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Independent Health's Assure Advantage (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Independent Health's Assure Advantage (HMO C-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 Assure Advantage (HMO C-SNP) in 2026, please refer to our full plan details page.
Independent Health's Assure Advantage (HMO C-SNP) is a HMO C-SNP plan offered by Independent Health Association, Inc. available for enrollment in 2025 to people living in Erie County. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that Independent Health's Assure Advantage (HMO C-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 Assure Advantage (HMO C-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 Assure Advantage (HMO C-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 Assure Advantage (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.50. 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 $50.00 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 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
Independent Health's Assure Advantage (HMO C-SNP) features an annual drug deductible of $50. Under this plan, there is no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic drugs, you will pay a $10 copay for a one-month supply and a $25 copay for a three-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a one-month supply and a $117.50 copay for a three-month supply. Higher-tier medications carry coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 32% coinsurance for a one-month supply.
Additional Benefits
Independent Health's Assure Advantage (HMO C-SNP) offers comprehensive healthcare coverage with predictable out-of-pocket costs and no coinsurance for many core services. Inpatient hospital stays require a $250 daily copay for days one through six and no copay thereafter, while primary care visits range from no copay up to $20. Emergency care is covered with a $125 copay, which is waived if you are admitted, and urgent care visits require a $50 copay. The plan also features valuable specialty care, including preventive dental services and routine eye exams with no copay, alongside a $200 annual eyewear allowance. Diagnostic hearing exams carry no copay, while prescription hearing aids are covered with copays ranging from $499 to $1,949. Additionally, home health services are fully covered with no copay or coinsurance, helping members manage their health at home.
Inpatient Hospital See details
Independent Health's Assure Advantage (HMO C-SNP) covers inpatient acute hospital stays with no coinsurance, requiring a $250 daily copay for days 1 through 6 and no copay for days 7 and beyond. Inpatient psychiatric care is also covered with no coinsurance, requiring a $395 daily copay for days 1 through 4 and no copay for days 5 through 90, though prior authorization is required and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Independent Health's Assure Advantage (HMO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $550, observation services carry a $250 to $550 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Independent Health's Assure Advantage (HMO C-SNP) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Independent Health's Assure Advantage (HMO C-SNP) covers Medicare-covered ground and air ambulance services with a $220 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Independent Health's Assure Advantage (HMO C-SNP) covers emergency services with a $125 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $10,000 maximum limit with no coinsurance and copays of $125, $50, and $220 respectively.
Primary Care See details
Independent Health's Assure Advantage (HMO C-SNP) covers primary care physician services with no copay to a $20 copay and no coinsurance, and specialist visits with no copay to a $50 copay and no coinsurance. Additional services like therapy, podiatry, and psychiatric care are covered with no coinsurance and low copays, though chiropractic services are only partially covered because routine chiropractic care is not covered.
Preventive Services See details
Independent Health's Assure Advantage (HMO C-SNP) covers preventive services, annual physicals, kidney education, and other screenings with no copay and no coinsurance. Additional preventive services are partially covered with no coinsurance and a $0 to $25 copay for remote access, but do not cover in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services covered by Independent Health's Assure Advantage (HMO C-SNP) include diagnostic exams with no copay and no coinsurance, routine exams with a $0 to $20 copay, and fitting evaluations for a $45 copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $499 to $1,949, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Independent Health's Assure Advantage (HMO C-SNP) partially covers vision services with a $0 to $20 copay, no coinsurance, and no deductible, providing one routine eye exam per year and a $200 annual allowance for eyewear. While contact lenses and eyeglasses are covered, 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 Assure Advantage (HMO C-SNP), offering select preventive care with no copay and no coinsurance up to a $2,000 annual limit. Medicare-covered dental services require a $20 to $550 copay and no coinsurance, while covered comprehensive services like endodontics and periodontics have no copay and 50% coinsurance. Other diagnostic and preventive services, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Independent Health's Assure Advantage (HMO C-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other Part B drugs, including chemotherapy and radiation, have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Independent Health's Assure Advantage (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Independent Health's Assure Advantage (HMO C-SNP) partially covers medical equipment, with medical supplies and diabetic therapeutic shoes or inserts excluded from coverage. Covered durable medical equipment, prosthetics, and diabetic supplies require no copay, with coinsurance ranging from no coinsurance up to 20% depending on the item.
Diagnostic and Radiological Services See details
Independent Health's Assure Advantage (HMO C-SNP) covers diagnostic and radiological services with prior authorization, including diagnostic tests with a copay ranging from no copay up to $50 plus coinsurance, and lab services with a copay and no coinsurance. Outpatient X-rays require a $30 copay plus coinsurance, while diagnostic radiology has a $155 copay and therapeutic radiology requires both a copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under Independent Health's Assure Advantage (HMO C-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Independent Health's Assure Advantage (HMO C-SNP) partially covers cardiac rehabilitation services with no coinsurance, requiring a $25 copay only for additional cardiac rehabilitation services. 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 Assure Advantage (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20 and a $214 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
Other Services are not covered under Independent Health's Assure Advantage (HMO C-SNP), as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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