Health Alliance Medicare POS 30 Rx (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) with Prescription Drug (Part D)

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

 

$105
$57
$48
$0
$11,300 In and Out-of-network
$5,500 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $15 copay per visit
Out-of-network: $50 copay per visit
In-network: $45 copay per visit
Out-of-network: $50 copay per visit

Tests, labs, & imaging

In-network: $40 copay
Out-of-network: $50 copay
In-network: $0-40 copay
Out-of-network: $50 copay
In-network: $40 copay
Out-of-network: $50 copay
In-network: $40 copay
Out-of-network: $50 copay
$90 copay per visit (always covered)
$40 copay per visit (always covered)

Hospital Services

In-network: $350 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $375 per day for days 1 through 8
$0 per day for days 9 through 60
$200 per day for days 61 through 90
In-network: $325 copay per visit
Out-of-network: $375 copay 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: $200 per day for days 1 through 20
$400 per day for days 21 through 100

Preventive services

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

Ambulance

In-network: $275 copay
Out-of-network: No Data

Therapy services

In-network: $20 copay
Out-of-network: $50 copay
In-network: $20 copay
Out-of-network: $50 copay

Mental health services

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

Opioid treatment services

Covered

Other services

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$2.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic$15.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug50%
Specialty Tier33%

Part B Drugs

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

Extra Benefits

Hearing

In-network: $25 copay
Out-of-network: $40 copay
In-network: $0 copay
Out-of-network: No Data
In-network: $699-999 copay
Out-of-network: No Data

Preventive Dental

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

Comprehensive dental

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

Vision

In-network: $0 copay
Out-of-network: No Data
Not covered
Not covered
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 4
 4
 3
 5
 4
 4
 3.5
 4
 4
 4
 4

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