2017 Medicare Advantage Plan Details | |||||
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Medicare Plan Name: | Health Alliance Medicare HMO 20 (HMO) | ||||
Location: | Boone, Illinois Click to see other locations | ||||
Plan ID: | H1463 - 001 - 0 Click to see other plans | ||||
Member Services: | 1-800-965-4022 TTY users 1-800-526-0844 | ||||
— This plan information is for research purposes only. — Click here to see plans for the current plan year | |||||
Medicare Contact Information: | Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options. TTY users 1-877-486-2048 or contact your local SHIP for assistance |
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Email a copy of the Health Alliance Medicare HMO 20 (HMO) benefit details
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— Medicare Plan Features — | |||||
Monthly Premium: | $85.00 (see Plan Premium Details below) | ||||
Annual Deductible: | no drug coverage | ||||
Health Plan Type: | Local HMO * | ||||
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): | $3,500 | ||||
Number of Members enrolled in this plan in Illinois: | 150 members | ||||
Number of Members enrolled in this plan in (H1463 - 001): | 702 members | ||||
Plan’s Summary Star Rating: | 4.5 out of 5 Stars. | ||||
• Customer Service Rating: | 5 out of 5 Stars. | ||||
• Member Experience Rating: | 5 out of 5 Stars. | ||||
• Drug Cost Accuracy Rating: | 4 out of 5 Stars. | ||||
— Plan Premium Details — | |||||
Monthly Premium with Extra Help Low-Income Subsidy (LIS): ❔ | 100% Subsidy | 75% Subsidy | 50% Subsidy | 25% Subsidy | |
Monthly Part D Premium with LIS: | $0.00 | $0.00 | $0.00 | $0.00 | |
— Plan Health Benefits — | |||||
** General Plan Information ** | |||||
Choice of Doctors?: Plan Doctors for Most Services | |||||
** Cost ** | |||||
Monthly Health Plan Premium: $85.00 | |||||
Monthly Drug Plan Premium: Not Applicable | |||||
Health Plan Deductible: $0 | |||||
Other Health Plan Deductibles?: No | |||||
Maximum Out-of-Pocket Enrollee Responsibility (does not include prescription drugs) : $3,500 In-network | |||||
** Extra Benefits ** | |||||
Prescription Drugs Covered?: No | |||||
Optional Supplemental Benefits?: No | |||||
** Outpatient Care and Services ** | |||||
Ambulance: $150 | |||||
Doctor's office visits:
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Durable medical equipment (wheelchairs, oxygen, etc.): 20% per item | |||||
Emergency care: $75 per visit (always covered) | |||||
Home health care: You pay nothing | |||||
Mental health care:
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Outpatient hospital: $150 per visit | |||||
Renal dialysis: You pay nothing | |||||
** Inpatient Care ** | |||||
Inpatient hospital care:
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Optional Supplemental Benefits?: No | |||||
Skilled Nursing Facility (SNF):
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Prescription Drugs Covered?: No | |||||
** Additional Benefits ** | |||||
Optional Supplemental Benefits?: No |