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Independent Health's Medicare Family Choice (HMO I-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Independent Health's Medicare Family Choice (HMO I-SNP). 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 Family Choice (HMO I-SNP) in 2026, please refer to our full plan details page.
Independent Health's Medicare Family Choice (HMO I-SNP) is a HMO I-SNP 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 Medicare Family Choice (HMO I-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Independent Health's Medicare Family Choice (HMO I-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Independent Health's Medicare Family Choice (HMO I-SNP).
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 Family Choice (HMO I-SNP), 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 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
Independent Health's Medicare Family Choice (HMO I-SNP) features no drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay a $2 copay for a 1-month supply or a $5 copay for a 3-month supply at standard pharmacies and mail order. Tier 2 generic drugs cost a $10 copay for a 1-month supply and a $25 copay for a 3-month supply. Tier 3 preferred brand drugs require a $37 copay for a 1-month supply and a $92.50 copay for a 3-month supply. For higher-tier medications, Tier 4 non-preferred drugs carry a 40% coinsurance for both 1-month and 3-month supplies, while Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply.
Additional Benefits
Independent Health's Medicare Family Choice (HMO I-SNP) offers comprehensive medical coverage with many essential services featuring no copay and no coinsurance to keep your out-of-pocket costs low. Primary care, specialist visits, and Medicare-covered preventive services generally require low or no copays and no coinsurance. Emergency and urgent care are also highly accessible, with urgently needed services requiring no copay and emergency room visits carrying a flat $50 copay that is waived if you are admitted within 24 hours. The plan also includes valuable everyday benefits, such as no copay for routine vision and hearing exams, a $150 annual eyewear allowance, and up to $1,000 per ear annually for prescription hearing aids. Additionally, members receive a $120 allowance every three months for over-the-counter items and up to 36 free one-way transportation trips per year to approved locations with no copay. While core services like dialysis and home health care have no copay, routine dental care and some specialized services are not covered.
Inpatient Hospital See details
Independent Health's Medicare Family Choice (HMO I-SNP) partially covers inpatient hospital services with no coinsurance, but prior authorization is required and upgrades and non-Medicare-covered stays are not covered. Acute inpatient stays require a $200 copay with unlimited additional days at no copay, while psychiatric stays require a $150 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers outpatient hospital services with no coinsurance and copays between $250 and $550, and ambulatory surgical services with a $150 copay and no coinsurance. Outpatient blood services have no copay or coinsurance, but outpatient substance abuse services are not covered because individual and group sessions are excluded.
Partial Hospitalization See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers partial hospitalization with no copay and no coinsurance. Prior authorization may be required for some of these covered services.
Ambulance and Transportation Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers ambulance services requiring prior authorization, with a $30.00 copay for ground transport and a 20% coinsurance for air transport. Transportation services are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers emergency services with a $50 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency services are also covered up to a $10,000 maximum, including a $50 copay for emergency coverage and a $30 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers primary care services with a $0 to $20 copay and specialist visits with a $0 to $50 copay, both featuring no coinsurance. Therapy, podiatry, and opioid treatment are covered with no copay and no coinsurance, though chiropractic care is only partially covered as routine chiropractic care is excluded. Mental health and psychiatric benefits cover some services with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
Preventive services under Independent Health's Medicare Family Choice (HMO I-SNP) are partially covered, featuring no copay and no coinsurance for Medicare-covered preventive services, kidney disease education, and screenings, while health education carries a $0 to $20 copay with no coinsurance. However, several sub-services are not covered under this plan, including annual physical exams, fitness benefits, in-home safety assessments, and weight management programs.
Hearing Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers routine hearing exams with no copay and no coinsurance, while hearing aid fittings and evaluations require a $45 copay and no coinsurance. Some prescription hearing aid services are covered up to $1,000 per ear annually with no copay or coinsurance, but 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 Medicare Family Choice (HMO I-SNP), offering no copay and no coinsurance for one routine eye exam annually and select eyewear up to a $150 yearly limit. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Independent Health's Medicare Family Choice (HMO I-SNP), with Medicare-covered dental services requiring no coinsurance and a copay ranging from no copay to $550.00, subject to prior authorization. Other dental services, including oral exams, cleanings, x-rays, preventive care, restorative services, and orthodontics, are not covered by the plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered by Independent Health's Medicare Family Choice (HMO I-SNP) with no copay and no coinsurance, although prior authorization is required. While Medicare Part B insulin is covered with no copay and no coinsurance, Medicare Part B chemotherapy or radiation drugs and other Medicare Part B drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by Independent Health's Medicare Family Choice (HMO I-SNP) with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers durable medical equipment with no copay and no coinsurance, but other medical equipment benefits are only partially covered. Under these benefits, prosthetic devices are covered with no copay and a 10% coinsurance, while medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers diagnostic and radiological services with prior authorization. Diagnostic procedures and tests require a copay of no copay to $50 plus coinsurance, lab services require a copay with no coinsurance, and radiological services require a minimum $50 copay or a minimum 10% coinsurance depending on the service.
Home Health Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required before you can receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Independent Health's Medicare Family Choice (HMO I-SNP) with no copay and no coinsurance. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are partially covered by Independent Health's Medicare Family Choice (HMO I-SNP) with no copay and no coinsurance, though prior authorization is required. While the plan allows SNF admission with less than a three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Independent Health's Medicare Family Choice (HMO I-SNP) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $120 allowance every three months. Acupuncture, meal benefits, and other miscellaneous services are not covered.
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