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Independent Health's Medicare Passport Access (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Independent Health's Medicare Passport Access (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Independent Health's Medicare Passport Access (PPO) in 2025, please refer to our full plan details page.
Independent Health's Medicare Passport Access (PPO) is a PPO plan offered by Independent Health Association, Inc. available for enrollment in 2025 to people living in Western New York. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Independent Health's Medicare Passport Access (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Independent Health's Medicare Passport Access (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Independent Health's Medicare Passport Access (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $450.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Independent Health's Medicare Passport Access (PPO)
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Drug Coverage
Independent Health's Medicare Passport Access (PPO) has a $450 deductible. After the deductible is met, you will pay a copay or coinsurance for your prescriptions. For example, you will pay a $20 copay for a tier 1 drug at a standard pharmacy. In the initial coverage phase, you will pay the cost-sharing amounts until your total drug costs reach $2000. After this, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
Independent Health's Medicare Passport Access (PPO) plan offers comprehensive coverage with a variety of benefits. The plan includes coverage for inpatient and outpatient hospital services, doctor visits, and emergency care, with varying copays depending on the service. You can also expect coverage for hearing, vision, and dental services, and the plan provides additional benefits such as home health services and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $320 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $375 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $375 copay, observation services with a $320 copay, and ambulatory surgical center services with a $350 copay. Outpatient substance abuse services include individual and group sessions, each with a copay between $40 and $40. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under Independent Health's Medicare Passport Access (PPO) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Independent Health's Medicare Passport Access (PPO). Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Independent Health's Medicare Passport Access (PPO). Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay. Worldwide Emergency Transportation has a $275 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have copays of $125 and $55, respectively.
Primary Care See details
Independent Health's Medicare Passport Access (PPO) covers Primary Care Physician Services, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services with a $35 copay for individual and group sessions. The plan also covers Other Health Care Professional services with a $40 copay, Psychiatric Services with a $35 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a copay between $0 and $55, and Opioid Treatment Program Services with a $40 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, annual physical exams, health education with a copay between $0 and $20, in-home safety assessments, nutritional/dietary benefits (4 visits), fitness benefits, and remote access technologies with a copay between $0 and $25. Other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered. Personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a copay between $0 and $40, and fitting/evaluation for hearing aids with a $45 copay. Prescription hearing aids (all types) are covered with a copay between $499 and $1949, while inner ear, outer ear, and over-the-ear prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, and eyewear coverage with a $0 copay, including contact lenses, and eyeglasses (lenses and frames), up to a combined maximum of $200 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Independent Health's Medicare Passport Access (PPO) offers dental services including Medicare Dental Services with a copay of $40-$375, and Other Dental Services with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered with a 50% coinsurance, while Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Independent Health's Medicare Passport Access (PPO), including Medicare Part B Insulin Drugs with a $35 copay, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by Independent Health's Medicare Passport Access (PPO) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 10-20% coinsurance, and Prosthetic Devices with a 20% coinsurance, though Durable Medical Equipment for use outside the home is not covered. The plan also covers Diabetic Supplies with 0-20% coinsurance, but does not cover Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $40, Lab Services with a coinsurance up to 20%, Diagnostic Radiological Services with a copay of $200, Therapeutic Radiological Services with a coinsurance up to 20%, and Outpatient X-Ray Services with a $30 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by Independent Health's Medicare Passport Access (PPO) with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Independent Health's Medicare Passport Access (PPO) plan. Specifically, Additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Independent Health's Medicare Passport Access (PPO), but require prior authorization. There is no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $45 every three months, and the plan also offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as Part C OTC benefits. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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