OSF MedAdvantage Enrich (HMO-POS) H1463-042 is a 2023 Medicare Advantage Plan or Part-C by Health Alliance Medicare available to residents in Illinois. This plan includes extra prescription drug (Part-D) coverage. Health Alliance Medicare OSF MedAdvantage Enrich (HMO-POS) has a monthly premium of $150.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be an extremely nice safety net.

Health Alliance Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for OSF MedAdvantage Enrich (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Health Alliance Medicare and not Original Medicare. With 2023 Medicare Advantage Plan 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 if you sign up for Medicare Advantage in Illinois.

2023 Health Alliance Medicare Medicare Advantage Plan Overview

What type of plan is OSF MedAdvantage Enrich (HMO-POS)

OSF MedAdvantage Enrich (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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does OSF MedAdvantage Enrich (HMO-POS) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Health Alliance Medicare charges a $150.00 consolidated premium. The Part C premium is $111.50 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. OSF MedAdvantage Enrich (HMO-POS) has a monthly drug premium of $38.50 and a $175.00 drug deductible. This Health Alliance Medicare plan offers a $38.50 Part-D Basic Premium that is Not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0. This Premium covers any enhanced plan benefits offered by Health Alliance Medicare above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $38.50. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Health Alliance Medicare Gap Coverage

In 2023 once you and your plan provider have spent $4660 on covered drugs. (Combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers extra coverage. This Health Alliance Medicare plan does offer extra coverage through the gap.

Extra Help Premium Assistance

The Low Income Subsidy (LIS) Extra Helps people with Medicare pay for prescription drugs and lowers the costs of Medicare prescription drug coverage. Income limits are based on the Federal Poverty Level (FPL), which changes every year in February or March. The 2022 income limit is $1,719 ($2,309 for couples) per month. Depending on your income level you may be eligible for a full 75%, 50%, 25% premium assistance. The OSF MedAdvantage Enrich (HMO-POS) medicare insurance offers a $11.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $18.00 for 75% low-income subsidy $24.80 for 50% and $31.70 for 25%.

Formulary and Drug Coverage

OSF MedAdvantage Enrich (HMO-POS) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$2
Tier 2	NA	$15
Tier 3	NA	$47
Tier 4	NA	50%
Tier 5	NA	30%

The complete OSF MedAdvantage Enrich (HMO-POS) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what OSF MedAdvantage Enrich (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Health Alliance Medicare helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

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

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Contact lenses

Vision	Not covered

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

Vision	Not covered

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Upgrades

Vision	Not covered

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Transportation	Not covered
Out-of-Network Skilled Nursing Facility	$0 copay
In-Network Skilled Nursing Facility	$0 copay

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Occupational therapy visit

Out-of-Network Rehabilitation services	$0 copay
In-Network Rehabilitation services	$0 copay

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Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$0 copay
Out-of-Network Rehabilitation services	$0 copay

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Cleaning

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	0-40% coinsurance

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Dental x-ray(s)

Out-of-Network Preventive dental	0-40% coinsurance
In-Network Preventive dental	$0 copay

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Fluoride treatment

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	0-40% coinsurance

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Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	0-40% coinsurance

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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay
In-Network Outpatient hospital coverage	$0 copay
Out-of-Network Outpatient hospital coverage	$0 copay
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Outpatient group therapy visit

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Outpatient individual therapy visit

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$0 copay
Out-of-Network Mental health services	$0 copay

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Chemotherapy

Out-of-Network Medicare Part B drugs	$0 copay
In-Network Medicare Part B drugs	$0 copay

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Other Part B drugs

Out-of-Network Medicare Part B drugs	$0 copay
In-Network Medicare Part B drugs	$0 copay

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Diabetes supplies

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	$0 copay

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Durable medical equipment (e.g., wheelchairs, oxygen)

Out-of-Network Medical equipment/supplies	$0 copay
In-Network Medical equipment/supplies	$0 copay

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Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	$0 copay

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$0 In and Out-of-network $0 In-network
In-Network Inpatient hospital coverage	$0 copay
Out-of-Network Inpatient hospital coverage	$0 copay

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Fitting/evaluation

Hearing	Not covered

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Hearing aids - inner ear

Hearing	Not covered

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Hearing aids - outer ear

Hearing	Not covered

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Hearing aids - over the ear

Hearing	Not covered

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Hearing exam

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

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Health plan deductible	$0
In-Network Ground ambulance	$0 copay

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Foot exams and treatment

In-Network Foot care (podiatry services)	$0 copay
Out-of-Network Foot care (podiatry services)	$0 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$0 copay

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Urgent care

Emergency care/Urgent care	$0 copay

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Primary

Out-of-Network Doctor visits	$0 copay
In-Network Doctor visits	$0 copay

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Specialist

Out-of-Network Doctor visits	$0 copay
In-Network Doctor visits	$0 copay

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay

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Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay
In-Network Diagnostic procedures/lab services/imaging	$0 copay

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Outpatient x-rays

Out-of-Network Diagnostic procedures/lab services/imaging	$0 copay
In-Network Diagnostic procedures/lab services/imaging	$0 copay

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Diagnostic services

In-Network Comprehensive dental	20% coinsurance
Out-of-Network Comprehensive dental	0-40% coinsurance

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Endodontics

Out-of-Network Comprehensive dental	0-40% coinsurance
In-Network Comprehensive dental	20% coinsurance

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Extractions

In-Network Comprehensive dental	20% coinsurance
Out-of-Network Comprehensive dental	0-40% coinsurance

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Non-routine services

Out-of-Network Comprehensive dental	0-40% coinsurance
In-Network Comprehensive dental	20% coinsurance

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Periodontics

Out-of-Network Comprehensive dental	0-40% coinsurance
In-Network Comprehensive dental	20% coinsurance

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Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	20-40% coinsurance
Out-of-Network Comprehensive dental	0-40% coinsurance

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Restorative services

Out-of-Network Comprehensive dental	0-40% coinsurance
In-Network Comprehensive dental	20% coinsurance

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

OSF MedAdvantage Enrich (HMO-POS) Reviews

Is OSF MedAdvantage Enrich (HMO-POS) a good plan? OSF MedAdvantage Enrich (HMO-POS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare OSF MedAdvantage Enrich Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H1463-042 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Health Alliance Medicare

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

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for OSF MedAdvantage Enrich (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.