Pay Bill2026 Encompass 65® RED 043 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
$190
PRIMARY/SPECIALTY COPAY (In-Network)
Tier A: $0/$25
Tier B: $20/$50
INPATIENT HOSPITAL COPAY (In-Network)
Tier A: Days 1-6: $300 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,800 Annual Member Copay Maximum).
Tier B: Days 1-5: $485 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($2,425 Annual Member Copay Maximum).
PART D PRESCRIPTION BENEFIT
$50 deductible on tiers 3, 4 & 5 only. $0/$10/19%/42%/32% to out-of-pocket maximum of $2,100.