2021 Quad Cities Medicare Guidebook

Quad Cities

Medicare Made for You 2021 Medicare Advantage + Prescription Drug Coverage Guide

IA: Scott IL: M ercer, Henry, Rock Island, Whiteside

How to Enroll Online

Broker

Go to HealthAllianceMedicare.org to get started.

If you attend a seminar, the person presenting can schedule an appointment to help you enroll.

By Phone Call (877) 933-8454 (TTY 711), daily from 8 a.m. to 8 p.m. local time. Voicemail is used on holidays and weekends from April 1 to September 30.

By Mail Fill out and mail us the enrollment form in the back of this guide. You can also download it from HealthAllianceMedicare.org.

Mail to: Health Alliance Medicare Application Processing Center 3310 Fields South Dr. Champaign, IL 61822

If you enroll in a Medicare Advantage plan during the Annual Enrollment Period, your coverage will begin January 1, 2021. In the meantime, we’ll mail you your member materials and your member ID card, which you’ll use instead of your red, white and blue Medicare card at the doctor, hospital and pharmacy starting January 1.

Contents Welcome to Medicare Your Network Your Providers Your Pharmacy Coverage Stages of Pharmacy Coverage Your Team Your Travel Your Perks and Programs Your Health at Your Fingertips Your Protection: Appeals and Grievances Enrollment Your Plan HMO Plan Formulary

Welcome to Medicare made for you.

When you become a member, you get a health plan made with you in mind – access to doctors you trust, perks you deserve and local customer service reps always ready to help. And we strive to make these plans affordable for you. Use this guide to find the plan that’s made for you.

Your Options Guide HMO Rx 2 (HMO)

Your Network You should have access to the trusted healthcare you need, so as a provider-driven health plan, we partnered with doctors and hospitals in our communities to give you seamless Medicare Advantage plans close to home.

When your doctor and health plan are on the same team working toward the same goal, you get programs and benefits made for you and access to providers you trust every step of the way.

Your Providers Check out the list below to see some of our providers. Go to HealthAllianceMedicare.org for a full list.

Galesburg • Galesburg

Cottage Hospital HealthCare St. Mary Medical Center • OSF Medical Group • OSF

Quad Cities Health System – Genesis Medical Centers – Genesis Health Group • Genesis Medical Centers & Physicians • UnityPoint Clinics • UnityPoint Health - Trinity Medical Centers • Genesis

Iowa City • University

of Iowa Health Care (University of Iowa Hospitals and Clinics) • University of Iowa Physicians

We don’t require a referral, but your doctor might.

When your doctor directs you to another provider, it’s called a referral. We don’t require this, but your doctor might. Check with your doctor before you see a specialist or other provider to make sure you’ve taken

the proper steps. If we don’t have an in-network specialist to treat your specific condition, we’ll help you find one. And you’ll still pay the in-network cost if you get it preauthorized by us.

Your Pharmacy Coverage Plans with pharmacy coverage built right in help you keep all your coverage in one place and help you save with special programs and discounts made for you.

Pharmacy Basics Drug Formulary A formulary is the list of drugs we cover. You can find it at HealthAllianceMedicare.org or in the back of this guide. (Generally, we only cover drugs that are listed.)

Pharmacy Network You must use an in-network pharmacy to get covered drugs unless it’s an emergency. For a list of innetwork pharmacies, view our pharmacy directory at HealthAllianceMedicare.org, or request a copy using the card in the back of this guide.

Savings for Members without Part D Our Medicare Advantage members without Part D coverage get help paying for their prescription drug costs by showing their health plan ID card.

Late Enrollment Penalty If you don’t enroll in a prescription drug (Part D) plan when you’re first eligible, you may have to pay a penalty for enrolling later. That penalty will increase for every month you didn’t have prescription coverage.

You can’t be enrolled in a Medicare Advantage HMO plan and a stand-alone prescription drug plan (PDP) at the same time.

Benefits No Rx Deductible Unlike many other Medicare Advantage plans, our Part D plans have no pharmacy deductible.

$2 Tier 1 Generics Get Tier 1 generic drugs for $2 at any in-network pharmacy.

Drug Compare Tool See how much you’ll pay each month and how much you could save by switching to a pharmacy with lower prescription costs or by taking a lower-cost drug.

You can check costs at different pharmacies and see the differences in costs between retail (pickup) or mail order (delivery of a 90-day supply). You can also estimate your total annual drug costs.

90-Day Supply Options Limit your trips to the pharmacy with two convenient options. With our mail-order benefit, you are able to get a 90-day supply of your drugs delivered directly to you for two copays. If you prefer to get your drugs at a retail pharmacy, you are able to visit any in-network pharmacy and get a 90-day supply for three copays.

Medication Therapy Management If you take multiple medications, this program can help you use them safely and effectively.

Extra Help

You might be able to get help to pay for your prescription drug premiums and costs through the Extra Help program. To see if you qualify, call one of the following: • (800)

MEDICARE (800-633-4227), 24 hours a day, seven days a week (TTY 877-486-2048).

• The Social Security Administration at (800) 772-1213, 7 a.m. to 7 p.m., Monday through Friday (TTY 800-325-0778).

• The state’s Medicaid office.

Stages of Pharmacy Coverage There are three pharmacy coverage stages, but most people stay in the initial coverage stage.

Most people stay in this range $4,130 Few people reach this stage $6,550 Even fewer people reach this stage

Initial Coverage You pay the following until the amount you pay plus the amount we pay reaches $4,130: • Tier

1: $2.

2: $15.

• Tier 3: $47.

• Tier 4: 50%.

• Tier 5: 33%.

• Tier

Coverage Gap Also known as the “donut hole,” this stage begins when the amount you pay plus the amount we pay for your prescription drugs reaches $4,130.

Here, you pay the following until you reach $6,550:

Catastrophic Coverage This stage begins when your outof-pocket drug costs reach $6,550.

Here, we pay for most of your drug costs for the rest of the year, while you pay the greater of the following: • 5%

• 25% • 25%

for covered generic drugs. for covered brand-name drugs.

of the cost. or • $3.70 for covered generic drugs (including brand-name drugs treated as generic) and $9.20 for covered brand-name drugs.

Your Team Your plan is made for more than when you’re sick. It’s made to help you stay healthy in the first place, so you have a team of health coaches, care coordinators and more to help you with both.

Care Coordinators Whether you’d like to speak to a dietitian, want to quit smoking or need help understanding a recent diagnosis, we have teams to help you achieve your goals or get you back on track.

Connect to a team of providers, like nurse practitioners, social workers, health coaches, dietitians, pharmacists and more, who work with your doctor to make sure you have the resources you need to stay healthy or work through your medical issues.

The care coordination team reaches out to offer these services, but you can also request them if you’d like this personalized help.

Set and reach health and wellness goals.

Find helpful resources.

Understand and manage health issues, like diabetes and asthma.

Care for yourself to help prevent illness and hospital stays.

Coordinate your care when you have complicated health conditions.

Use your health benefits to save money.

Lora Felger Community Liaison Health Alliance

Your Community We like to get out and meet the entire community.

We’ll be at health fairs, senior expos and other events ready to educate and talk with you and others throughout the area. Led by our team of liaisons, we’re excited to get to know you.

Your Travel No matter where sickness or injury strikes – even if you’re traveling – you’re covered for emergency care, urgent care (also called convenient care or a walk-in clinic) or an ambulance at the in-network cost-share amount.

You’re also covered at the in-network cost-share if you’re admitted to a hospital through the emergency department.

• Take

With an HMO, out-of-network routine care won’t be covered, but some services, like physical therapy, might be covered if deemed medically necessary for you to be able to return home.

• Come

a tumble and need physical therapy in order to return home? You’re covered both in and out of network if deemed medically necessary.

down with a cold or flu? Urgent care (also called convenient care or a walk-in clinic) is covered at the innetwork level regardless of where you get your care.

• Need

How You’re Covered • Break your ankle while hiking? Your emergency care is covered both in and out of network, and so is any emergency surgery you need as a result.

• Need

routine physical therapy? With an HMO plan, you only have coverage when seeing an in-network provider.

a routine physical? With an HMO plan, you only have coverage when seeing an in-network provider.

If you have questions about other situations, give us a call.

Helpful Travel Reminders Your plan includes perks that can make your travel easier, like the 24-hour Anytime Nurse Line, virtual health coverage and Assist America global emergency services. Learn about these perks and more in the next section of this guide.

Your Perks and Programs Your plan is made with plenty of extras to help you with your health goals.

Anytime Nurse Line

Be Fit

Get 24/7 answers to your health questions, like whether you need to set up an appointment or see a doctor right away.

Get fit at the fitness center of your choice. You choose where you want to work out, and we pay you back up to $360 per year for gym membership or fitness class fees.

Assist America Have peace of mind whenever you travel 100 miles or more from home. With doctors, nurses and emergency medical technicians on staff, help is just a phone call away, 24 hours a day and 365 days a year.

Assist America can connect you to prompt medical attention and help make sure you’re admitted to reliable hospitals when needed. Plus, it can even help in some situations that aren’t health-related.

Here are just some of its many features: assistance if you need medication or left your prescription behind.

• Compassionate visit from someone close to you if you need to be hospitalized for more than a week.

• Return of mortal remains.

• Medical referrals.

• Emergency medical evacuation.

• Help returning home if you need medical care to travel.

• Lost luggage assistance.

• Interpreter and legal referrals.

• Prescription

All Assist America benefits apply on all of our Medicare Advantage plans, but when you’re out-of-network, our HMO plans cover only emergency and urgent care.

Assist America will not pay you back for ambulance and other services you arrange on your own. In a lifethreatening emergency, always call the ambulance right away. There is no added cost for the service itself, but there could still be a cost with any medical care.

Other conditions and exclusions may apply.

If your fees are more than $360 per year, you pay the difference. If they’re less, we pay you back the amount you paid. Be Fit doesn’t cover services that require additional fees, like personal trainers or personal equipment. It applies to only standard fitness class and gym membership fees at non-residential commercial or community facilities.

Dental Coverage We cover up to $325 a year for use on dental services.

You pay the dentist and then send us the receipt.

If your dentist submits the claim for you, you don’t need to send us the receipt. Some plans may have higher coverage.

Disease Management Programs Get help staying on track if you have asthma, diabetes or high blood pressure. We connect you to resources, support and reminders.

Hearing Benefit Through TruHearing®, you can get one routine hearing exam for a $45 copay and lowered rates on up to two TruHearing hearing aids per year when you see a TruHearing provider.

Over-the-Counter Coverage Get access to a quarterly over-the-counter (OTC) benefit and purchase up to $40 per quarter in OTC products from a catalog with hundreds of items to choose from.

Reminder: Get your yearly flu shot.

Help prevent getting or spreading the flu with your flu shot. The viruses that cause the flu can change yearly, so it’s important to get your shot every year.

You can get your shot for no extra cost at any in-network provider or pharmacy that offers it. You may have an office visit copay if you get it at the doctor’s office.

Preventive Care Focus on preventing sickness and catching problems before they get worse with these services and more: • Yearly

wellness visit. screenings, like mammograms or colorectal cancer screenings.

• Flu shot.

• Routine

Quit For Life® Get help ending your tobacco use with: • One-on-one

coaching from a quit coach. plan made just for you.

• Helpful tools, like Text2Quit.

• Web Coach®, an online learning and support community.

• Quit

Virtual Health Coverage Get care when and where you need it with virtual health coverage. If you need to interact with your primary care provider (PCP) or specialist over the phone or online, you’re covered through the telehealth benefit. You don’t even need to leave the comfort of your home.

You can also get care for common conditions like allergies, cold, flu and pink eye from anywhere you have phone or internet connection in the U.S. Whether at home or traveling, you can talk to a board certified

doctor or counselor by phone or secure video through the Hally™ app or hally.com at any time of the day, any day of the year.

Vision Get access to vision services beyond what Original Medicare covers, including a routine vision exam with an in-network provider.

Wellness Rewards Take steps toward better health while working your way toward a $50 gift card. Have a yearly wellness visit or physical, plus complete two other activities outlined at HealthAllianceMedicare.org/Perks to qualify for your $50 gift card.

Your Health at Your Fingertips Find helpful tools at hally.com.

Get access to plenty of resources to help you stay healthy with no login required at hally.com. You’ll find: • Classes

on exercise, cooking and caring for your conditions.

• Hallly™ Healthcast, a monthly podcast focused on health and wellness.

• Hally blog.

Access secure member information.

Get secure, instant access to your coverage anytime by logging in to the Hally app or on hally.com. Manage your health plan and get the care you need anytime, anywhere with: • All

your account activities in one place.

ID card access.

• Search functions.

• Quick access to virtual visits.

• Doctor match and cost estimates.

• Virtual

Visit the App Store or Google Play to download.

App Store is a service mark of Apple Inc., registered in the U.S. and other countries.

Google Play and the Google Play logo are trademarks of Google LLC.

Your Protection: Appeals and Grievances Medicare Advantage plans offer safeguards to make sure you’re treated fairly and have the chance to voice your opinion if you think you’ve been mistreated.

Appeal This is a type of complaint you can file if you disagree with the plan’s decision to not cover healthcare services you’re trying to get or have already gotten.

You must file an appeal in writing within 60 days of the decision or as soon as you can.

Grievance This is a type of complaint you can make about your plan. Some examples are poor quality of care, bad customer service or feeling like an employee is encouraging you to leave the plan.

You can file a grievance by calling our Member Services department within 60 days of the event or as soon as you can.

Enrollment Timelines and Requirements The Centers for Medicare & Medicaid Services (CMS) sets certain times during the year when you can enroll in a Medicare Advantage or prescription drug plan.

Timelines and Requirements Annual Enrollment Period From October 15 to December 7, you can enroll in Medicare Advantage or a stand-alone prescription drug plan, or you can switch plans. If you enroll during this period, your coverage begins January 1 of the following year.

Initial Enrollment Period You have a seven-month initial enrollment period to enroll in Original Medicare, Medicare Advantage or a prescription drug plan. It starts three months before the month you turn 65, includes the month of your 65th birthday and ends three months after the month you turn 65.

• If

you enroll one to three months before your 65th birthday, your coverage begins the first day of the month you turn 65.

• If you enroll during your birth month, your coverage begins the first day of the following month.

• If you enroll one to three months after the month you turn 65, your coverage begins the first day of the month after you enroll.

Open Enrollment Period From January 1 to March 31, you can switch to Original Medicare and/or join a stand-alone prescription drug plan.

Special Enrollment Period You can enroll in a new plan or change your plan in certain situations. Examples include: • Permanent

address change. of coverage due to employment change.

• Becoming eligible for a low-income subsidy.

• Loss

Contact us for other situations that qualify.

To be eligible for our plans you must: • Have

Medicare Parts A and B and live in the service area.

• Continue to pay your Medicare Part B premium if not otherwise paid for by Social Security or another third party.

Enrollment in a plan will automatically disenroll you from any other Medicare Advantage plan.

But it won’t automatically disenroll you from a Medicare Supplement plan. You must contact that plan to disenroll.

Your Enrollment Process How to Enroll Online Go to HealthAllianceMedicare.org to get started.

By Phone Call (877) 933-8454 (TTY 711), daily from 8 a.m. to 8 p.m. local time. Voicemail is used on holidays and weekends from April 1 to September 30.

By Mail Fill out and mail us the enrollment form in the back of this guide. You can also download it from HealthAllianceMedicare.org.

Mail to: Health Alliance Medicare Application Processing Center 3310 Fields South Dr. Champaign, IL 61822 Broker If you attend a seminar, the person presenting can schedule an appointment to help you enroll.

If you enroll in a Medicare Advantage plan during the Annual Enrollment Period, your coverage will begin January 1, 2021. In the meantime, we’ll mail you your member materials and your member ID card, which you’ll use instead of your red, white and blue Medicare card at the doctor, hospital and pharmacy starting January 1.

Your Plan You deserve coverage that gives you peace of mind and security, so we give you a health maintenance organization (HMO) plan made for you.

Your HMO • Comfort

of having an in-network primary care provider (PCP) to oversee all your care.

• Must see doctors in our large provider network but can go out of network for emergency and urgent care.

• Focus on strong doctor-patient relationships and familiarity with your provider network.

HMO Plan Our HMO plan gives you access to a network of respected doctors close to home.

2021 Star Ratings Health Alliance Medicare - H1737 2021 Medicare Star Ratings Every year, Medicare evaluates plans based on a 5-star rating system. Medicare Star Ratings help you know how good a job our plan is doing. You can use these Star Ratings to compare our plan's performance to other plans. The two main types of Star Ratings are: 1. An Overall Star Rating that combines all of our plan's scores.

2. Summary Star Ratings that focus on our medical or our prescription drug services.

Some of the areas Medicare reviews for these ratings include: How our members rate our plan's services and care; How well our doctors detect illnesses and keep members healthy; How well our plan helps our members use recommended and safe prescription medications.

For 2021, Health Alliance Medicare received the following Overall Star Rating from Medicare.

3.5 Stars We received the following Summary Star Ratings for Health Alliance Medicare's health/drug plan services: Health Plan Services:

3.5 Stars

Drug Plan Services:

4 Stars

The number of stars shows how well our plan performs.

5 stars - excellent 4 stars - above average 3 stars - average 2 stars - below average 1 star - poor Learn more about our plan and how we are different from other plans at www.medicare.gov.

You may also contact us 7 days a week from 8:00 a.m. to 8:00 p.m. Central time at 877-925-0424 (toll-free) or 711 (TTY), from October 1 to March 31.

Our hours of operation from April 1 to September 30 are Monday through Friday from 8:00 a.m. to 8:00 p.m. Central time.

Current members please call 877-917-8550 (toll-free) or 711 (TTY).

Star Ratings are based on 5 Stars. Star Ratings are assessed each year and may change from one year to the next.

Health Alliance Medicare is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal.

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Quad Cities

(877) 933-8454 (TTY 711) Daily 8 a.m. to 8 p.m. local time Voicemail used on holidays and weekends, April 1 – September 30 HealthAllianceMedicare.org Health Alliance Medicare is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal.

Health Alliance Medicare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Spanish: ATENCIÓN: Si habla español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted. Llame 1-800-965-4022 (TTY: 711).

Chinese: 注意：如果你講中文，語言協助服務，免費的，都可以給你。呼叫 1-800-965-4022 (TTY: 711).

Out-of-network/non-contracted providers are under no obligation to treat Health Alliance Medicare members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Other pharmacies/physicians/providers are available in our network. Every year, Medicare Evaluates plans based on a 5-star rating system.

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