2022 Health Alliance Medicare POS Basic (HMO-POS)

Health Alliance Medicare POS Basic (HMO-POS) H1463-014 is a 2022 Medicare Advantage Plan or Part-C by Health Alliance Medicare available to residents in Illinois and Indiana. This plan does not provide additional prescription drug (Part-D) coverage. The Health Alliance Medicare POS Basic (HMO-POS) has a monthly premium of $23.00 and has an in-network maximum out-of-pocket limit of $6,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,700 out-of-pocket. This can be a extremely nice safety net.

Health Alliance Medicare POS Basic (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 require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

Health Alliance Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Health Alliance Medicare POS Basic (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 you are always covered for urgently needed and emergency care. Plus you receive all 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 Medicare Advantage.

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2022 Health Alliance Medicare Medicare Advantage Plan Costs

2021 Health Alliance Medicare POS Basic (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

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

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$50 copay (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$40 copay
Diagnostic tests and procedures	$40 copay
Diagnostic tests and procedures	$50 copay (Out-of-Network)
Lab services	$0-40 copay
Lab services	$50 copay (Out-of-Network)
Outpatient x-rays	$50 copay (Out-of-Network)
Outpatient x-rays	$40 copay

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Doctor Visits

Primary	$35 copay per visit
Primary	$50 copay per visit (Out-of-Network)
Specialist	$65 copay per visit (Out-of-Network)
Specialist	$50 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$65 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$50 copay
Foot exams and treatment	$50 copay (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$350 copay

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Hearing

Fitting/evaluation	$0 copay
Hearing aids	$699-999 copay
Hearing exam	$25 copay
Hearing exam	$40 copay (Out-of-Network)

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Inpatient Hospital Coverage

$600 per day for days 1 through 6 $0 per day for days 7 through 90 (Out-of-Network)
$450 per day for days 1 through 4 $0 per day for days 5 through 90

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Medical Equipment/Supplies

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

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	20% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	20% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$395 per day for days 1 through 4 $0 per day for days 5 through 90
Inpatient hospital - psychiatric	$470 per day for days 1 through 4 $0 per day for days 5 through 90 (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$50 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	$50 copay (Out-of-Network)
Outpatient individual therapy visit	$50 copay (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$50 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

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

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

25% coinsurance per visit (Out-of-Network)
25% coinsurance per visit

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Oral exam	$0 copay (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	$50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay

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Skilled Nursing Facility

$100 per day for days 1 through 20 $200 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $178 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Health Alliance Medicare POS Basic (HMO-POS) H1463

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Health Alliance Medicare POS Basic (HMO-POS) Plans Performance

Health Plan Customer Service Rating for Health Alliance Medicare POS Basic (HMO-POS)

Health Alliance Medicare POS Basic (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

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1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

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

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.