2023 Key Medicare Advantage Benefits Made for You
the guide inside to see the amount you pay for some commonly used benefits and to learn more about some
holidays
Use of 965-4022 (TTY 711) Daily 8 a.m. to 8 p.m. local time Voicemail used on and 1 September
the many perks that come with your plan. (800)
weekends, April
–
HealthAlliance.org/Medicare30 OSF + Legacy (ILN) Plans
Medicare Advantage vs. Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your
Medicare. May cover benefits that Original Medicare doesn’t. No medical underwriting. Lower premiums than Medicare Supplement plans. Who pays in what order: health plan, you. Not age- or Medicaretobacco-rated.Advantage
Get more out of Medicare with Medicare Advantage. Replacescare.Original
Generally gives you the flexibility to see any doctor who accepts Original
Original OnlyMedicare.covers expenses covered by Original Medicare. Medical underwriting. (except for guaranteed issue plans) Higher premiums than Medicare Advantage plans. Who pays in what order: Original Medicare, health plan, you. Age- and tobacco-rated.
Medicare Supplement SupplementsMedicare.
With a POS plan, you still choose an in-network PCP, but you have the freedom to go out of network. You save money by staying in network, though.
* Review the provider directory at HealthAlliance.org/Medicare for our in-network doctors and hospitals. With an HMO plan, you choose a primary doctor (or PCP) from our broad network. You’re not covered out of network unless it’s for emergency or urgent care.
• Tier 1 (Preferred Generic).
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.*
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
Generally, the higher the tier, the more you pay for the drug. Some prescriptions require step therapy (for you to try a lower tier first), prior authorization or a limit on the amount you can receive at one time. If your drug isn’t covered, you can ask for an exception. For more information, see the formulary.
Outpatient surgery: What you pay for an outpatient procedure.
Yearly limit: The limit of how much money you pay for covered medical services, including copayments and coinsurance, each year. It’s also called out-of-pocket maximum.
Copayment/coinsurance: The set dollar amount or percentage you pay for a doctor’s visit, at the hospital or at the pharmacy. Copayment is a specific dollar amount (like $20), and coinsurance is a percentage (like 20%).
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups:
Ambulance: What you pay for an ambulance ride in an emergency.
Helpful Terms
• Tier 5 (Specialty Tier).
• Tier 4 (Non-Preferred Drug).
Emergency care: The amount you pay for emergency care, like a trip to the emergency department.
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Urgent care: The amount you pay for urgent or convenient care.
• Tier 2 (Generic).
Medical deductible: What you pay out-of-pocket before your coverage starts.
• Tier 3 (Preferred Brand).
Lab: What you pay for lab services, like blood tests.
Inpatient hospital care: The amount you pay for a stay in an in-network hospital.*
# Not available on OSF Enrich.
4 HMO $275 $110 $25 $275 $250 Days 1-7; $0 Days 8+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
Key: This is a summary of commonly used benefits.
OON $11,300 $50 $65 $0 $50 $50 $50 $50 $50 $350 $95 $60 25%
† Members on POS plans may pay more for preventive care out of network.
Tier 1 $39 $250 Days 1-7; $0 Days 8+ $0 Days 1-20; $160 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap $325 Days 1-6; $0 Days 7+ $0 Days 1-20; $196 Days 21-100
$0 Days 7+ $0 Days
The OON yearly limit includes your combined costs for both in-network and out-of-network care.
Days
POS Basic Rx (HMO-POS) IN $53 $0 $6,700 $15 $50 $0 $40 $20 $40 $50 $50 $350 $95 $60 25% $450 Days
11
& Dollar amounts listed for inpatient hospital care and SNF are amounts you pay per day.
Days
» Non-emergency cost-sharing may vary. Contact the plan for details.
OON $275 $110 $40 $375 $375 Days 1-8; $0 Days 9-60; $200 Days 61-90 $200 Days 1-20; $400 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
5 HMO $400 $95 $60 25% $300 1-6; 1-20; $196 1-20; $196 21-100 N/A N/A $600 Days 1-6; $0 Days 7-90 $100 Days 1-20; $200 Days 21-100 N/A N/A N/A N/A N/A N/A N/A
Drugs
Tier 2 $35 $50 $0 $40 $20 20% 20% 20% $295 $110 $0 $375 $350 Days 1-5; $0 Days 6+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
Tier 2 $35 $50 $0 $40 $20 $25 $60 $60 $295 $110 $0 30%
$0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap OON $8,950 $50 $60 $0 $60 $50 25% 25% 25% $295 $110 $0 50% $600 Days 1-4; $0 Days 5-90 $100 Days 1-20; $200 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap 12 OSF MedAdvantage Enrich (HMO-POS) IN $150 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $175 (Tier 3,4,5) $2 $15 $47 50% 30% Tier 1 Drugs Covered Through the Coverage Gap OON $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $0 $175 (Tier 3,4,5) $2 $15 $47 50% 30% Tier 1 Drugs Covered Through the Coverage Gap
Be Fit
$0
Companion Benefit#
$105 $0 $5,500 $15 $45 $0 $20 $20 $40 $40 $40 $275 $110
7 1-4; $0 Days $0 Days 1-20; $196 Days 21-100 1-6; Days 7-90 Days 1-20; $200 Days 21-100 $2 $15 $47 Covered
Vision Coverage #
50% 33% Tier 1 Drugs
20 Rx (HMO) IN $125 $0 $4,000 $20 $40 $0 $40 $20 $10 $0 $5
* Emergency care available worldwide.
** Not available for HMO Classic Rx.
IN $30 $275 $250 Days 1-8; $0 Days 9+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
10
OSF MedAdvantage Core (HMO)
OSF MedAdvantage
Get fit with a $360/year reimbursement on a variety of fitness activities.
Get one routine hearing exam for a $0 copay when you see a TruHearing® provider and lowered rates on up to two TruHearing hearing aids per year.
IN means in network, and OON means out of network.
HMO 40 Rx (HMO) IN $75 $0 $4,700 $10 $40 $0 $40 $20 $15 $10 $150 $275 $110 $40 $275
50% 33% Tier 1 Drugs Covered Through
+ Also called convenient or walk-in care.
OTC4Me
Hearing Benefit# **
5+
$100
Get up to 30 hours of in-home support yearly (in one-hour increments).
Tier 1 $0 $0 $3,900 $40 $0 $10 $20 $15 $40 $40 $295 $110 $0 $275 $300 Days 1-5; $0 Days 6+ $0 Days 1-20; $165 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
Plan Cost Office Visits DiagnosticServices Emergency Services Hospital Services Initial Rx Coverage (for 30-day supply; applies only to Rx plans) Plan Type† Network Premium DeductibleMedical Yearly Limit (does not include pharmacy) PCP Visit VisitSpecialist VisitVirtual TherapyPhysical Chiropractic Lab X-Ray CT/ MRI Ambulance» Emergency Care* Urgent Care HospitalOutpatientCare Inpatient Hospital Care^& (including services received) Skilled Nursing Facility& (noncustodial care based on medical necessity) Rx Cost by Tier Rx Deductible 1 2 3 4 5 Rx Gap Coverage 1 HMO Basic (HMO) IN $0 $0 $6,700 $10 $45 $0 $40 $20 20% 20% $150 $275 $95 $60 20% $300 Days 1-6; $0 Days 7+ $0 Days 1-20; $196 Days 21-100 N/A N/A N/A N/A N/A N/A N/A 2 HMO Basic Rx (HMO) IN $33 $0 $6,700 $5 $45 $0 $40 $20 $20 20% $150 $275 $95 $60 20% $300 Days 1-6; $0 Days 7+ $0
$0
Dental Coverage
$0
Open (HMO-POS)
$0
N/A N/A N/A N/A N/A
IN $40 $325 $350 Days 1-5; $0 Days 6+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
$0 $4,750 $0 $10 $0 $10 $20 $10 $35 $35 $295 $110 $0 $275
3 $275 Days 1-7; $0 Days 8+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Covered Through the Coverage
$0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap OON $11,300 $50 $65 $0 $50 $50 $50 $50 $50 $350 $95 $60 25% $600 Days
Virtual Visits
Classic Rx (HMO) IN $0 $0 $8,300 $35 $50 $0 $40 $20 $40 20% $250
Get a 10% discount code for a wide variety of competitively priced over-the-counter (OTC) products with OTC4Me. You can order online or by phone, and all orders are shipped directly to you. Shipping is free on orders over $25.
$8,950 $50 $50 $0 $50 $50 $50 $50 $50
Connect with your primary care provider or specialist over the phone or online without the inconvenience of going to the doctor’s office or sitting in a waiting room. Copayment may apply.
Perks and Programs
Get help paying for dental services, like cleanings, X-rays and more, with coverage up to $2,000 a year. (Health Alliance HMO Basic and POS Basic have a $1,500 limit.)
Talk to a board certified doctor or counselor by phone or secure video through hally.com, 24/7.
Telehealth Benefit
OON $5,750 $40 $40 $0 $30 $45 $30 $30 $30 $275 $110 $30 $325 25% $85 Days 1-20; $225 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap
Get access to vision services beyond what Original Medicare covers, including a $150** allowance for eyewear. Days 1-20; $196 Days 21-100 $2 $15 $47 the
9 POS 10 Rx (HMO-POS)
Virtual Health Coverage
Through the Coverage Gap 8 POS 30 Rx (HMO-POS)
Coverage Gap
^ You pay nothing for days 91 and beyond in network.
Gap
Days 21-100 $100 $2 $15 $47 50% 31% Tier 1 Drugs Covered Through the Coverage Gap 6 POS Basic (HMO-POS) IN $23 $0 $6,700 $35 $50 $0 $40 $20 $40 $40 $40 $350 $95 $60 25% $450 Days 1-4; $0 Days 5+ $0 Days
$165 $0 $4,500 $20 $30 $0 $20 $20 $0 $0 $0 $275 $110
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 (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 (800) 965-4022 (TTY 711). Health Alliance Medicare is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract Out-of-network/non-contractedrenewal. 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 within our network. MDMBHA23-OSFILNfoldguide-0622 • H1463_23_108815_M OSF + Legacy (ILN) Plans