2024 Eastern IN/Western OH Medicare Advantage Guide

How to Enroll

Online

Go to HealthAlliance.org/Medicare to get started.

By Phone

Call (888) 382-9771 (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 HealthAlliance.org/Medicare.

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.

After You Enroll

If you enroll in a Medicare Advantage plan during the Annual Enrollment Period, your coverage will begin January 1, 2024. 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 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 Plans

HMO-POS Plans

Note: Not all plans are offered in all counties. Please refer to sales materials for specific plan offerings.

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 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. Plus, compare plan options and key benefits all in one place with the 2024 Key Medicare Advantage Benefits guide.

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.

You can find a list of some of the providers, clinics and hospitals that are in network in the provider flier. For a full list, go to HealthAlliance.org/Medicare.

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 prior authorization from us.

Your Pharmacy Coverage

Plans with pharmacy coverage 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 HealthAlliance.org/Medicare/Pharmacy. (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 in-network pharmacies, view our pharmacy directory at HealthAlliance.org/Medicare/Find-a-Pharmacy.

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.

$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.

Medication Therapy Management

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

90-Day Supply Options

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 or HMO-POS plan and a stand-alone prescription drug plan (PDP) at the same time.

Benefits

Rx Deductible

Most of our plans don’t have a pharmacy deductible, but for the HMO Basic Rx 2 plan, you must meet a $100 yearly deductible on tiers 3-5. After that, you pay the copays listed in the Stages of Pharmacy Coverage chart.

Limit your trips to the pharmacy with two convenient options. With our mail-order benefit, you can get a 90-day supply of your drugs delivered directly to you for two copays on Tiers 1 – 3.

If you prefer to get your drugs at a retail pharmacy, you can visit any in-network pharmacy and get a 90-day supply on Tiers 1 – 3 for three copays.

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.

Note: The following information only applies to plans with pharmacy coverage.

Stages of Pharmacy Coverage

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

$5,030

$8,000

Initial Coverage

You pay the following until the amount you pay plus the amount we pay reaches $5,030:

• Tier 1: $2.

• Tier 2: $15.

• Tier 3: $47.

• Tier 4: 50%.

• Tier 5: 33%*

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 $5,030. Here, you pay the following until your out-of-pocket expenses reach $8,000:

• Your copay for Tier 1 drugs.

• 25% for Tier 2 through Tier 5 drugs.

Most people stay in this stage. Few people reach this stage.

Even fewer people reach this stage.

Catastrophic Coverage

This stage begins when your out-of-pocket drug costs reach $8,000. Once you reach this stage, as a Health Alliance member, your drug cost-share will be $0 for the rest of the year.

Your Team

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.

Health Coaching

Health coaches are your health partners. They’ll help you reach your health goals in the following areas and more:

• Nutrition.

• Weight loss.

• Staying active.

Find helpful resources.

Care for yourself to help prevent illness and hospital stays.

Set and reach health and wellness goals.

Understand and manage health issues, like diabetes and asthma.

Coordinate your care when you have complicated health conditions.

Use your health benefits to save money.

Terra Mullins Community Outreach Director 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 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.

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.

POS plans offer out-of-network coverage for routine care, including physical therapy or doctor’s visits. 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.

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? You’re covered on a POS plan, but you may have to pay more for being out of network. With an HMO plan, you only have coverage when seeing an in-network provider.

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

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

• Need 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 Nurse Advice Line and virtual health coverage.

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:

• Prescription 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.

• Emergency medical evacuation.

• Lost luggage assistance.

• Interpreter and legal referrals.

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 life-threatening 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.

Your Perks and Programs

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

Dental Coverage

We cover up to $2,000 a year for use on dental services, like cleanings, X-rays and more. 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. There’s no set network, so you can go to any dentist you choose. (HMO Basic has a $1,500 limit.)

You may have a copay or coinsurance for some dental services. Check your Summary of Benefits.

Vision

Get access to vision services beyond what Original Medicare covers, including a $200 annual allowance for eyewear. (HMO Basic has a $150 vision hardware allowance.) See enclosed flier for more information on how to use this benefit.

Be Fit

Get the most out of your fitness activities with Be Fit. You get to choose how you want to work out, and your $360-per-year benefit will cover the costs.

Activities include the following and more:

• Fitness class fees.

• Gym memberships.

• Online fitness subscriptions.

• Weight loss subscriptions.

• Ski memberships.

• Rowing.

• Golf.

Hearing Benefit

Through TruHearing®, you can get one routine hearing exam for a $0 copay and lowered rates on up to two TruHearing hearing aids per year when you see a TruHearing provider.

Companion Benefit

Get up to 30 hours of in-home support yearly through the Papa Pal program. This service gives you access to a friendly companion who can help you with a variety of tasks. Plus, they can be a fun person to chat with. And they can go with you to places like a library, park, doctor’s office, pharmacy and more. Services include:

• Companionship (like playing games, eating lunch or having a conversation).

• Transportation.

• Grocery shopping.

• Help with your pet.

• Bowling.

• Tennis.

• Pickleball.

• Recreational league fees.

• Pool exercise classes.

• 5K/10K race fees.

If your fees are more than $360 a year, you pay the difference. Be Fit doesn’t cover fitness trackers or personal equipment. See enclosed flier for more information on how to use this benefit.

OTC Benefit

Save money with the new over-the-counter supplemental benefit from Health Alliance. This program gives you an allowance of up to $140/year ($35 every three months, with no rollover) for commonly used OTC products.

• Technical support (like setting up streaming platforms or teaching you how to make a video call).

• Light help around the house.

• Light exercise.

Services are typically provided in one-hour increments.

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 hally.com at any time of the day, any day of the year.

Virtual Primary Care

Talk with a primary care provider virtually for routine wellness visits, preventive care and chronic care. Get unlimited visits at no additional cost. For questions and enrollment, call (800) 400-6354.

whiskerDocs

Connect to 24/7 help from veterinary technicians with whiskerDocs. You can call, chat or email with questions about your animals’ health or well-being. The service helps with cats, dogs, birds, reptiles and pocket pets (like rabbits or hamsters). About 60% of issues are taken care of over the phone without a visit to the veterinarian.

Nurse Advice Line

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

Disease Management Programs

Get connected to resources, motivation, support and reminders to help you manage the following and more:

• High blood pressure.

• Congestive heart failure.

• Migraines.

Preventive Care

• Asthma.

• Diabetes.

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

• Yearly wellness visit.

• Routine screenings, like mammograms or colorectal cancer screenings.

• Flu shot.

Your Health at Your Fingertips

We value giving you the member experience you deserve with a variety of options to fit your busy lifestyle – and as a member of our health plan, you get access to our comprehensive suite of health and wellness resources, programs, perks and offerings. We call this Hally ® health.

Hally health is your ally in your wellness journey. Whenever you see the word “Hally,” it’s us at your health plan connecting you with a resource or support that’ll help you live your healthiest life.

As a member, you also get secure, instant access to your health insurance coverage by logging in to your Hally account through the MyChart app or on hally.com. Review your plan coverage, discover resources and support for your health conditions and find the care you need anytime, anywhere.

Find helpful tools at hally.com.

Get access to a wealth of resources to help you stay healthy –with no login required. At hally.com, you’ll find:

• Health tools, tips and resources.

• Access to our quarterly “Simply Well” newsletter.

• Hally Healthcast , a monthly podcast led by medical experts who discuss common health and wellness topics.

• Free online fitness and cooking classes.

• Hally health blog, featuring informational articles and healthy tips for the entire family.

• Tasty recipes that’ll help you eat healthier.

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, if you’re already on a Medicare Advantage plan, you can switch to Original Medicare (and join a stand-alone prescription drug plan). Or you can switch from one Medicare Advantage plan to another.

Special Enrollment Period

You can enroll in a new plan or change your plan in certain situations. Examples include:

• Permanent address change.

• Loss of coverage due to employment change.

• Becoming eligible for a low-income subsidy.

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 at least six months of the year.

• 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 HealthAlliance.org/Medicare to get started.

By Phone

Call (888) 382-9771 (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 HealthAlliance.org/Medicare.

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.

After You Enroll

If you enroll in a Medicare Advantage plan during the Annual Enrollment Period, your coverage will begin January 1, 2024. 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.

Meet us in our local office.

Stop by our office for a visit. We look forward to meeting you.

3301 Fields South Dr. Suite 105 Champaign, IL

Your Plan

You deserve coverage that fits your lifestyle, so we offer plans made for your needs.

Does staying in network or having lower monthly premiums give you peace of mind? You might prefer a health maintenance organization (HMO) plan:

• 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.

Find an overview of your plan options and benefits made for you in our 2024 Key Medicare Advantage Benefits guide.

Do you travel often or like having freedom to see doctors in and out of network? You might prefer a point of service (HMO-POS) plan, also called a POS plan:

• Comfort of having an in-network PCP to oversee all your care.

• Flexibility to see out-of-network providers but may save money by staying in network.

• Balance between security and freedom.

HMO Plans

Our HMO plans give you access to a network of respected doctors close to home.

HMO-POS Plans

POS plans are made to give you the comfort of having a primary care provider with the freedom to see out-of-network providers.

(888)382-9771 (TTY 711)

Daily 8 a.m. to 8 p.m. Local Time

Voicemail Used on Holidays and Weekends, April 1 – September 30

HealthAlliance.org/Medicare

Health Alliance Medicare is a HMO plan with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal.

Health Alliance Medical Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity). Health Alliance Medical Plans does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex (including pregnancy, sexual orientation, and gender identity). 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).

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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If you would like to shop and enroll, click here .

Illinois Star Ratings

Click on the link below to view the most up-to-date star ratings for your service area.

2023 Star Ratings

2024 Star Ratings (available mid-October 2023)