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2023 Key Medicare Advantage Benefits Made for You Indiana/Ohio, Reid
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.
Generally gives you the flexibility to see any doctor who accepts Original
Medicare Advantage vs. Medicare Supplement
Comfort of having an in-network primary care provider to oversee all your
Get more out of Medicare with Medicare Advantage. Replacescare.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 Supplement SupplementsMedicare.
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.
Inpatient hospital care: The amount you pay for a stay in an in-network hospital.*
Medical deductible: What you pay out-of-pocket before your coverage starts.
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 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 4 (Non-Preferred Drug).
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
• Tier 3 (Preferred Brand).
Outpatient surgery: What you pay for an outpatient procedure.
Lab: What you pay for lab services, like blood tests.
Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
• Tier 2 (Generic).
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.
Urgent care: The amount you pay for urgent or convenient care.
• Tier 1 (Preferred Generic).
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Ambulance: What you pay for an ambulance ride in an emergency.
• Tier 5 (Specialty Tier).
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.
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.*
Helpful Terms
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:
Virtual Visits
Get help paying for dental services, like cleanings, X-rays and more, with coverage up to $1,500 a year. (Reid Health Alliance HMO has a $2,000 limit.)
Virtual Health Coverage
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.
Telehealth Benefit
Talk to a board certified doctor or counselor by phone or secure video through hally.com, 24/7. Copayment may apply.
Hearing Benefit
Get 10% off on over-the-counter (OTC) products online or by phone.
Vision Coverage
Get access to vision services beyond what Original Medicare covers, including a $150 allowance for eyewear.
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 Specialist Visit Virtual Visit TherapyPhysical Chiropractic Lab X-Ray CT/MRI Ambulance» Care***Emergency Urgent Care+ Outpatient Hospital Care 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 Reid Health Alliance HMO (HMO) IN $0 $0 $6,700 $15 $50 $0 $40 $20 $10 20% $250 $300 $95 $45 $345 $300/Day (1-6); $0/Day (7+) $0/Day (1-20); $196/Day (21-100) N/A N/A N/A N/A N/A N/A N/A 2 Reid Health Alliance POS Rx (HMO-POS)* IN $35 $0 $6,700 $10 $50 $0 $30 $20 $20 $30 $275 $300 $95 $40 $425 $325/Day (1-6); $0/Day (7+) $0/Day (1-20); $196/Day (21-100) $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap OON $11,300 30% 30% $0 $30 30% 30% 30% 30% $300 $95 $40 30% 30% 30% $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap 3 Reid Health Alliance POS Basic Rx (HMO-POS)* IN $0 $0 $6,800 $5 $45 $0 $40 $20 $10 20% 20% $300 $95 $50 20% $400/Day (1-5); $0/Day (6+) $0/Day (1-20); $196/Day (21-100) $100 Tiers 3-5 $2 $15 $47 50% 31% Tier 1 Drugs Covered Through the Coverage Gap OON $11,300 $5 $45 $0 $40 $20 $10 20% 20% $300 $95 $50 20% $400/Day (1-5); $0/Day (6-90) $0/Day (1-20); $196/Day (21-100) $100 Tiers 3-5 $2 $15 $47 50% 31% Tier 1 Drugs Covered Through the Coverage Gap 4 Reid Health Alliance HMO Rx Basic Rx 2 (HMO) IN $0 $0 $4,900 $0 $45 $0 $40 $20 $0 $0 15% $250 $110 $50 20% $400/Day (1-5); $0/Day (6+) $0/Day (1-20); $196/Day (21-100) $100 Tiers 3-5 $2 $15 $47 50% 31% Tier 1 Drugs Covered Through the Coverage Gap *Available only in Indiana. 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. » Non-emergency cost-sharing may vary. Contact the plan for details. † Members on POS plans may pay more for preventive care out of network. *** Emergency care available worldwide. + Also called convenient or walk-in care. ^ You pay nothing for days 91 and beyond in network. & Dollar amounts listed for inpatient hospital care and SNF are amounts you pay per day.
Wellness Rewards
Companion Benefit
OTC4Me
Perks and Programs Be Fit
Talk to a board certified doctor or counselor by phone or secure video through hally.com, 24/7. Copayment may apply.
Earn a $50 gift card for taking specific healthy steps.
Get up to 30 hours of in-home support yearly (in one-hour increments).
Get fit with a $360/year reimbursement on a variety of fitness activities.
Dental 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.
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 (877) 749-3253 (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 (877) 749-3253 (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. MDUNHA23-RHAfoldguide-0622 • H1463_23_108818_M Indiana/Ohio, Reid