A non-government entity
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 2025, 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 4.5 out of 5 stars in 2025.
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 $49.00. 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 $200.00 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:
Sign up for Independent Health's Assure Advantage (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Independent Health's Assure Advantage (HMO C-SNP) has a $200 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you pay $12 for preferred generic drugs at a standard pharmacy, while standard generic drugs cost $47. Preferred brand drugs have 50% coinsurance, and non-preferred drugs have 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
Independent Health's Assure Advantage (HMO C-SNP) offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $395 depending on the service. It also provides coverage for primary care, preventive, hearing, vision, and dental services, with copays and coinsurance amounts varying by service. Additional benefits include ambulance and transportation services, emergency services, home health services, and skilled nursing facility care. The plan also covers home infusion services and medical equipment with coinsurance requirements. However, certain services like cardiac rehabilitation, and some dental and vision services, are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services. For acute care, you'll pay a $250 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay, while non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric care has a $395 copay for days 1-4, and no copay for days 5-90, with additional days and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Independent Health's Assure Advantage (HMO C-SNP) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $245 copay and no coinsurance. Transportation Services to plan-approved health-related locations are covered for 12 one-way taxi trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by Independent Health's Assure Advantage (HMO C-SNP). Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $245 copay, and all have no coinsurance.
Primary Care See details
Primary Care services include coverage for primary care physician services. Chiropractic services have a $15 copay, while routine chiropractic care is not covered. Occupational Therapy Services have a $10 copay, and Physician Specialist Services have a copay that ranges from $0 to $20. Mental Health Specialty Services and Psychiatric Services have a $30 copay for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $10 copay. Additional Telehealth Benefits have a copay that ranges from $0 to $55, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, as well as annual physical exams and additional preventive services. Additional preventive services may have a copay, including Health Education (minimum $0, maximum $20) and Remote Access Technologies (minimum $0, maximum $25).
Hearing Services See details
Hearing Services with Independent Health's Assure Advantage (HMO C-SNP) includes hearing exams with no copay, routine hearing exams with a copay between $0 and $20, and fitting/evaluation for hearing aids with a $45 copay. Prescription hearing aids are covered with a copay between $499 and $1949, while prescription hearing aids for the inner and outer ear, and over the ear hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$20, and eyewear with no copay, including contact lenses. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Independent Health's Assure Advantage (HMO C-SNP) plan covers dental services including Medicare Dental Services with a copay of $20-$350, 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, while Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 Assure Advantage (HMO C-SNP) with a 20% coinsurance. There is no copay for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 10-20% coinsurance and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered medical supplies. Diabetic Equipment is covered, with Diabetic Supplies having a 0-20% coinsurance, but Durable Medical Equipment for use outside the home, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Independent Health's Assure Advantage (HMO C-SNP), including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with a coinsurance of up to 20%, Diagnostic Radiological Services with a copay of $155, Therapeutic Radiological Services with a coinsurance of 20%, and Outpatient X-Ray Services with a $30 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by Independent Health's Assure Advantage (HMO C-SNP) with no copay and no coinsurance. 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 Assure Advantage (HMO C-SNP). The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Independent Health's Assure Advantage (HMO C-SNP), with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) items with a maximum benefit of $40 every three months and meal benefits requiring prior authorization. Acupuncture, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved