Independent Health's Medicare Family Choice (HMO I-SNP)

INDEPENDENT HEALTH ASSOCIATION, INC. · 2027 plan year

Plan ID H3362-020-000

HMO★ 4.5 CMS StarsInstitutional SNP
MOOP (in-network)
$5,000
MOOP (combined)
—
Monthly premium
$40/mo
Part C $0 + Part D $40, before Extra Help
Prescription drugs
Included

This plan in 2026

Plan information

Contract / Plan / Segment
H3362-020-000
Medical deductible
$0 — no deductible
Part D premium
$40/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$0/yr
Also owed
Your Medicare Part B premium, paid separately

More INDEPENDENT HEALTH ASSOCIATION, INC. plans in NY

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$400/day for days 1–3, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$400/day for days 1–3, $0 after
Worldwide Urgent Care CoverageNo charge

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Other Part B DrugsNo charge
Chemotherapy & Radiation Drugs (Part B)No charge

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Mental Health — Group SessionsNo charge
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Worldwide Emergency Transportation$30 copay + 20% coinsurance
Partial Hospitalization ProgramNo charge
Skilled Nursing Facility (SNF)No charge
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional SessionsNo charge
Intensive Cardiac Rehabilitation — Additional SessionsNo charge
Pulmonary Rehabilitation — Additional SessionsNo charge
Supervised Exercise Therapy (SET)No charge
Emergency Services$60
Urgently Needed ServicesNo charge
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$60
Intensive Outpatient Program (IOP)No charge
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic ServicesNo charge
Chiropractic — Other ServicesNo charge
Occupational Therapy ServicesNo charge
Physician Specialist ServicesNo charge
Podiatry ServicesNo charge
Other Health Care Professional ServicesNo charge
Psychiatric ServicesSee plan details
Psychiatric Services — Individual SessionsNo charge
Psychiatric Services — Group SessionsNo charge
Physical Therapy & Speech-Language PathologyNo charge
Ambulance ServicesSee plan details
Additional Telehealth Services (Part B)No charge
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & TestsNo charge
Laboratory Services0%-20% coinsurance
Radiological ServicesSee plan details
Diagnostic Radiology$100
Therapeutic Radiology10% coinsurance
X-Ray Services10% coinsurance
Outpatient Hospital Services$400
Hospital Observation Services$400 per stay
Ambulatory Surgical Center (ASC)$300
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual SessionsNo charge
Substance Abuse — Group SessionsNo charge
Outpatient Blood ServicesNo charge
Ground Ambulance$30
Air Ambulance20% coinsurance
Non-Emergency Transportation — Health FacilityNo charge
Durable Medical Equipment (DME)No charge
Prosthetics & OrthoticsSee plan details
Prosthetic Devices10% coinsurance
Medical SuppliesNo charge
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic MonitorsNo charge
Dialysis ServicesNo charge
Over-the-Counter (OTC) ItemsNo charge
Medicare-Covered Preventive ServicesSee plan details
Health Education$0-$20
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)No charge
Dental — Medicare-Covered Services$0-$400
Vision — Eye ExamsNo charge
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Chiropractic ServicesSee plan details
Vision — Eyeglasses (Lenses & Frames)No charge
Hearing — ExamsNo charge
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing Aid$45
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge

Service area

  • NY: 8 counties

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