Health Alliance Medicare POS 30 Rx (HMO-POS)

4 out of 5 stars* for plan year 2023
$105.00 Monthly Premium

Health Alliance Medicare POS 30 Rx (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by The Carle Foundation

Plan ID: H1463-017-000

$105.00 Monthly Premium

Illinois, Indiana and Iowa Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Illinois, Indiana and Iowa Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$105.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$5,500.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit
POS (Out-of-Network):

Doctor Office Visit:
Copayment for Medicare Covered Primary Care Office Visit $50.00
Specialty doctor visitIn-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $45.00
Inpatient hospital care
Out-of-Network:
$375.00 per day for days 1 to 8
$0.00 per day for days 9 to 60
$200.00 per day for days 61 to 90
Urgent care
Urgent Care:
Copayment for Urgent Care $40.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $40.00
Emergency room visit
Emergency Care:
Copayment for Emergency Care $110.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $110.00
Copayment for Worldwide Emergency Transportation $275.00
Ambulance transportationIn-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $275.00

Air Ambulance:
Copayment for Air Ambulance Services $275.00

Please see Evidence of Coverage for Prior Authorization rules

Health Care Services and Medical Supplies

Health Alliance Medicare POS 30 Rx (HMO-POS) covers a range of additional benefits. Learn more about Health Alliance Medicare POS 30 Rx (HMO-POS) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic services
POS (Out-of-Network):

Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $50.00
Diabetes supplies, training, nutrition therapy and monitoring
POS (Out-of-Network):

Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies and Services 20%
Durable medical equipment (DME)
POS (Out-of-Network):

Durable Medical Equipment:
Coinsurance for Medicare Covered Durable Medical Equipment 20%
Diagnostic tests, lab and radiology services, and X-raysIn-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $40.00
Copayment for Medicare-covered Lab Services $0.00 to $40.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $40.00
Copayment for Medicare-covered Therapeutic Radiological Services $40.00
Copayment for Medicare-covered X-Ray Services $40.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Home health careIn-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0.00
Mental health inpatient care
Out-of-Network:
$275.00 per day for days 1 to 8
$0.00 per day for days 9 to 60
$150.00 per day for days 61 to 90
Mental health outpatient careIn-Network:

Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $40.00
Copayment for Medicare-covered Group Sessions $40.00
Outpatient services/surgery
POS (Out-of-Network):

Outpatient Hospital and ASC Services:
Copayment for Medicare Covered Outpatient Hospital Services $375.00
Copayment for Medicare Covered Ambulatory Surgical Center Services $375.00
Outpatient substance abuse care
POS (Out-of-Network):

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual or Group Sessions $50.00
Over-the-counter itemsIn-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $96.00 every month
Podiatry services
POS (Out-of-Network):

Podiatry Services:
Copayment for Medicare Covered Podiatry Services $50.00
Skilled Nursing Facility (SNF) care
Out-of-Network:
$200.00 per day for days 1 to 20
$400.00 per day for days 21 to 100

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental care
POS (Out-of-Network):

Medicare Covered Dental Services:
Copayment for Medicare Covered Comprehensive Dental $20.00
Non-Medicare Covered Dental Services:
Coinsurance for Non-Medicare Covered Preventive Dental 0% to 40%
Coinsurance for Non-Medicare Covered Comprehensive Dental 0% to 40%
Maximum Plan Benefit of $2000.00 every year

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefits
POS (Out-of-Network):

Medicare Covered Vision Services:
Copayment for Medicare Covered Eye Exams $50.00
Copayment for Medicare Covered Eyewear $40.00
Non-Medicare Covered Vision Services:
Copayment for Non-Medicare Covered Eyewear $0.00
Maximum Plan Benefit of $150.00 every year

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefitsIn-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $25.00
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00

Hearing Aids:
Copayment for Hearing Aids $699.00 to $999.00
  • Maximum 2 Hearing Aids every year
Up to two TruHearing-branded hearing aids every year (one per ear per year). Benefit is limited to TruHearing's Advanced and Premium hearing aids, which come in various styles and colors and are available in rechargeable style options (for an additional $50 per aid). You must see a TruHearing provider to use this benefit.

*Routine hearing exam cost and hearing aid copayments are not subject to the out-of-pocket maximum.

Hearing aid purchase includes:
- First year of follow-up provider visits
- 60 day trial period
- 3 year extended warranty
- 80 batteries per aid for non-rechargeable models

Benefit does not include or cover any of the following:
- Additional cost for optional hearing aid rechargeability
- Ear molds
- Hearing aid accessories
- Additional provider visits
- Additional batteries, batteries when a rechargeable hearing aid is purchased
- Hearing aids that are not TruHearing-branded hearing aids
- Costs associated with loss and damage warranty claims

POS (Out-of-Network):

Medicare Covered Hearing Services:
Copayment for Medicare Covered Hearing Exams $40.00

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programsIn-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
Tobacco use cessation
Yearly "Wellness" visit

Any other preventive services approved by Medicare during the contract year will be covered

When reviewing Illinois, Indiana and Iowa Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Illinois, Indiana and Iowa that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Illinois Counties Served

Indiana Counties Served

Iowa Counties Served

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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