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Independent Health's Encompass 65 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Independent Health's Encompass 65 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Independent Health's Encompass 65 (HMO) in 2026, please refer to our full plan details page.
Independent Health's Encompass 65 (HMO) is a HMO 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 5 out of 5 stars in 2026.
It's important to know that Independent Health's Encompass 65 (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Independent Health's Encompass 65 (HMO).
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 Encompass 65 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $11.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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
Prescription drugs are not covered by Independent Health's Encompass 65 (HMO).
Additional Benefits
Independent Health's Encompass 65 (HMO) offers robust medical coverage with predictable copayments and no coinsurance for many core services. Primary care visits range from no copay to a $20 copay, while specialist visits require a $10 to $50 copay. For hospital stays, acute inpatient services carry a $150 copay for days one through five and no copay for subsequent days, while emergency room visits have a $130 copay. This plan also includes valuable extra benefits, such as preventive dental care, annual physicals, and home health services with no copays. Additionally, members receive a $75 over-the-counter allowance every three months with no copay, alongside routine hearing exams and up to 24 one-way transportation trips per year at no cost. Comprehensive dental coverage is also available with a $2,000 annual limit and 50% coinsurance.
Inpatient Hospital See details
Independent Health's Encompass 65 (HMO) partially covers inpatient hospital services, with no coinsurance required, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $150 copay for days 1 to 5 and no copay for days 6 and beyond, while psychiatric stays require a $250 copay for days 1 to 6 and no copay for days 7 to 90.
Outpatient Services See details
Independent Health's Encompass 65 (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $100 to $550 copay and observation services with a $150 to $550 copay per stay. Ambulatory surgical center services carry a $100 copay and no coinsurance, outpatient substance abuse sessions have a $40 copay and no coinsurance, and outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Independent Health's Encompass 65 (HMO) with a $40.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Independent Health's Encompass 65 (HMO) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are partially covered with no copay or coinsurance, offering up to 24 one-way trips per year to plan-approved locations only.
Emergency Services See details
Emergency services are covered by Independent Health's Encompass 65 (HMO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency services are covered up to a $10,000 maximum and include emergency transportation for a $150 copay and 20% coinsurance.
Primary Care See details
Independent Health's Encompass 65 (HMO) covers primary care physician services with no copay to a $20.00 copay and no coinsurance, and specialist visits with a $10.00 to $50.00 copay and no coinsurance. Chiropractic services are partially covered with a $10.00 copay and no coinsurance, excluding routine care, while podiatry services are not covered. Therapy, mental health, and telehealth services are covered with copays ranging from no copay up to $50.00 and no coinsurance.
Preventive Services See details
Independent Health's Encompass 65 (HMO) covers preventive services, including annual physicals, kidney disease education, and routine screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no coinsurance, offering fitness benefits and personal emergency response systems with no copay, and health education and remote access technologies with copays up to $25. Uncovered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Independent Health's Encompass 65 (HMO) covers hearing exams with no coinsurance, featuring no copay for Medicare-covered exams, a $0 to $10 copay for routine exams, and a $45 copay for fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $1,949 up to a $200 annual limit per ear, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Independent Health's Encompass 65 (HMO) with no deductibles or coinsurance, offering eye exams with a $0 to $10 copay and eyewear with no copay up to a $200 annual limit. Covered benefits include one routine eye exam per year, contact lenses, and eyeglasses (lenses and frames), while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Independent Health's Encompass 65 (HMO) provides partially covered dental services with an annual maximum benefit of $2,000. Medicare-covered dental services require a $10.00 to $550.00 copay and no coinsurance, while covered preventive services have no copay and no coinsurance, and covered comprehensive services have no copay and 50% coinsurance. Sub-services that are not covered include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Independent Health's Encompass 65 (HMO) with no copay, requiring prior authorization. Under this benefit, 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 Encompass 65 (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Independent Health's Encompass 65 (HMO) partially covers medical equipment with no copays, featuring coinsurance of 10% to 20% for durable medical equipment, 20% for prosthetics, and no coinsurance to 20% for diabetic supplies. However, medical supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Independent Health's Encompass 65 (HMO) with prior authorization, offering diagnostic tests with no copay to a $50 copay plus coinsurance, and lab services with a copay and no coinsurance. Diagnostic radiological services require a minimum $50 copay and no coinsurance, outpatient X-rays carry a $25 copay plus coinsurance, and therapeutic radiological services require a copay and at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered under Independent Health's Encompass 65 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Independent Health's Encompass 65 (HMO) partially covers cardiac rehabilitation services with no coinsurance and a $25 copay for additional cardiac rehabilitation services. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Independent Health's Encompass 65 (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day 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 standard Medicare-covered period are not covered.
Other Services See details
Independent Health's Encompass 65 (HMO) partially covers other services, providing an over-the-counter (OTC) benefit of up to $75 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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