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Independent Health's Encompass 65 RED 044 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Independent Health's Encompass 65 RED 044 (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 RED 044 (HMO) in 2026, please refer to our full plan details page.
Independent Health's Encompass 65 RED 044 (HMO) is a HMO plan offered by Independent Health Association, Inc. available for enrollment in 2026 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 RED 044 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Independent Health's Encompass 65 RED 044 (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 RED 044 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $95.00. 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 $150.00 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 $7500.00 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 Encompass 65 RED 044 (HMO) drug coverage includes an annual drug deductible of $150. Under this plan, Tier 1 preferred generic drugs are highly affordable with no copay for a 1-month or 3-month supply at standard pharmacies, or a 3-month supply via standard mail order. For Tier 2 generic drugs, you will pay a $7.00 copay for a 1-month supply and a $17.50 copay for a 3-month supply at standard pharmacies or through standard mail order. Higher-tier medications are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 16% coinsurance, while Tier 4 non-preferred drugs carry a 39% coinsurance, both applicable to 1-month and 3-month supplies at standard pharmacies and standard mail order. Tier 5 specialty drugs are available with a 31% coinsurance for a 1-month supply at standard pharmacies.
Additional Benefits
Independent Health's Encompass 65 RED 044 (HMO) offers comprehensive medical coverage with predictable copays and no coinsurance for many key services. Primary care visits range from no copay to $20, while specialist visits require a $35 to $50 copay. Emergency care has a $115 copay, and inpatient hospital stays carry a $350 daily copay for the first six days, with no copay for additional days. Preventive care, annual physicals, routine eye exams, and preventive dental services are covered with no copay. The plan also includes a $200 annual allowance for eyewear and up to $1,500 yearly for preventive dental care, though advanced services like prescription hearing aids and comprehensive dental care require copays or coinsurance. Additionally, home health services feature no copay, and skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
Independent Health's Encompass 65 RED 044 (HMO) covers inpatient acute hospital stays with no coinsurance and a $350 daily copay for days 1 through 6, and no copay for days 7 and beyond. Inpatient psychiatric stays are covered with no coinsurance and a $395 daily copay for days 1 through 4, and no copay for days 5 through 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Independent Health's Encompass 65 RED 044 (HMO) covers outpatient services with no coinsurance, though copays apply to most categories. Under this plan, you will pay a copay of $400 to $600 for outpatient hospital services, $350 to $600 per stay for observation services, $375 for ambulatory surgical center services, and $40 for substance abuse sessions, while outpatient blood services have no copay.
Partial Hospitalization See details
Independent Health's Encompass 65 RED 044 (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Independent Health's Encompass 65 RED 044 (HMO) with a $250 copay for ground ambulance services and a 20% coinsurance for air ambulance services, requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Independent Health's Encompass 65 RED 044 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are covered up to a $10,000 lifetime maximum, requiring a $115 copay for emergency care (no coinsurance), a $40 copay for urgent care (no coinsurance), and a $250 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Independent Health's Encompass 65 RED 044 (HMO) covers primary care visits with no copay to a $20 copay, specialist visits with a $35 to $50 copay, and physical, occupational, and speech therapies with a $15 copay, all with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care, while podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Independent Health's Encompass 65 RED 044 (HMO), featuring no copay and no coinsurance for annual physicals, kidney disease education, and routine screenings. Covered supplemental benefits include fitness, PERS, health education (up to a $20 copay), and remote access technologies (up to a $25 copay) with no coinsurance, while services like in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered under Independent Health's Encompass 65 RED 044 (HMO) with no coinsurance, offering no copay for Medicare-covered exams, $0 to $35 copays for routine exams, and a $45 copay for fitting evaluations. Prescription hearing aids require a copay between $499 and $1,949 with a $200 annual maximum benefit per ear, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Independent Health's Encompass 65 RED 044 (HMO) with no coinsurance, featuring one annual routine eye exam with no copay, though other eye exam services are not covered. Eyewear is partially covered with no copay up to a $200 yearly limit for contact lenses and eyeglasses (lenses and frames), but individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Independent Health's Encompass 65 RED 044 (HMO) partially covers dental services, offering preventive care like exams and cleanings with no copay and no coinsurance up to a $1,500 yearly maximum. Medicare-covered dental services require a $35 to $600 copay and no coinsurance, while covered comprehensive services like restorative care and oral surgery 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 Encompass 65 RED 044 (HMO) with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Independent Health's Encompass 65 RED 044 (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Independent Health's Encompass 65 RED 044 (HMO) covers durable medical equipment with no copay and 10% to 20% coinsurance, but prosthetics and diabetic equipment are only partially covered. Covered prosthetic devices carry no copay and 20% coinsurance, and covered diabetic supplies have no copay and range from no coinsurance to 20% coinsurance; however, medical supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Independent Health's Encompass 65 RED 044 (HMO) with prior authorization. Diagnostic tests require no copay to a $50 copay along with coinsurance, lab services require a copay with no coinsurance, outpatient X-rays carry a $35 copay with coinsurance, and diagnostic radiological services require a minimum $200 copay with no coinsurance while therapeutic services require a copay and 20% coinsurance.
Home Health Services See details
Independent Health's Encompass 65 RED 044 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Independent Health's Encompass 65 RED 044 (HMO) partially covers cardiac rehabilitation services, offering additional cardiac rehabilitation services for a $20 copay and no coinsurance. 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 Encompass 65 RED 044 (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other Services are not covered under Independent Health's Encompass 65 RED 044 (HMO), which means there is no coverage, copay, or coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits.
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