Plan Documents

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This is an overview of commonly used benefits.

${{ plan.PREMIUM }}/mo

{{ plan.PCP_in }} PCP Visit
{{ plan.SPECIALIST_in }} Specialist
{{ plan.LIMIT_in }} Yearly Medical Limit
$0 Tier 1 Drugs*
$400 Yearly Rx Deductible (Tiers 3-5)
No Rx Coverage

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*You can get Tier 1 generic drugs for $0 when you fill your prescription at Walgreens or other preferred cost-sharing pharmacies. You can also get drugs at other standard cost-sharing network pharmacies for a low cost.

 

Plan Documents:

Summary of Benefits - A simple overview that lets you compare costs and coverage. Resumen de beneficios

Evidence of Coverage - The detailed health and drug benefits available on this plan. Evidencia de Cobertura

Plan Annual Notice of Change - Any changes in coverage, costs, or service area that will start in January. Aviso Anual de Cambios Para el Plan

 

This Advantage Plan Includes:

 

This plan is available to residents of Chelan, Douglas, Grant, and Okanogan counties in WashingtonBenton, Cedar, Johnson, Keokuk, Linn, and Scott counties in IowaAdams, Boone, Brown, Bureau, Cass, Champaign, Christian, Clark, Coles, Crawford, Cumberland, DeKalb, DeWitt, Douglas, Edgar, Effingham, Ford, Franklin, Fulton, Hancock, Henry, Iroquois, Jasper, Johnson, Kankakee, Knox, La Salle, Livingston, Logan, McDonough, McLean, Macon, Macoupin, Marshall, Mason, Menard, Mercer, Montgomery, Morgan, Moultrie, Peoria, Perry, Piatt, Pike, Putnam, Richland , Rock Island, Saline, Sangamon, Schuyler, Scott, Stark, Tazewell, Vermilion, Williamson, Winnebago, and Woodford counties in Illinois, as well as Warren, Fountain, and Vermillion counties in IndianaThurston county in WashingtonRandolph, Fayette, and Union counties in Indiana, as well as Darke and Preble counties in OhioYakima county in Washington. View Service Area Map

{{ plan.NAME }}

This is an overview of commonly used benefits.

  $ = Copay         % = Coinsurance  

Medicare Star Rating Learn More

Office Visits and Diagnostics

  In-Network Out-of-Network
Medical Deductible $0 $0
PCP Visit {{ plan.PCP_in }} {{ plan.PCP_oon }}
Specialist Visit {{ plan.SPECIALIST_in }} {{ plan.SPECIALIST_oon }}
Physical Therapy {{ plan.PT_in }} {{ plan.PT_oon }}
Chiropractic {{ plan.CHIRO_in }} {{ plan.CHIRO_oon }}
Lab {{ plan.LAB_in }} {{ plan.LAB_oon }}
X-Ray {{ plan.XRAY_in }} {{ plan.XRAY_oon }}

Emergency and Hospital Care

  In-Network Out-of-Network
Ambulance {{ plan.AMBULANCE_in }} {{ plan.AMBULANCE_oon }}
Emergency Care
Emergency care's available worldwide. If you're immediately admitted to the hospital, you don't have to pay your share of the cost for emergency care.
{{ plan.EMERGENCY_in }} {{ plan.EMERGENCY_oon }}
Urgent Care
(Also called convenient or walk-in care.)
{{ plan.URGENT_in }} {{ plan.URGENT_oon }}
Outpatient Hospital Care {{ plan.OUTPATIENT_in }} {{ plan.OUTPATIENT_oon }}
Inpatient Hospital Care
(Including services received)
You pay nothing for days 91 and beyond in-network.
{{ plan.INPATIENT_in }} {{ plan.INPATIENT_oon }}
Skilled Nursing Facility
(Noncustodial care based on medical necessity)
{{ plan.SNF_in }} {{ plan.SNF_oon }}

Prescription Drug Coverage

See more details on this plan's prescription drug coverage in the Summary of Benefits. See more pharmacy info and programs or learn more about Part D and the coverage gap.

Tier 1
(Walgreens and other preferred cost-sharing pharmacies)
{{ plan.RX1_STORE }}
Tier 1 {{ plan.RX1 }}
Tier 2 {{ plan.RX2 }}
Rx Deductible
(Tiers 3-5)
{{ plan.RX_DEDUCTIBLE }}
Tier 3 {{ plan.RX3 }}
Tier 4 {{ plan.RX4 }}
Tier 5 {{ plan.RX5 }}

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Plans are only available in some locations. Health Alliance Medicare is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments, and restrictions may apply. Benefits and copayments or coinsurance may change on January 1 of each year. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. You must continue to pay your Medicare Part B premium. The provider network may change at any time. You will receive notice when necessary. Medicare beneficiaries may also enroll in Health Alliance Medicare through the CMS Medicare Online Enrollment Center located at Medicare.gov.