Pay Bill2025 Encompass 65® Basic HMO
Plan Highlights
MONTHLY PREMIUM
PRIMARY/SPECIALTY COPAY (In-Network)
INPATIENT HOSPITAL COPAY (In-Network)
PART D PRESCRIPTION BENEFIT
(Tier 1 / 2 / 3 / 4 / 5)
MONTHLY PREMIUM
$134
PRIMARY/SPECIALTY COPAY (In-Network)
$0/$20
INPATIENT HOSPITAL COPAY (In-Network)
Days 1-6: $250 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,500 Annual Member Copay Maximum).
PART D PRESCRIPTION BENEFIT
$250 deductible on tiers 3, 4 and 5. $0/$13/$42/50%/30% to out-pocket limit of $2,000.