Independent Health’s Encompass 65 (HMO) is a Medicare Advantage (Part C) Plan by Independent Health.
This page features plan details for 2023 Independent Health’s Encompass 65 (HMO) H3362 – 016 – 0 available in Western New York.
Independent Health’s Encompass 65 (HMO) is offered in the following locations.
Independent Health’s Encompass 65 (HMO) offers the following coverage and cost-sharing.
Insurer: | Independent Health |
Health Plan Deductible: | $0.00 |
MOOP: | $6,700 In-network |
Drugs Covered: | No |
Ready to sign up for Independent Health’s Encompass 65 (HMO) ?
Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$164.90 | $0.00 | $0.00 | $164.90 |
Independent Health’s Encompass 65 (HMO) also provides the following benefits.
In-Network: Yes, contact plan for further details |
Diagnostic services: | Not covered (no limits) |
Endodontics: | 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Extractions: | 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Non-routine services: | Not covered (no limits) |
Periodontics: | 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Prosthodontics, other oral/maxillofacial surgery, other services: | 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Restorative services: | 50% coinsurance (limits may apply) (authorization not required) (referral not required) |
Cleaning: | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
Office visit: | $0.00 (authorization not required) (referral not required) |
Oral exam: | Covered under office visit (limits may apply) (authorization not required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | $50 copay (authorization required) (referral not required) |
Diagnostic tests and procedures: | $0-10 copay (authorization required) (referral not required) |
Lab services: | $0 copay or 20% coinsurance (authorization required) (referral not required) |
Outpatient x-rays: | $25 copay (authorization required) (referral not required) |
Primary: | $0 copay |
Specialist: | $10 copay per visit (authorization not required) (referral not required) |
Emergency: | $95 copay per visit (always covered) |
Urgent care: | $60 copay per visit (always covered) |
Foot exams and treatment: | $10 copay (authorization not required) (referral not required) |
Routine foot care: | Not covered |
$150 copay |
$0.00 |
In-Network: No |
Fitting/evaluation: | $45 copay (no limits) (authorization not required) (referral not required) |
Hearing aids: | $499-2,199 copay (no limits) (authorization not required) (referral not required) |
Hearing exam: | $10 copay (authorization not required) (referral not required) |
$150 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
$100 copay per visit (authorization required) (referral not required) |
$6,700 In-network |
Diabetes supplies: | $0 copay (authorization not required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | 10-20% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
Chemotherapy: | 20% coinsurance (authorization required) |
Other Part B drugs: | $35 copay or 20% coinsurance (authorization required) |
Inpatient hospital – psychiatric: | $250 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) (referral not required) |
Outpatient group therapy visit: | $20 copay (authorization not required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | $20 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit: | $20 copay (authorization not required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | $20 copay (authorization not required) (referral not required) |
No |
$0 copay (authorization not required) (referral not required) |
Occupational therapy visit: | $10 copay (authorization not required) (referral not required) |
Physical therapy and speech and language therapy visit: | $10 copay (authorization not required) (referral not required) |
$0 per day for days 1 through 20 $196 per day for days 21 through 100 (authorization required) (referral not required) |
$0 copay (limits may apply) (authorization required) (referral not required) |
Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass frames: | Not covered (no limits) |
Eyeglass lenses: | Not covered (no limits) |
Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral not required) |
Other: | Not covered (no limits) |
Routine eye exam: | $0 copay (limits may apply) (authorization not required) (referral not required) |
Upgrades: | Not covered |
Covered (authorization not required) (referral not required) |
Ready to sign up for Independent Health’s Encompass 65 (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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