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Independent Health's Medicare Passport Connect (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Independent Health's Medicare Passport Connect (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 Connect (PPO) in 2026, please refer to our full plan details page.
Independent Health's Medicare Passport Connect (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 2026.
It's important to know that Independent Health's Medicare Passport Connect (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 Connect (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 Connect (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.80. 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 has a $175.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $13900.00 (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 $13900.00 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:
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Drug Coverage
Independent Health's Medicare Passport Connect (PPO) has a yearly prescription drug deductible of $615. This means you will pay the full cost of your covered medications up to this amount before your plan benefits begin. Detailed information regarding specific drug coverage tiers, copays, and coinsurance is not currently available for this plan. To determine how your specific prescriptions are covered, you should consult the plan's formulary or contact the provider directly.
Additional Benefits
Independent Health's Medicare Passport Connect (PPO) provides robust medical coverage featuring no coinsurance for major services, including inpatient hospital stays that require a $375 daily copay for days 1 through 6 and no copay for subsequent days. Primary care visits range from no copay to $20, while specialist visits require a $55 copay. Emergency care is available with a $115 copay, which is waived if you are admitted, and urgent care carries a $40 copay. For extra wellness needs, the plan covers preventive dental care with no copay and comprehensive dental services with no copay and a 50% coinsurance up to a $1,500 yearly limit. Routine vision and hearing exams are covered with no copay, and the plan provides a $200 annual eyewear allowance and copays ranging from $499 to $1,949 for prescription hearing aids. Home health services require no copay, and skilled nursing facility care features no copay for the first 20 days.
Inpatient Hospital See details
Independent Health's Medicare Passport Connect (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $375 daily copay for days 1 through 6 and no copay for subsequent unlimited days. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $395 daily copay for days 1 through 4 and no copay for days 5 through 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Independent Health's Medicare Passport Connect (PPO) covers outpatient services with no coinsurance, featuring a $425 to $550 copay for outpatient hospital services and a $375 copay for ambulatory surgical center services. Observation services require a $375 to $550 copay per stay, outpatient substance abuse sessions have a $40 copay, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Independent Health's Medicare Passport Connect (PPO) covers partial hospitalization benefits with a $55 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Independent Health's Medicare Passport Connect (PPO) covers ambulance services with prior authorization, requiring a $265 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Independent Health's Medicare Passport Connect (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgent care with a $40 copay, with no coinsurance required for either service. Worldwide emergency and urgent services are covered up to a $10,000 maximum limit, featuring a $115 copay for emergency care, a $40 copay for urgent care, and a $265 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Independent Health's Medicare Passport Connect (PPO) covers primary care with copays ranging from no copay up to $20, and specialist visits for a $55 copay, all with no coinsurance. Other covered services include mental health, psychiatric, and occupational or physical therapies with copays ranging from $30 to $55 and no coinsurance, though routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Independent Health's Medicare Passport Connect (PPO) covers annual physical exams, kidney disease education, and other preventive services with no copay and no coinsurance. Additional preventive services are partially covered with no coinsurance, with copays ranging from no copay to $20 for health education and no copay to $25 for remote access technologies. Sub-services that are not covered include in-home safety assessments, PERS, MNT, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Independent Health's Medicare Passport Connect (PPO) covers hearing services with no deductible and no coinsurance, offering no copay for Medicare-covered exams, no copay to a $55 copay for routine exams, and a $45 copay for fitting evaluations. Prescription hearing aids are partially covered with copays ranging from $499 to $1,949 and a $200 annual maximum benefit per ear, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Independent Health's Medicare Passport Connect (PPO) with no deductibles and no coinsurance. Eye exams feature a $0 to $55 copay (with no copay for annual routine exams), and eyewear is covered up to a $200 annual limit with no copay. Other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Independent Health's Medicare Passport Connect (PPO) partially covers dental services up to a $1,500 annual limit, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 50% coinsurance. Medicare-covered dental requires a $40 to $550 copay and no coinsurance, though other diagnostic and preventive services, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Independent Health's Medicare Passport Connect (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Independent Health's Medicare Passport Connect (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Independent Health's Medicare Passport Connect (PPO) with no copays, featuring 10% to 20% coinsurance for durable medical equipment, 20% coinsurance for prosthetic devices, and no coinsurance to 20% coinsurance for diabetic supplies. Prior authorization is required for certain benefits, and medical supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Independent Health's Medicare Passport Connect (PPO) covers diagnostic and radiological services with prior authorization, featuring diagnostic test copays from no copay up to $55 plus coinsurance, and lab services with a copay and no coinsurance. Diagnostic radiological services require a minimum $225 copay, outpatient X-rays carry a $45 copay plus coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Independent Health's Medicare Passport Connect (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Independent Health's Medicare Passport Connect (PPO) partially covers Cardiac Rehabilitation Services, with only Additional Cardiac Rehabilitation Services covered at a $20 copay and no coinsurance. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Independent Health's Medicare Passport Connect (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are not covered under Independent Health's Medicare Passport Connect (PPO), as the plan does not provide benefits for acupuncture, over-the-counter (OTC) items, or meals.
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