A non-government entity
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 2025, 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 2025.
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 $72.30. 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 $575.00 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 Connect (PPO)
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Drug Coverage
The Independent Health's Medicare Passport Connect (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $575.00. In the initial coverage phase, after the deductible, you will pay 25% coinsurance for all drugs at a standard pharmacy. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
Independent Health's Medicare Passport Connect (PPO) offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays ranging from $40 to $400, and ambulance services with a copay or coinsurance. The plan also covers preventive services, primary care, and mental health services with varying copays, as well as vision, hearing, and dental services, with some services having no copay. Additional benefits include home health services with no copay, skilled nursing facility stays with copays, and coverage for home infusion and dialysis services. The plan also covers diagnostic and radiological services with copays and coinsurance, along with medical equipment and diabetic supplies. Other services include OTC items, and transportation to health-related locations.
Inpatient Hospital See details
Inpatient Hospital benefits for Independent Health's Medicare Passport Connect (PPO) include coverage for Inpatient Hospital-Acute with a $325 copay for days 1-6 and no copay for days 7-90, and Inpatient Hospital Psychiatric with a $395 copay for days 1-4 and no copay for days 5-90. The plan does not cover Non-Medicare-covered Stay or Upgrades for Inpatient Hospital-Acute, nor does it cover Additional Days or Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $400 copay, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with a $350 copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by Independent Health's Medicare Passport Connect (PPO), with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Independent Health's Medicare Passport Connect (PPO), with prior authorization required for all ambulance services. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance. Transportation services to any plan-approved health-related location are covered. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services under Independent Health's Medicare Passport Connect (PPO) include a $125 copay, while Urgently Needed Services have a $55 copay. Worldwide Emergency Services include a $125 copay for Worldwide Emergency Coverage, a $55 copay for Worldwide Urgent Coverage, and a $300 copay with 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Independent Health's Medicare Passport Connect (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $40 copay, mental health specialty services with a $35 copay for individual and group sessions, 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 $30 copay, additional telehealth benefits with a $0-$55 copay, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, annual physical exams, and other preventive services. Health Education and Remote Access Technologies have a copay between $0 and $25, and Nutritional/Dietary Benefits are covered for up to 4 sessions.
Hearing Services See details
Hearing services include routine hearing exams with no copay, and fitting/evaluation for hearing aids with a copay of $45. Prescription hearing aids (all types) are covered with a copay between $499 and $1949, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, and eyewear with no copay. Eyeglasses (lenses and frames) and contact lenses are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a copay of $40-$400, 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. 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 Connect (PPO), including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Independent Health's Medicare Passport Connect (PPO), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with a 10-20% coinsurance and Prosthetic Devices with a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Medical Supplies are not covered. Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Independent Health's Medicare Passport Connect (PPO). Diagnostic Procedures/Tests have a copay between $0 and $40, and Lab Services have a coinsurance of up to 20%. Diagnostic Radiological Services have a copay of $225, while Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered by Independent Health's Medicare Passport Connect (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Independent Health's Medicare Passport Connect (PPO). Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Independent Health's Medicare Passport Connect (PPO) with prior authorization. You will pay no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $100 every three months, including nicotine replacement therapy and Naloxone. 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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