2023 Key Medicare Advantage Benefits Made for You Use the guide inside to see the amount you pay for some commonly used benefits and to learn more about some of the many perks that come with your plan. (800) 965-4022 (TTY 711) Daily 8 a.m. to 8 p.m. local time Voicemail used on holidays and weekends, April 1 – September HealthAlliance.org/Medicare30 Quad Cities (M)
Comfort of having an in-network primary care provider to oversee all your
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.
Generally gives you the flexibility to see any doctor who accepts Original
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
Medicare Advantage vs. Medicare Supplement
Get more out of Medicare with Medicare Advantage. Replacescare.Original
Medicare Supplement SupplementsMedicare.
• Tier 1 (Preferred Generic).
Urgent care: The amount you pay for urgent or convenient care.
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups:
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.
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%).
Lab: What you pay for lab services, like blood tests.
• Tier 4 (Non-Preferred Drug).
*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.
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
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.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
• Tier 2 (Generic).
• Tier 3 (Preferred Brand).
Medical deductible: What you pay out-of-pocket before your coverage starts. Our plans don’t have medical deductibles.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.*
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.
Emergency care: The amount you pay for emergency care, like a trip to the emergency department.
Outpatient surgery: What you pay for an outpatient procedure.
• Tier 5 (Specialty Tier).
Helpful Terms
Inpatient hospital care: The amount you pay for a stay in an in-network hospital.*
Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
Ambulance: What you pay for an ambulance ride in an emergency.
N/A N/A N/A N/A N/A N/A N/A OON $11,300 $50 $65 $0 $50 $50 $50
Be
Dental
50% 33% Tier 1 Coverage
Get help paying for dental services, like cleanings, X-rays and more, with coverage up to $2,000 a year.
$40 $40 $40 $275 $110 $40 $325 $350 Days 1-5; $0 Days 6+ $0 Days
Gap 5 HMO 40 Rx (HMO) IN $75 $0 $4,700 $10 $40 $0 $40 $20 $15 $10 $150 $275 $110 $40 $275 $275 Days
4 $300 Days 1-6; $0 Days 7+ $0 Days 1-20; $196 Days 21-100 $2 $15 $47 Through the 1-7; Days $0 Days 1-20; $196 Days 21-100 $2 $15 $47 Through the $196 Days 21-100 $2 $15 $47 Days 1-4; $0 Days $0 Days 1-20; $196 Days 21-100 $50 $50 $350 $95 $60 25% $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
50% 33% Tier 1 Coverage
$196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Coverage Through the Gap OON $8,950 $50 $50 $0 $50 $50 $50 $50 $50 $275 $110 $40 $375 $375 Days 1-8; $0 Days 9-60; $200 Days 61-90 $200 Days
& Dollar amounts listed for inpatient hospital care and SNF are amounts you pay per day.
$400 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Coverage Through the Gap 11 POS 10 Rx (HMO-POS) IN $165 $0 $4,500 $20 $30 $0 $20 $20 $0 $0 $0 $275 $110 $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 Coverage Through the Gap 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 Coverage Through the Gap Key: This is a summary of commonly used benefits. IN means in network, and OON means out of network. The OON yearly limit includes your combined costs for both in-network and out-of-network care. † Members on POS plans may pay more for preventive care out of network. » Non-emergency cost-sharing may vary. Contact the plan for details. * Emergency care available worldwide. + Also called convenient or
POS Basic Rx (HMO-POS) IN
Companion
10 POS 30 Rx (HMO-POS) IN $105 $0 $5,500 $15 $45 $0 $20 $20 1-20; 1-20; walk-in care.
OON $11,300 $50 $65 $0 $50 $50 $50 $50 $50 $350 $95 $60 25% $600 Days 1-6; $0 Days 7-90 $100 Days 1-20; $200 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Coverage Through the Gap
$0
HMO Basic Rx (HMO) IN $33 $0 $6,700 $5 $45 $0 $40 $20 $20 20% $150 $275 $95 $60 20%
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.
$0
Get fit with a $360/year reimbursement on a variety of fitness activities.
Over-the-Counter Benefit
50% 31% Tier 1 Coverage Through the Gap 8 POS Basic (HMO-POS) IN $23 $0 $6,700 $35 $50 $0 $40 $20 $40 $40 $40 $350 $95 $60 25% $450
^ You pay nothing for days 91 and beyond in network.
5+
* Only available in Scott County, IA.
$0
Gap 6 HMO 20 Rx (HMO) IN $125 $0 $4,000 $20 $40 $0 $40 $20 $10 $0 $5 $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 Coverage Through the Gap 7 HMO Classic Rx (HMO) IN $0 $0 $8,300 $35 $50 $0 $40 $20 $40 20% $250 $400 $95 $60 25% $300 Days 1-6; $0 Days 7+ $0 Days 1-20;
$0
** Not available for HMO Rx Classic.
Perks and Programs Fit
You have a limit of one order per quarter and unused dollars roll over to the next quarter.
All other plans include OTC4Me, where you can get 10% off on OTC products online or by phone.
Talk to a board certified doctor or counselor by phone or secure video through hally.com, 24/7.
Vision Coverage
9 $53 $6,700 $50 $50 $350 $95 $60 25% $450 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Coverage Through the Gap
The Guide HMO Rx2 and Guide HMO Rx plans include an allowance to purchase up to $40 per quarter in over-the-counter (OTC) products from a catalog with hundreds of items to choose from.
Get up to 30 hours of in-home support yearly (in one-hour increments).
Hearing Benefit **
Get access to vision services beyond what Original Medicare covers, including a $150 ** allowance for eyewear.
$15 $50 $0 $40 $20 $40
Telehealth Benefit
8+
Coverage
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.
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 pharmacy)include PCP Visit Specialist Visit Virtual Visit 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 Guide HMO Rx 2 (HMO) IN $0 $0 $5,600 $0 $50 $0 $40 $15 20% 20% 20% $265 $110 $60 $425 $350 Days 1-5; $0 Days 6+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Coverage Through the Gap 2 Guide HMO Rx (HMO)* IN $0 $0 $5,600 $0 $50 $0 $40 $15 20% 20% 20% $265 $110 $60 $425 $350 Days 1-5; $0 Days 6+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Coverage Through the Gap 3 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
Benefit
Virtual Health Coverage
$100
Virtual Visits
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 renewal. 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 within our network. MDMBHA23-QUAfoldguide-0622 • Y0034_23_108817_M Quad Cities (M)