Health Alliance Medicare POS Basic (HMO-POS)

Medicare Plan Details

2021 Plan

Monthly Premium

(select county for price)

by Health Alliance Medicare

Additional Coverage

Hearing Vision Dental

Overall Government Star Rating

4.0

out of 5 stars

State: Illinois

Select your county to view the price for this plan

Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

Monthly Premium

$23

Health Portion of Premium

$23

Drug Portion of Premium

Health Plan Deductible

Health Plan Max Out-of-Pocket

$11,300 In and Out-of-network
$6,700 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.healthalliancemedicare.org

Plan Link

http://www.healthalliancemedicare.org

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $35 copay per visit
Out-of-network: $50 copay per visit

Specialist visit

In-network: $50 copay per visit
Out-of-network: $65 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $40 copay
Out-of-network: $50 copay

Lab services

In-network: $0-40 copay
Out-of-network: $50 copay

Diagnostic radiology services (like MRI)

In-network: $40 copay
Out-of-network: $50 copay

Outpatient x-rays

In-network: $40 copay
Out-of-network: $50 copay

Emergency care

$90 copay per visit (always covered)

Urgent care

$65 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $450 per day for days 1 through 4
$0 per day for days 5 through 90
Out-of-network: $600 per day for days 1 through 6
$0 per day for days 7 through 90

Outpatient hospital coverage

In-network: 25% coinsurance per visit
Out-of-network: 25% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: $100 per day for days 1 through 20
$200 per day for days 21 through 100

Preventive services

In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance

In-network: $350 copay
Out-of-network: No Data

Therapy services

Occupational therapy visit

In-network: $40 copay
Out-of-network: $50 copay

Physical therapy & speech & language therapy visit

In-network: $40 copay
Out-of-network: $50 copay

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $40 copay
Out-of-network: $50 copay

Outpatient individual therapy with a psychiatrist

In-network: $40 copay
Out-of-network: $50 copay

Outpatient group therapy visit

In-network: $40 copay
Out-of-network: $50 copay

Outpatient individual therapy visit

In-network: $40 copay
Out-of-network: $50 copay

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 0-20% coinsurance per item
Out-of-network: 20% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item

Diabetes supplies

In-network: $0 copay
Out-of-network: 20% coinsurance per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Extra Benefits

Hearing

Hearing exam

In-network: $25 copay
Out-of-network: $40 copay

Fitting/evaluation

In-network: $0 copay
Out-of-network: No Data

Hearing aids - All types

In-network: $699-999 copay
Out-of-network: No Data

Preventive Dental

Oral exam

In-network: $0 copay
Out-of-network: $0 copay

Cleaning

In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment

In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays

In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Non-routine services

In-network: $0 copay
Out-of-network: $0 copay

Diagnostic services

In-network: $0 copay
Out-of-network: $0 copay

Restorative services

In-network: $0 copay
Out-of-network: $0 copay

Endodontics

In-network: $0 copay
Out-of-network: $0 copay

Periodontics

In-network: $0 copay
Out-of-network: $0 copay

Extractions

In-network: $0 copay
Out-of-network: $0 copay

Prosthodontics, other oral/maxillofacial surgery, other services

In-network: $0 copay
Out-of-network: $0 copay

Vision

Routine eye exam

In-network: $0 copay
Out-of-network: No Data

Contact lenses

Not covered

Eyeglasses (frames & lenses)

Not covered

Eyeglass frames (only)

Not covered

Eyeglass lenses (only)

Not covered

Upgrades

Not covered

Other benefits

Fitness benefit

Limited coverage

Over the counter drug benefits

Not covered

In-home support services

Not covered

Home and bathroom safety devices

Not covered

Meals for short duration

Limited coverage

Annual physical exams

Limited coverage

Telehealth

Limited coverage

Summary rating of health plan quality

Staying healthy: screenings, tests, & vaccines

Managing chronic (long term) conditions

Member experience with health plan

Member complaints & changes in the health plan's performance

Health plan customer service

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