2023 Assure Advantage® HMO C-SNP Plan

Plan Highlights

(Tier 1 / 2 / 3 / 4 / 5)





Days 1-6: $250 per day. Additional days: $0 Unlimited Days for Medicare covered stays. ($1,500 Annual Member Copay Maximum).


No deductible. $0/$12/$47/38%/33% to initial coverage limit of $4,660. $20 for insulins on our formulary.

Plan Details

Independent Health’s Assure Advantage (HMO-SNP) is a specialized Medicare Advantage Plan (a Medicare “Special Needs Plan”), which means its benefits are designed for people with special health care needs. Independent Health’s Assure Advantage is designed to provide additional health benefits that specifically help people who have chronic heart failure.

Our plan includes providers who specialize in treating chronic heart failure. It also includes health programs designed to serve the specialized needs of people with this condition. In addition, our plan covers prescription drugs to treat most medical conditions, including the drugs that are usually used to treat chronic heart failure. As a member of the plan, you get benefits specially tailored to your condition and have all your care coordinated through our plan.

Eligibility Requirements:
To be eligible, it’s important that you meet all of the following criteria:

  • Reside in Erie County.
  • Have chronic heart failure.
  • Must be entitled or enrolled in Medicare Parts A and B.

Note: Enrollment into Independent Health’s Assure Advantage HMO-SNP plan will automatically disenroll a person from any other Medicare Advantage plan.

For more information or to enroll speak with an Independent Health representative today at:
(716) 635-4900 or 1-800-958-4405 (TTY users call 711):
October 1 – March 31: Monday – Sunday, 8 a.m. – 8 p.m.
April 1 – September 30: Monday – Friday, 8 a.m. – 8 p.m.

Monthly Premium


Plan Premium with Full 100% Low Income Subsidy (LIS)


Part D Prescription Benefit Tier 1 / 2 / 3 / 4 / 5 / 6

No deductible. $0/$12/$47/38%/33% to initial coverage limit of $4,660.  $20 for insulins on our formulary.

Primary Copay


Specialty Copay


Preventive Services


Inpatient Hospital Copay

Days 1-6: $250 per day. Additional days: $0 Unlimited Days for Medicare covered stays. ($1,500 Annual Member Copay Maximum).

Worldwide Emergency / Urgent Care**


Lab Copay*


General X-ray / Advanced Radiology Copay

$30 / $155

Non-Emergency Transportation (from a network provider)

$0 for up to 12 one-way trips to plan-approved locations (30-mile limit per trip).

Wellness Benefits

Over-the-Counter (OTC)***

$50 per quarter

SilverSneakers® Fitness Benefit (from a participating facility that offers SilverSneakers)

$0 copayment (memberships will not roll over from 2022 to 2023 or 2023 to 2024. Memberships will restart on January 1st of each year).

Vision (from a network provider)

$0 routine eye exam. $200 allowance for routine eyewear. $0 for diabetic retinopathy exam for diabetics. $0 for Ophthalmologist too.

Dental (from a network provider)

$0 per visit for preventive dental: Two routine cleanings, exams, fluoride treatments and bitewing X-rays per calendar year. One full-mouth series every 36 months.

Comprehensive dental services are built into this plan and are subject to $0 deductible and 50% coinsurance on covered services.  $3,000 annual benefit maximum.

Hearing Aid Benefit (from a network provider)

$45 hearing aid evaluation exam. Member pays: $499 - $2,199 (per ear) for hearing aid device. The average cost for hearing aids without coverage is $2,445 - $3,125 per ear.

Personal Emergency Response System (PERS)


Enhanced Annual Wellness Visit (EAV)


These benefits will help members with diabetes manage their special needs, live healthier and save money. Learn more.

Home Delivered Meals

$0 copay for up to 28 meals (14 consecutive days) following discharge from an overnight stay in a hospital or skilled nursing facility.

$0 copay for up to an additional 28 meals (14 consecutive days) any time to help you manage your health.

All of our Medicare Advantage plans come with additional benefits to help you maintain an active, healthy lifestyle. Learn More


* Member pays 20% for genetic testing.

This plan requires the use of participating providers, except in the case of emergency care, urgent care or out of area renal dialysis. This information is not a complete description of benefits. Call (716) 250-4401 or 1-800-665-1502 (TTY users call 711) for more information.

** $10,000 annual maximum plan limit for emergency care, urgent care or ambulance outside the USA and its territories.

***Allowance is made available by quarter. Allowance carries over quarter to quarter, however does not carry over plan year to plan year. Costs over the allowed amount are the member’s responsibility. This benefit can only be used for covered items through NationsOTC.®

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

Last Updated 1/3/2023