Quad Cities (S)
Helpful Terms Ambulance: What you pay for an ambulance ride in an emergency.
Outpatient surgery: What you pay for an outpatient procedure.
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%).
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups: • Tier
1 (Preferred Generic) • Tier 2 (Generic) • Tier 3 (Preferred Brand) • Tier 4 (Non-Preferred Drug) • Tier 5 (Specialty Tier) 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), preauthorization 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.
Emergency care: The amount you pay for emergency care, like a trip to the emergency department. Inpatient hospital care: The amount you pay for a stay in an in-network hospital.* Lab: What you pay for lab services, like blood tests. Medical deductible: What you pay out-of-pocket before your coverage starts. Our plans don’t have medical deductibles.
Quad Cities (S)
2021 Key Medicare Advantage Benefits Made for You
Medicare Advantage vs. Medicare Supplement Get More out of Medicare with Medicare Advantage.
Medicare Advantage
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your care.
Generally gives you the flexibility to see any doctor who accepts Original Medicare.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Replaces Original Medicare.
Supplements Original Medicare.
Urgent care: The amount you pay for urgent or convenient care.
May cover benefits that Original Medicare doesn’t.
Only covers expenses covered by Original Medicare.
No medical underwriting.
Medical underwriting.
Lower premiums than Medicare Supplement plans.
Higher premiums than Medicare Advantage plans.
Who pays in what order: Health plan, you.
Who pays in what order: Original Medicare, health plan, you.
Not age- or tobacco-rated.
Age- and tobacco-rated.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.* Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
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. * Review the provider directory at HealthAllianceMedicare.org 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. 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). 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. MDMKHA21-QUAfoldguide-0420 • Y0034_21_91033_M
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. (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
(except for guaranteed issue plans)
Quad Cities (S)
Helpful Terms Ambulance: What you pay for an ambulance ride in an emergency.
Outpatient surgery: What you pay for an outpatient procedure.
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%).
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups: • Tier
1 (Preferred Generic) • Tier 2 (Generic) • Tier 3 (Preferred Brand) • Tier 4 (Non-Preferred Drug) • Tier 5 (Specialty Tier) 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), preauthorization 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.
Emergency care: The amount you pay for emergency care, like a trip to the emergency department. Inpatient hospital care: The amount you pay for a stay in an in-network hospital.* Lab: What you pay for lab services, like blood tests. Medical deductible: What you pay out-of-pocket before your coverage starts. Our plans don’t have medical deductibles.
Quad Cities (S)
2021 Key Medicare Advantage Benefits Made for You
Medicare Advantage vs. Medicare Supplement Get More out of Medicare with Medicare Advantage.
Medicare Advantage
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your care.
Generally gives you the flexibility to see any doctor who accepts Original Medicare.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Replaces Original Medicare.
Supplements Original Medicare.
Urgent care: The amount you pay for urgent or convenient care.
May cover benefits that Original Medicare doesn’t.
Only covers expenses covered by Original Medicare.
No medical underwriting.
Medical underwriting.
Lower premiums than Medicare Supplement plans.
Higher premiums than Medicare Advantage plans.
Who pays in what order: Health plan, you.
Who pays in what order: Original Medicare, health plan, you.
Not age- or tobacco-rated.
Age- and tobacco-rated.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.* Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
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. * Review the provider directory at HealthAllianceMedicare.org 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. 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). 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. MDMKHA21-QUAfoldguide-0420 • Y0034_21_91033_M
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. (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
(except for guaranteed issue plans)
Quad Cities (S)
Helpful Terms Ambulance: What you pay for an ambulance ride in an emergency.
Outpatient surgery: What you pay for an outpatient procedure.
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%).
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups: • Tier
1 (Preferred Generic) • Tier 2 (Generic) • Tier 3 (Preferred Brand) • Tier 4 (Non-Preferred Drug) • Tier 5 (Specialty Tier) 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), preauthorization 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.
Emergency care: The amount you pay for emergency care, like a trip to the emergency department. Inpatient hospital care: The amount you pay for a stay in an in-network hospital.* Lab: What you pay for lab services, like blood tests. Medical deductible: What you pay out-of-pocket before your coverage starts. Our plans don’t have medical deductibles.
Quad Cities (S)
2021 Key Medicare Advantage Benefits Made for You
Medicare Advantage vs. Medicare Supplement Get More out of Medicare with Medicare Advantage.
Medicare Advantage
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your care.
Generally gives you the flexibility to see any doctor who accepts Original Medicare.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Replaces Original Medicare.
Supplements Original Medicare.
Urgent care: The amount you pay for urgent or convenient care.
May cover benefits that Original Medicare doesn’t.
Only covers expenses covered by Original Medicare.
No medical underwriting.
Medical underwriting.
Lower premiums than Medicare Supplement plans.
Higher premiums than Medicare Advantage plans.
Who pays in what order: Health plan, you.
Who pays in what order: Original Medicare, health plan, you.
Not age- or tobacco-rated.
Age- and tobacco-rated.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.* Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
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. * Review the provider directory at HealthAllianceMedicare.org 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. 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). 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. MDMKHA21-QUAfoldguide-0420 • Y0034_21_91033_M
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. (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
(except for guaranteed issue plans)
Plan†
1
2
3
4
5
Plan Cost
Office Visits
Diagnostic Services
Emergency Services
Hospital Services
Network
Premium
Medical Deductible
Yearly Limit PCP Visit (does not include pharmacy)
Specialist Visit
Virtual Visit
Physical Therapy
Chiropractic Lab
X-Ray
CT/MRI
Ambulance»
Emergency Care***
Urgent Care+
Initial Rx Coverage (for 30-day supply; applies only to Rx plans)
Outpatient Inpatient Hospital Care^ Hospital Care (including services received)
Skilled Nursing Facility (noncustodial care based on medical necessity)
1
2
3
4
5
Rx Cost by Tier
1
*Guide HMO RX (HMO)
IN
$0
$0
$5,600
$0
$50
$0
$40
$15
20%
20%
20%
$265
$90
$65
$425
$350/Day (1-5), $0 (Days 6+)
$0/Day (1-20), $178 (Days 21-100)
$2
$15
$47
50%
33%
2
Guide HMO Rx 2 (HMO)
IN
$0
$0
$5,600
$0
$50
$0
$40
$15
20%
20%
20%
$265
$90
$65
$425
$350/Day (1-5), $0 (Days 6+)
$0/Day (1-20), $178 (Days 21-100)
$2
$15
$47
50%
33%
*Only available to Iowa residents.
Perks and Programs Key: This is a summary of commonly used benefits. IN means in-network.
+ Also called convenient or walk-in care
» Non-emergency cost-sharing may vary. Contact the plan for details.
^ You pay nothing for days 91 and beyond in-network.
*** Emergency care available worldwide.
# Members may have costs related to travel services.
Be Fit
Assist America#
House Calls
Virtual Health Coverage
Get fit with a $360/year reimbursement at the fitness center of your choice.
Get expert medical help when you're 100 miles or more from home.
Member magazine to share healthy tips and plan details.
Anytime Nurse Line
Preventive Care
Dental Coverage
Talk to a board certified doctor or counselor by phone or secure video through the Hally™ app 24/7.
Get 24/7 answers to your health questions, like whether you need to set up an appointment or see a doctor right away.
Focus on prevention with coverage for a yearly wellness visit, routine screenings, flu shot and more.
Get help paying for dental services, like cleanings, X-rays and more, with coverage up to $325 a year. (Some plans may have higher coverage.)
Disease Management Programs
Quit For Life®
Wellness Rewards
Get help with programs and support if you have asthma, diabetes or high blood pressure.
Personalized help to end your tobacco use.
Earn a $50 gift card for taking specific healthy steps outlined at HealthAllianceMedicare.org/Perks.
Over-the-Counter Coverage
Connect to a team of providers who work with your doctor to make sure you have the resources you need to stay healthy or work through your medical issues.
Purchase $40 per quarter in over-the-counter products from a catalog with hundreds of items to choose from.
Care Coordination
Hearing Benefit Routine hearing exam for a $45 copay and lowered rates up to two TruHearing® hearing aids per year.
Vision Coverage Get access to vision services beyond what Original Medicare covers.
Quad Cities (S)
Helpful Terms Ambulance: What you pay for an ambulance ride in an emergency.
Outpatient surgery: What you pay for an outpatient procedure.
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%).
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups: • Tier
1 (Preferred Generic) • Tier 2 (Generic) • Tier 3 (Preferred Brand) • Tier 4 (Non-Preferred Drug) • Tier 5 (Specialty Tier) 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), preauthorization 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.
Emergency care: The amount you pay for emergency care, like a trip to the emergency department. Inpatient hospital care: The amount you pay for a stay in an in-network hospital.* Lab: What you pay for lab services, like blood tests. Medical deductible: What you pay out-of-pocket before your coverage starts. Our plans don’t have medical deductibles.
Quad Cities (S)
2021 Key Medicare Advantage Benefits Made for You
Medicare Advantage vs. Medicare Supplement Get More out of Medicare with Medicare Advantage.
Medicare Advantage
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your care.
Generally gives you the flexibility to see any doctor who accepts Original Medicare.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Replaces Original Medicare.
Supplements Original Medicare.
Urgent care: The amount you pay for urgent or convenient care.
May cover benefits that Original Medicare doesn’t.
Only covers expenses covered by Original Medicare.
No medical underwriting.
Medical underwriting.
Lower premiums than Medicare Supplement plans.
Higher premiums than Medicare Advantage plans.
Who pays in what order: Health plan, you.
Who pays in what order: Original Medicare, health plan, you.
Not age- or tobacco-rated.
Age- and tobacco-rated.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.* Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
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. * Review the provider directory at HealthAllianceMedicare.org 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. 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). 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. MDMKHA21-QUAfoldguide-0420 • Y0034_21_91033_M
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. (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
(except for guaranteed issue plans)