2023 Encompass 65® Basic HMO
Plan Highlights
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/$20
INPATIENT HOSPITAL COPAY (In-Network)
Days 1-6: $250 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,500 Annual Member Copay Maximum).
PART D PRESCRIPTION BENEFIT
$0 deductible. $0/$10/$42/43%/33% to initial coverage limit of $4,660.