2018 Health Alliance Medicare HMO 40 (HMO) H1463-011 By Health Alliance Medicare

2018 Medicare Advantage Health Alliance Medicare HMO 40 (HMO)

Health Alliance Medicare HMO 40 (HMO) H1463-011 is a 2018 Medicare Advantage or Medicare Part-C plan by Health Alliance Medicare available to residents in Illinois Indiana. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Health Alliance Medicare HMO 40 (HMO) has a monthly premium of $39.00 and has a in-network Maximum Out-of-Pocket limit of $4,700 (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 $4,700 this can be a very nice safety net.

Health Alliance Medicare HMO 40 (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 (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and 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.


2018 Health Alliance Medicare Medicare Advantage Plan Details

Health Alliance Medicare HMO 40 (HMO)
Provider:Health Alliance Medicare
Type: Local HMO *
Monthly Premium C+D: $39.00
MOOP: $4,700

Plan Services

Health plan deductible


Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures $10
Lab services $10
Diagnostic radiology services (e.g., MRI) $150
Outpatient x-rays $10


Hearing exam $25
Fitting/evaluation Not covered
Hearing aids $699-999

Preventive dental

Oral exam $20
Cleaning $0 copay
Fluoride treatment Not covered
Dental x-ray(s) Not covered

Comprehensive dental

Non-routine services $0 copay
Diagnostic services $0 copay
Restorative services $0 copay
Endodontics $0 copay
Periodontics $0 copay
Extractions $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay


Routine eye exam Not covered
Other Not covered
Contact lenses Not covered
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered

Mental health services

$225 for days 1 through 7
$0 for days 8 through 60
$75 for days 61 through 90
Outpatient group therapy visit with a psychiatrist $30
Outpatient individual therapy visit with a psychiatrist $30
Outpatient group therapy visit $30
Outpatient individual therapy visit $30

Skilled Nursing Facility

$0 for days 1 through 20
$167.50 for days 21 through 100

Rehabilitation services

Occupational therapy visit $40
Physical therapy and speech and language therapy visit $40




Not covered

Other health plan deductibles?

In-Network No

Foot care (podiatry services)

Foot exams and treatment $45
Routine foot care Not covered

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen) 20% per item
Prosthetics (e.g., braces, artificial limbs) 20% per item
Diabetes supplies 0-20% per item

Wellness programs (e.g., fitness, nursing hotline)


Medicare Part B drugs

Chemotherapy 20%
Other Part B drugs 20%

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$4,700 In-network

Optional supplemental benefits


Inpatient hospital coverage

$225 for days 1 through 7
$0 for days 8 through 60
$75 for days 61 through 90

Outpatient hospital coverage

$200 per visit

Doctor visits

Primary $10 per visit
Specialist $45 per visit

Preventive care

$0 copay

Emergency care/Urgent care

Emergency $80 per visit (always covered)
Urgent care $40 per visit (always covered)

Ratings for Health Alliance Medicare HMO 40 (HMO) H1463

2018 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 (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 (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 Cancer 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
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 (HMO) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language

Coverage Area for Health Alliance Medicare HMO 40 (HMO)

(Click county to compare all available plans)

Source: CMS.

Data as of September 5, 2017

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change as contracts are finalized. For 2018, 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 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Call For A licensed Sales Agent

Or Enroll Online Here

Call to Enroll!