2017 Medicare Advantage Health Alliance Medicare HMO 40 Rx (HMO)
Health Alliance Medicare HMO 40 Rx (HMO) H1463-010 is a 2017 Medicare Advantage or Medicare Part-C plan by Health Alliance Medicare available to residents in Illinois Indiana. This plan includes additional Medicare prescription drug (Part-D) coverage. The Health Alliance Medicare HMO 40 Rx (HMO) has a monthly premium of $74.00 and has a in-network Maximum Out-of-Pocket limit of $4,200 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $4,200 this can be a very nice safety net.
Health Alliance Medicare HMO 40 Rx (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.
Health Alliance Medicare works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Health Alliance Medicare HMO 40 Rx (HMO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Health Alliance Medicare and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from Health Alliance Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2017 Health Alliance Medicare Medicare Advantage Plan Details
| Name: | Health Alliance Medicare HMO 40 Rx (HMO) |
|---|---|
| ID: | H1463-010 |
| Provider: | Health Alliance Medicare |
| Year: | 2017 |
| Type: | Local HMO |
| Monthly Premium C+D: | $74.00 |
| MOOP: | $4,200 |
Ratings for Health Alliance Medicare HMO 40 Rx (HMO) H1463
| 2017 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Part D Summary Rating | ||
| Staying Healthy: Screenings, Tests, Vaccines | ||
| Managing Chronic (Long Term) Conditions | ||
| Member Experience with Health Plan | ||
| Complaints and Changes in Plans Performance | ||
| Health Plan Customer Service | ||
| Drug Plan Customer Service | ||
| Complaints and Changes in the Drug Plan | ||
| Member Experience with the Drug Plan | ||
| Drug Safety and Accuracy of Drug Pricing |
Member Experience with Health Plan
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints and Changes in Health Alliance Medicare HMO 40 Rx (HMO) Plans Performance
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Beneficiary Access | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Health Alliance Medicare HMO 40 Rx (HMO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
| Total Rating | ||
|---|---|---|
| SNP Care Management | ||
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Member Experience with the Drug Plan
| Total Rating | ||
|---|---|---|
| Rating of Drug Plan | ||
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating | ||
|---|---|---|
| MPF Price Accuracy | ||
| High Risk Medication | ||
| Drug Adherence for Diabetes Medications | ||
| Drug Adherence for Hypertension (RAS antagonists) | ||
| Drug Adherence for Cholesterol (Statins) | ||
| MTM Program Completion Rate for CMR |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about the Drug Plan | ||
| Members Choosing to Leave the Plan | ||
| Beneficiary Access | ||
| Drug Plan Quality Improvement |
Health Alliance Medicare HMO 40 Rx (HMO) Drug Plan Customer Service ratings
| Total Rating | ||
|---|---|---|
| Appeals Auto Forward | ||
| Appeals Upheld | ||
| Call Center, TTY, Foreign Language |
Part-C Premium
Health Alliance Medicare plan charges a $26.80 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
Health Alliance Medicare HMO 40 Rx (HMO) has a monthly drug premium of $47.20 and a $400.00 drug deductible. This Health Alliance Medicare plan offers a $47.20 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Health Alliance Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $47.20. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Premium Assistance
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Health Alliance Medicare HMO 40 Rx (HMO) medicare insurance offers a $18.50 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $25.70 for 75% low income subsidy $32.90 for 50% and $40.00 for 25%.
| Part C Premium: | $26.80 |
|---|---|
| Part D (Drug) Premium: | $47.20 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $47.20 |
| Drug Deductible: | $400.00 |
| Tiers with No Deductible: | 1 |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Full LIS Premium: | $18.50 |
| 75% LIS Premium: | $25.70 |
| 50% LIS Premium: | $32.90 |
| 25% LIS Premium: | $40.00 |
| Initial Coverage Limit: | $3700 |
| Gap Coverage: | No |
Gap Coverage
In 2017 once you and your plan provider have spent $3700 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 40% for brand-name drugs and 51% on generic drugs unless your plan offers additional coverage. This Health Alliance Medicare plan does not offer additional coverage through the gap.
Coverage Area for Health Alliance Medicare HMO 40 Rx (HMO)
(Click county to compare all available Advantage plans)
Source: CMS.
Data as of September 6, 2016.
Star Rating as of September 26, 2016.
For More Information on Ratings Please See the CMS Tech Notes Here.
Notes: Data are subject to change as contracts are finalized. For 2017, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit
Includes 2017 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
