Health Alliance Medicare POS 10 Rx (HMO-POS) is a Medicare Advantage (Part C) Plan by Health Alliance Medicare.
This page features plan details for 2024 Health Alliance Medicare POS 10 Rx (HMO-POS) H1463 – 019 – 0 available in North Central, Central, Southern, & Quad Cities IL.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Health Alliance Medicare POS 10 Rx (HMO-POS) is offered in the following locations.
Health Alliance Medicare POS 10 Rx (HMO-POS) offers the following coverage and cost-sharing.
Insurer: | Health Alliance Medicare |
Health Plan Deductible: | $0.00 |
MOOP: | $5,750 In and Out-of-network $2,900 In-network |
Drugs Covered: | Yes |
Ready to sign up for Health Alliance Medicare POS 10 Rx (HMO-POS) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$174.70 | $127.80 | $37.20 | $0.00 | $339.70 |
Health Alliance Medicare POS 10 Rx (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $0.00 |
Initial Coverage Limit: | $5,030.00 |
Catastrophic Coverage Limit: | $8,000.00 |
Drug Benefit Type: | Enhanced Alternative |
Additional Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
Part D | LIS Full |
---|---|
$37.20 | $ |
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $2.00 copay | $2.00 copay | ||
2 (Generic) | $15.00 copay | $15.00 copay | ||
3 (Preferred Brand) | $47.00 copay | $47.00 copay | ||
4 (Non-Preferred Drug) | 50% | 50% | ||
5 (Specialty Tier) | 33% | 33% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $6.00 copay | $4.00 copay | ||
2 (Generic) | $45.00 copay | $30.00 copay | ||
3 (Preferred Brand) | $141.00 copay | $94.00 copay | ||
4 (Non-Preferred Drug) | 50% | 50% | ||
5 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $2.00 copay | $2.00 copay | ||
Generic drugs | ||||
Brand-name drugs |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $6.00 copay | $4.00 copay | ||
Generic drugs | ||||
Brand-name drugs |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Health Alliance Medicare POS 10 Rx (HMO-POS) also provides the following benefits.
$0 |
In-network | No |
$5,750 In and Out-of-network $2,900 In-network |
No |
In-network | No |
In-network | $300 copay per visit (Authorization is required.) (Referral is not required.) |
out-of-network | $350 copay per visit (Authorization is required.) (Referral is not required.) |
In-network Primary | $20 copay per visit (Not applicable.) (Not applicable.) |
out-of-network Primary | $40 copay per visit (Not applicable.) (Not applicable.) |
In-network Specialist | $30 copay per visit (Authorization is not required.) (Referral is not required.) |
out-of-network Specialist | $40 copay per visit (Authorization is not required.) (Referral is not required.) |
In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
out-of-network | $30 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $30 copay per visit (always covered) (Not applicable.) (Not applicable.) |
In-network Diagnostic tests and procedures | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic tests and procedures | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Lab services | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Diagnostic radiology services (e.g., MRI) | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Outpatient x-rays | $0 copay (Authorization is required.) (Referral is not required.) |
out-of-network Outpatient x-rays | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Hearing exam | $25 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Hearing exam | $40 copay (Authorization is not required.) (Referral is not required.) |
In-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
In-network Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Oral exam | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Cleaning | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Fluoride treatment | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Dental x-ray(s) | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Non-routine services | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Non-routine services | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Diagnostic services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Diagnostic services | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Restorative services | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Restorative services | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Endodontics | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Endodontics | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Periodontics | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Periodontics | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Extractions | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Extractions | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Prosthodontics, other oral/maxillofacial surgery, other services | 20-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | 0-40% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
out-of-network Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
In-network Occupational therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
out-of-network Occupational therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
In-network Physical therapy and speech and language therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
out-of-network Physical therapy and speech and language therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
In-network | $275 copay (Not applicable.) (Not applicable.) |
out-of-network | $275 copay (Not applicable.) (Not applicable.) |
Not covered (Not applicable.) (Not applicable.) |
In-network Foot exams and treatment | $30 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Foot exams and treatment | $40 copay (Authorization is not required.) (Referral is not required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
out-of-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
In-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
out-of-network Diabetes supplies | 20% coinsurance per item (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
In-network Chemotherapy | 0-15% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Chemotherapy | 25% coinsurance (Authorization is required.) (Not applicable.) |
In-network Other Part B drugs | 0-15% coinsurance (Authorization is required.) (Not applicable.) |
out-of-network Other Part B drugs | 25% coinsurance (Authorization is required.) (Not applicable.) |
In-network Part B Insulin drugs | 0-15% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
out-of-network Part B Insulin drugs | 25% coinsurance (Authorization is required.) (Not applicable.) |
In-network | $250 per day for days 1 through 7 $0 per day for days 8 through 90 (Authorization is required.) (Referral is not required.) |
out-of-network | 25% per stay (Authorization is required.) (Referral is not required.) |
In-network Inpatient hospital – psychiatric | $175 per day for days 1 through 9 $0 per day for days 10 through 90 (Authorization is required.) (Referral is not required.) |
out-of-network Inpatient hospital – psychiatric | 25% per stay (Authorization is required.) (Referral is not required.) |
In-network Outpatient group therapy visit with a psychiatrist | $30 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
In-network Outpatient individual therapy visit with a psychiatrist | $30 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
In-network Outpatient group therapy visit | $30 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Outpatient group therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
In-network Outpatient individual therapy visit | $30 copay (Authorization is not required.) (Referral is not required.) |
out-of-network Outpatient individual therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
In-network | $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
out-of-network | $85 per day for days 1 through 20 $225 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Ready to sign up for Health Alliance Medicare POS 10 Rx (HMO-POS) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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