Pay Bill2025 Encompass 65® Core 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
$73
PRIMARY/SPECIALTY COPAY (In-Network)
$0/$30
INPATIENT HOSPITAL COPAY (In-Network)
Days 1-6: $275 per day. Additional days: $0. Unlimited Days for Medicare covered stays. ($1,650 Annual Member Copay Maximum).
PART D PRESCRIPTION BENEFIT
$350 deductible on tiers 3, 4 & 5 only. $0/$15/$42/50%/28% to out-of-pocket maximum of $2,000.