2017 Health Alliance Medicare POS 10 Rx (HMO-POS) H1463-019 By Health Alliance Medicare

2017 Medicare Advantage Health Alliance Medicare POS 10 Rx (HMO-POS)

Health Alliance Medicare POS 10 Rx (HMO-POS) H1463-019 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 POS 10 Rx (HMO-POS) has a monthly premium of $158.00 and has a in-network Maximum Out-of-Pocket limit of $4,000 (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 $4,000 this can be a very nice safety net.

Health Alliance Medicare POS 10 Rx (HMO-POS) 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 POS 10 Rx (HMO-POS) 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

Health Alliance Medicare POS 10 Rx (HMO-POS)
Provider:Health Alliance Medicare
Type: Local HMO
Monthly Premium C+D: $158.00
MOOP: $4,000

Ratings for Health Alliance Medicare POS 10 Rx (HMO-POS) 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 POS 10 Rx (HMO-POS) 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 POS 10 Rx (HMO-POS)

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 POS 10 Rx (HMO-POS) 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 $100.70 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 POS 10 Rx (HMO-POS) has a monthly drug premium of $57.30 and a $400.00 drug deductible. This Health Alliance Medicare plan offers a $57.30 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 $57.30. 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 POS 10 Rx (HMO-POS) medicare insurance offers a $26.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $34.50 for 75% low income subsidy $42.10 for 50% and $49.70 for 25%.

Part C Premium: $100.70
Part D (Drug) Premium: $57.30
Part D Supplemental Premium $0.00
Total Part D Premium: $57.30
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: $26.90
75% LIS Premium: $34.50
50% LIS Premium: $42.10
25% LIS Premium: $49.70
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 POS 10 Rx (HMO-POS)

(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.

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