2018 Health Alliance Medicare POS 30 (HMO-POS) H1463-016 By Health Alliance Medicare

2018 Medicare Advantage Health Alliance Medicare POS 30 (HMO-POS)

Health Alliance Medicare POS 30 (HMO-POS) H1463-016 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 POS 30 (HMO-POS) has a monthly premium of $59.00 and has a in-network Maximum Out-of-Pocket limit of $5,500 (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 $5,500 this can be a very nice safety net.

Health Alliance Medicare POS 30 (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 30 (HMO-POS) 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.



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2018 Health Alliance Medicare Medicare Advantage Plan Details

Name:
Health Alliance Medicare POS 30 (HMO-POS)
ID:
H1463-016
Provider:Health Alliance Medicare
Year:2018
Type: Local HMO *
Monthly Premium C+D: $59.00
MOOP: $5,500




Plan Services






Health plan deductible


$0



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $40
Diagnostic tests and procedures Out-of-Network $50
Lab services In-Network $40
Lab services Out-of-Network $50
Diagnostic radiology services (e.g., MRI) In-Network $40
Diagnostic radiology services (e.g., MRI) Out-of-Network $50
Outpatient x-rays In-Network $40
Outpatient x-rays Out-of-Network $50



Hearing


Hearing exam In-Network $25
Hearing exam Out-of-Network $40
Fitting/evaluation Not covered
Hearing aids In-Network $699-999



Preventive dental


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



Comprehensive dental


Non-routine services In-Network $0 copay
Non-routine services Out-of-Network $25
Diagnostic services In-Network $0 copay
Diagnostic services Out-of-Network $25
Restorative services In-Network $0 copay
Restorative services Out-of-Network $25
Endodontics In-Network $0 copay
Endodontics Out-of-Network $25
Periodontics In-Network $0 copay
Periodontics Out-of-Network $25
Extractions In-Network $0 copay
Extractions Out-of-Network $25
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network $25



Vision


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


In-Network $245 for days 1 through 6
$0 for days 7 through 90
Out-of-Network $235 for days 1 through 8
$0 for days 9 through 60
$150 for days 61 through 90
Outpatient group therapy visit with a psychiatrist In-Network $40
Outpatient group therapy visit with a psychiatrist Out-of-Network $50
Outpatient individual therapy visit with a psychiatrist In-Network $40
Outpatient individual therapy visit with a psychiatrist Out-of-Network $50
Outpatient group therapy visit In-Network $40
Outpatient group therapy visit Out-of-Network $50
Outpatient individual therapy visit In-Network $40
Outpatient individual therapy visit Out-of-Network $50



Skilled Nursing Facility


In-Network $0 for days 1 through 20
$167.50 for days 21 through 100
Out-of-Network $200 for days 1 through 20
$400 for days 21 through 100



Rehabilitation services


Occupational therapy visit In-Network $20
Occupational therapy visit Out-of-Network $50
Physical therapy and speech and language therapy visit In-Network $20
Physical therapy and speech and language therapy visit Out-of-Network $50



Ambulance


In-Network $225
Out-of-Network $225



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment In-Network $45
Foot exams and treatment Out-of-Network $50
Routine foot care Not covered



Medical equipment/supplies


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



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


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 20%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 20%



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


$10,000 In and Out-of-network
$5,500 In-network



Optional supplemental benefits


No



Inpatient hospital coverage


In-Network $290 for days 1 through 6
$0 for days 7 through 90
Out-of-Network $320 for days 1 through 8
$0 for days 9 through 60
$200 for days 61 through 90



Outpatient hospital coverage


In-Network $275 per visit
Out-of-Network $300 per visit



Doctor visits


Primary In-Network $15 per visit
Primary Out-of-Network $50 per visit
Specialist In-Network $45 per visit
Specialist Out-of-Network $50 per visit



Preventive care


In-Network $0 copay
Out-of-Network $50



Emergency care/Urgent care


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






Ratings for Health Alliance Medicare POS 30 (HMO-POS) 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 POS 30 (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 30 (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 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 POS 30 (HMO-POS) Drug Plan Customer Service ratings

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


Coverage Area for Health Alliance Medicare POS 30 (HMO-POS)

(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.

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