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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 2025, 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 4.5 out of 5 stars in 2025.
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 $40.80. 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) has an enhanced alternative drug benefit. This plan has no deductible. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $13 copay for preferred generic drugs at a standard pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
Independent Health's Medicare Family Choice (HMO I-SNP) offers a range of benefits, including inpatient hospital stays with a $150 copay, outpatient services with varying coinsurance, and emergency services with a $50 copay. The plan also covers primary care, preventive services with some copays, and hearing and vision services, with no copays for routine exams. Additional benefits include dental services with coinsurance, home infusion, and medical equipment like DME with no copays. The plan provides coverage for ambulance services, home health services with no copay, and diagnostic services with no copay. However, certain services such as Cardiac Rehabilitation and Private Duty Nursing are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, there is a $150 copay for a Medicare-covered stay and a service-specific out-of-pocket maximum of $600, while Additional Days have no copay. For Inpatient Hospital Psychiatric, there is a $150 copay for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, observation services, outpatient substance abuse services, outpatient blood services, and ambulatory surgical center (ASC) services, are covered. Outpatient hospital services have a 10% coinsurance, and observation services have a $150 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Independent Health's Medicare Family Choice (HMO I-SNP). Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation to plan-approved health-related locations. Ground ambulance services have a $30 copay, and air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Independent Health's Medicare Family Choice (HMO I-SNP). Emergency Services have a $50 copay, while Urgently Needed Services have no copay. Worldwide Emergency Coverage has a $50 copay, and Worldwide Emergency Transportation has a $30 copay and 20% coinsurance.
Primary Care See details
Independent Health's Medicare Family Choice (HMO I-SNP) covers primary care physician services, chiropractic services (excluding routine care), occupational therapy services, physician specialist services, podiatry services, other health care professional services, physical therapy and speech-language pathology services, telehealth benefits, and opioid treatment program services. Occupational therapy and physical therapy have no copay or coinsurance. Mental health and psychiatric individual and group sessions are not covered.
Preventive Services See details
Preventive Services are covered, with the exception of the annual physical exam. Health Education has a copay between $0 and $20, while the plan also covers In-Home Safety Assessments, Nutritional/Dietary Benefits (up to 4 visits), Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline).
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids with a $45 copay. Prescription Hearing Aids (all types) are covered with a maximum benefit of $1000 per year, and 2 visits per year. However, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and routine eye exams have no copay. Eyewear is covered, with a $150 combined maximum plan benefit coverage amount per year, though eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a coinsurance of 10% and a copay ranging from $0 to $100. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Independent Health's Medicare Family Choice (HMO I-SNP), including insulin drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered under Independent Health's Medicare Family Choice (HMO I-SNP) and require prior authorization. The plan does not specify the cost of these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay or coinsurance, Prosthetics with a 10% coinsurance, and Diabetic Equipment with no copay or coinsurance. The plan does not cover Durable Medical Equipment for use outside the home, Medical Supplies, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for any service. Lab services have a coinsurance of up to 20%, and diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 10%.
Home Health Services See details
Home Health Services are covered by Independent Health's Medicare Family Choice (HMO I-SNP), with no copay and no coinsurance, but 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 Family Choice (HMO I-SNP). Specifically, 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, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Other Services covered by Independent Health's Medicare Family Choice (HMO I-SNP) include Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $175 every three months, and the benefit carries forward if unused. Acupuncture, Meal Benefit, 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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