Health Alliance NW SignalAdvantage HMO (HMO)
H3471 - 006 - 0
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Health Alliance NW SignalAdvantage HMO (HMO) is a Medicare Advantage Plan by Health Alliance Northwest.
This page features plan details for 2024 Health Alliance NW SignalAdvantage HMO (HMO) H3471 – 006 – 0 available in Yakima County.
IMPORTANT: This page features the 2024 version of this plan. See the 2025 version using the link below:
No 2025 version found. You can use the location links below to find 2025 plans in your area.
Locations
Health Alliance NW SignalAdvantage HMO (HMO) is offered in the following locations.
Plan Overview
Health Alliance NW SignalAdvantage HMO (HMO) offers the following coverage and cost-sharing.
| Insurer: | Health Alliance Northwest |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,900 In-network |
| Drugs Covered: | No |
Ready to sign up for Health Alliance NW SignalAdvantage HMO (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Premium Breakdown
Health Alliance NW SignalAdvantage HMO (HMO) has a monthly premium of $20.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $20.00 | $0.00 | $ |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Health Alliance NW SignalAdvantage HMO (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $4,900 In-network |
| No |
| In-network | No |
| $425 copay per visit (Authorization is required.) (Referral is not required.) |
| Primary | $5 copay per visit (Not applicable.) (Not applicable.) |
| Specialist | $40 copay per visit (Authorization is not required.) (Referral is not required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $10 copay (Authorization is required.) (Referral is not required.) |
| Lab services | $0-10 copay (Authorization is required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | $275 copay or 20% coinsurance (Authorization is required.) (Referral is not required.) |
| Outpatient x-rays | $20 copay (Authorization is required.) (Referral is not required.) |
| Hearing exam | $40 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Restorative services | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Endodontics | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Periodontics | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Extractions | 20% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | 20-50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| 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.) |
| Contact lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglasses (frames and lenses) | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass frames | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Eyeglass lenses | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
| Occupational therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| Physical therapy and speech and language therapy visit | $30 copay (Authorization is required.) (Referral is not required.) |
| $325 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| Foot exams and treatment | $35 copay (Authorization is not required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | 0-20% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
| $325 per day for days 1 through 6 $0 per day for days 7 through 90 (Authorization is required.) (Referral is not required.) |
| Inpatient hospital – psychiatric | $310 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient group therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| Outpatient individual therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| $0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Ready to sign up for Health Alliance NW SignalAdvantage HMO (HMO) ?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
M-F: 8:00 am – 10:00 pm EST
Sat-Sun: 8:00 am – 9:00 pm EST
Table of Contents
Need more information on Health Alliance NW SignalAdvantage HMO (HMO)? See 2025 Health Alliance NW SignalAdvantage HMO (HMO) at MedicareAdvantageRX.com.
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