Benefits Made for You
Northwest, Companion
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2023 Key Medicare Advantage
April 1 – September HealthAlliance.org/Medicare30
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.
Medicare Supplement gives SupplementsMedicare.
Generally
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
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.
Medicare Advantage vs. Medicare Supplement
you the flexibility to see any doctor who accepts Original
Premium: The amount you pay each month for plan coverage. You must continue to pay your Medicare Part B premium.
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%).
• Tier 4 (Non-Preferred Drug).
Inpatient hospital care: The amount you pay for a stay in an in-network hospital.*
Primary care provider (PCP) visit: The amount you pay at the doctor’s office when you visit your in-network primary care doctor.*
• Tier 3 (Preferred Brand).
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.
* 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.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic 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.
Urgent care: The amount you pay for urgent or convenient care.
Skilled nursing facility (SNF): What you pay for an approved stay at a SNF.
• Tier 5 (Specialty Tier).
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.
• Tier 1 (Preferred Generic).
Outpatient surgery: What you pay for an outpatient procedure.
Emergency care: The amount you pay for emergency care, like a trip to the emergency department.
Ambulance: What you pay for an ambulance ride in an emergency.
Drug tier: The cost group a drug belongs to. Drugs in our Medicare Part D formulary are in one of five groups:
Lab: What you pay for lab services, like blood tests.
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Helpful Terms
• Tier 2 (Generic).
Medical deductible: What you pay out-of-pocket before your coverage starts. Our plans don’t have medical deductibles.
Virtual Visits
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.
Get access to vision services beyond what Original Medicare covers, including a routine vision exam with an in-network provider.
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 DeductibleRx 1 2 3 4 5 Rx Gap Coverage Companion Basic Rx 2 (HMO) IN $0 $0 $7,550 $20 $50 $0 $35 $20 $25 $35 $375 $495 $95 $40 $475 $480 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap 2 Companion HMO (HMO) IN $33 $0 $6,300 $15 $50 $0 $35 $20 $10 $40 $325 $475 $95 $40 $425 $495 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 N/A N/A N/A N/A N/A N/A N/A 3 Companion Basic Rx (HMO) IN $40 $0 $7,000 $30 $50 $0 $35 $20 $20 $35 $375 $475 $95 $40 $450 $495 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap 4 Companion Rx (HMO) IN $74 $0 $6,400 $20 $50 $0 $35 $20 $20 $35 $350 $450 $95 $40 $450 $475 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap 5 Companion Rx Plus (HMO) IN $109 $0 $5,500 $10 $40 $0 $30 $20 $5 $20 $300 $400 $110 $40 $350 $425 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 $0 $2 $15 $47 50% 33% Tier 1 Drugs Covered Through the Coverage Gap 6 Companion POS Rx (HMO-POS) IN $49 $0 $7,550 $25 $50 $0 $35 $20 $20 $35 $375 $475 $95 $40 $450 $500 Days 1-4; $0 Days 5+ $0 Days 1-20; $196 Days 21-100 $175 Tiers 3,4,5 $2 $15 $47 50% 30% Tier 1 Drugs Covered Through the Coverage Gap 7 OON $11,300 30% 30% $0 30% 30% 30% 30% 30% $475 $95 $40 30% 30% 30% $175 Tiers 3,4,5 $2 $15 $47 50% 30% Tier 1 Drugs Covered Through the Coverage Gap
Earn a $50 gift card for taking specific healthy steps.
Perks and Programs
commonly
IN means in network, and OON means out of network.
OTC4Me
Vision Coverage
*** Emergency care available worldwide.
» Non-emergency cost-sharing may vary. Contact the plan for details.
Hearing Benefit
Companion Benefit
Telehealth Benefit
^ You pay nothing for days 91 and beyond in network.
Get up to 30 hours of in-home support yearly (in one-hour increments).
The OON yearly limit includes your combined costs for both in-network and out-of-network care.
benefits.
+ Also called convenient or walk-in care.
Wellness Rewards
Key: This is a summary of used
Get 10% off on over-the-counter (OTC) products online or by phone.
& Dollar amounts listed for inpatient hospital care and SNF are amounts you pay per day.
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.
Get help paying for dental services, like cleanings, X-rays and more, with coverage up to $250 a year. (Companion Basic Rx 2 has a $225 limit and Companion HMO has a $200 limit.)
Be Fit
Dental Coverage
Get fit with a $360/year reimbursement on a variety of fitness activities.
† Members on POS plans may pay more for preventive care out of network.
Talk to a board certified doctor or counselor by phone or secure video through Haly.com, 24.7.
Health Alliance Northwest™ 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) 750-3350 (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) 750-3350 (TTY 711). Health Alliance Northwest is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance Northwest depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Health Alliance Northwest 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. MDUNNW23-WACfoldguide-0622 • H3471_23_108819_M Northwest, Companion