

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Independent Health's

2021 Encompass 65® Element HMO

MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY
(In-Network)
INPATIENT HOSPITAL COPAY
(In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM

$0

PRIMARY/SPECIALTY COPAY
(In-Network)

$15/$50

INPATIENT HOSPITAL COPAY
(In-Network)

Days 1-5: $390 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($2,000 Annual Member Copay Maximum).

PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)

$375 deductible on tiers 3, 4 & 5 only. $4/$20/$47/41%/26% to initial coverage limit of $4,130.

Independent Health's

2021 Encompass 65® Core HMO

MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY
(In-Network)
INPATIENT HOSPITAL COPAY
(In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM

$65

PRIMARY/SPECIALTY COPAY
(In-Network)

$5/$35

INPATIENT HOSPITAL COPAY
(In-Network)

Days 1-6: $325 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,950 Annual Member Copay Maximum).

PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)

$225 deductible on tiers 3, 4 & 5 only. $0/$15/$42/46%/29% to initial coverage limit of $4,130.

Independent Health's

2021 Encompass 65® Basic HMO

MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY
(In-Network)
INPATIENT HOSPITAL COPAY
(In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM

$125

PRIMARY/SPECIALTY COPAY
(In-Network)

$0/$30

INPATIENT HOSPITAL COPAY
(In-Network)

Days 1-6: $275 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,925 Annual Member Copay Maximum).

PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)

$150 deductible on tiers 3, 4 & 5 only. $0/$10/$40/43%/30% to initial coverage limit of $4,130.

Independent Health's

2021 Encompass 65® HMO (without prescription coverage)

MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY
(In-Network)
INPATIENT HOSPITAL COPAY
(In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM

$0

PRIMARY/SPECIALTY COPAY
(In-Network)

$0/$10

INPATIENT HOSPITAL COPAY
(In-Network)

Days 1-5: $200 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,800 Annual Member Copay Maximum).

PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)

No prescription benefit.

Independent Health's

2021 Medicare Passport® Advantage PPO

MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY
(In-Network)
INPATIENT HOSPITAL COPAY
(In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM

$99

PRIMARY/SPECIALTY COPAY
(In-Network)

$5/$45

INPATIENT HOSPITAL COPAY
(In-Network)

Days 1-6: $310 per day (IN) / 40% coinsurance (OON). Additional days: $0 (IN) / 40% coinsurance (OON). Unlimited days for Medicare covered stays (IN). ($1,860 Annual Member Copay Maximum) (IN).

PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)

In-Network and Out-Of-Network $100 deductible on tiers 3, 4 & 5 only. $0/$20/$47/40%/31% to initial coverage limit of $4,130.

PLEASE NOTE THERE IS A SPECIAL NETWORK WITH THIS PPO PLAN ONLY – SPEAK WITH A REDSHIRT FOR DETAILS.

Independent Health's

2021 Medicare Passport ® Prime PPO

MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY
(In-Network)
INPATIENT HOSPITAL COPAY
(In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM

$215

PRIMARY/SPECIALTY COPAY
(In-Network)

$0/$30

INPATIENT HOSPITAL COPAY
(In-Network)

Days 1-6: $210 per day (IN) / 30% coinsurance (OON). Days 7-90: $0 (IN) / 30% coinsurance (OON). Unlimited Days for Medicare covered stays (IN). ($1,680 Annual Member Copay Maximum) (IN).

PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)

In-Network and Out-Of-Network $0 deductible. $0/$10/$45/40%/33% to initial coverage limit of $4,130.

Independent Health's

2021 Assure Advantage® HMO C-SNP Plan

This is a chronic special needs plan (C-SNP), specifically developed for eligible Medicare beneficiaries who have been diagnosed with both diabetes and chronic heart failure and reside in Erie County.

Independent Health's

2021 Medicare Family Choice® HMO I-SNP Plan

This plan is specifically designed to help you stay involved with the care of your loved one living in a nursing home or an assisted living facility with the help of a coordinated care team.

Interested in our plans?

We are here to help! You can request a copy of our full sales kit to help explain the differences between each plan.

Multi-Language Insert (Nondiscrimination statement and language assistance services)      Nondiscrimination Notice

Disclaimers
Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat Independent Health members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

IN = In-Network, OON = Out-of-Network

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Last Updated 10/01/2021