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Monthly Premium ${{ plan.PREMIUM }}
Medical Deductible $0
Maximum Out-of-Pocket {{ plan.LIMIT_in }} In-Network

2019 Medicare Open Enrollment is October 15 – December 7, 2018.
Enroll Now

Covered Medical and Hospital Benefits

Effective January 1, 2019 – December 31, 2019

This is an overview of commonly used benefits. $ = Copay. % = Coinsurance.

  Preferred Network In-Network Out-of-Network
Primary Care Physician Office Visit {{ plan.PCP_t1 }} {{ plan.PCP_in }} {{ plan.PCP_oon }}
Specialist Office Visit {{ plan.SPECIALIST_t1 }} {{ plan.SPECIALIST_in }} {{ plan.SPECIALIST_oon }}
Outpatient Physical Therapy {{ plan.PT_t1 }} {{ plan.PT_in }} {{ plan.PT_oon }}
Chiropractic Care {{ plan.CHIRO_t1 }} {{ plan.CHIRO_in }} {{ plan.CHIRO_oon }}
Ambulance {{ plan.AMBULANCE_t1 }} {{ 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_t1 }} {{ plan.EMERGENCY_in }} {{ plan.EMERGENCY_oon }}
Urgent Care
(Also called convenient or walk-in care.)
{{ plan.URGENT_t1 }} {{ plan.URGENT_in }} {{ plan.URGENT_oon }}
Outpatient Hospital Care {{ plan.OUTPATIENT_t1 }} {{ plan.OUTPATIENT_in }} {{ plan.OUTPATIENT_oon }}
Inpatient Hospital Care
(Including services received)
You pay nothing for days 91 and beyond in-network.
{{ plan.INPATIENT_t1 }} {{ plan.INPATIENT_in }} {{ plan.INPATIENT_oon }}
Skilled Nursing Facility
(Noncustodial care based on medical necessity)
{{ plan.SNF_t1 }} {{ plan.SNF_in }} {{ plan.SNF_oon }}

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Plan Documents:

 

This Advantage Plan Includes:

Prescription Drug Coverage

This plan does not includes prescription drug coverage.

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.

Prescription Drugs Deductible {{ plan.RX_DEDUCTIBLE }}
Tier 1 Preferred Generic {{ plan.RX1 }}
Tier 2 Generic {{ plan.RX2 }}
Tier 3 Preferred Brand {{ plan.RX3 }}
Tier 4 Non-Preferred Drug {{ plan.RX4 }}
Tier 5 Specialty Tier {{ plan.RX5 }}

Prices listed are for 30-Day Retail.

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.

Pharmacy Documents:


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. Health Alliance Northwest is a Medicare Advantage Organization with a Medicare contract. Enrollment in Health Alliance Northwest depends on contract renewal. This information is not a complete description of benefits. Call customer service for more information. Every year, Medicare evaluates plans based on a 5-star rating system. Out-of-network/non-contracted providers are under no obligation to treat Health Alliance Medicare 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.