Comfort of having an in-network primary care provider to oversee all your care. Replaces Original Medicare. May cover benefits that Original Medicare doesn’t.
Generally gives you the flexibility to see any doctor who accepts Original Medicare. Supplements Original Medicare. Only covers expenses covered by Original Medicare.
No medical underwriting.
Medical underwriting. (Except for guaranteed issue plans.)
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.
Ground ambulance: What you pay for an ambulance ride in an emergency.
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 fixed 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:
• Tier 1 (Preferred Generic).
• Tier 2 (Generic).
• Tier 3 (Preferred Brand).
• Tier 4 (Nonpreferred 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), 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.
Emergency care: This is the care you receive at an emergency room (ER) or emergency department. When you believe your health is at serious risk, seek emergency department care immediately. Don't hesitate to call 911 for assistance.
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: A set amount you pay before your plan starts helping pay for your medical care or pharmacy benefits. Our plans don't have medical deductibles.
Outpatient care: What you pay for a medical care or treatment that doesn't include staying overnight in a hospital.
Perks: Extra services that come with our Medicare Advantage plans but don’t come with Original Medicare.
Premium: The monthly fee you pay for coverage.
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.
Specialist visit: What you pay for each visit to an in-network specialist, like a cardiologist or orthopedic doctor.*
Urgent care: The amount you pay for urgent or convenient care.
Yearly limit: The most you'll pay in a coverage period before your plan pays 100% of covered expenses. It's also called the 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 care provider(or PCP) from our broad network. You’re not covered out of network unless it’s for emergency or urgent care.
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.
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.
Dental Coverage
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
Get fit with a $360/year benefit to use on a variety of fitness activities.
Hearing Benefit
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.
Companion Benefit
Get up to 30 hours of in-home support yearly (in one-hour increments).
Telehealth Benefit
Connect with your primary care provider or specialist over the phone or online with the telehealth benefit. You can securely speak with your personal healthcare providers without having to leave the comfort of your home.
Access varies by provider. Speak with your provider to determine availability. Copayment may apply.
Talk to a board certified doctor or counselor by phone or secure video through hally.com, 24/7. Copayment may apply.
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.
Health Alliance Northwest Health Plan 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 Northwest Health Plan 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 (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 HMO plan 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.
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