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Health Alliance Medicare HMO 20 Rx (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health Alliance Medicare HMO 20 Rx (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health Alliance Medicare HMO 20 Rx (HMO) in 2025, please refer to our full plan details page.
Health Alliance Medicare HMO 20 Rx (HMO) is a HMO plan offered by The Carle Foundation available for enrollment in 2025 to people living in North Central, Central, Southern, & Quad Cities IL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Health Alliance Medicare HMO 20 Rx (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Health Alliance Medicare HMO 20 Rx (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Health Alliance Medicare HMO 20 Rx (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $148.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Health Alliance Medicare HMO 20 Rx (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay a $15 copay for preferred generic drugs at a standard or mail-order pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your Part D premium may be reduced to $8.90.
Additional Benefits
The Health Alliance Medicare HMO 20 Rx (HMO) plan offers a wide range of benefits with varying costs. Hospital stays include a copay, with outpatient services also having copays, and ambulance services have copays depending on the type of service. This plan covers primary care, specialist visits, and mental health services with copays. Preventive services include routine exams and some additional screenings. Hearing, vision, and dental services are also covered with copays or coinsurance, and the plan includes coverage for home health, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $250 for days 1-8 and no copay for days 9-90 for Inpatient Hospital-Acute, and a copay of $200 for days 1-7 and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital-Acute are also covered, while Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $350, and observation services with a $30 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $20 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Health Alliance Medicare HMO 20 Rx (HMO) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health Alliance Medicare HMO 20 Rx (HMO) plan. Ground Ambulance Services have a $300 copay, while Air Ambulance Services have a $400 copay, and there is no coinsurance for either. Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $40 copay and no coinsurance, and Worldwide Emergency Services have varying copays depending on the service, with Worldwide Emergency Coverage at $140, Worldwide Urgent Coverage at $40, and Worldwide Emergency Transportation at $300-$400, with no coinsurance.
Primary Care See details
Primary Care Physician Services have a $10 copay, while Chiropractic Services have a $20 copay, but Routine Chiropractic Care is not covered. Occupational Therapy Services have a $45 copay, and Physician Specialist Services have a $40 copay. Mental Health Specialty Services have a $20 copay for individual and group sessions. Other Health Care Professional services have a copay between $20 and $40, and Psychiatric Services have a $20 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay, Additional Telehealth Benefits have a copay between $0 and $40, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, additional preventive services, kidney disease education, and other preventive services. This plan does not cover Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services. Additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered.
Hearing Services See details
Hearing services include routine hearing exams with a $25 copay and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, along with OTC hearing aids.
Vision Services See details
Vision Services includes coverage for routine eye exams, with one exam covered every year, and eyewear, which includes contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a $25 copay for contact lenses, and a combined maximum plan benefit of $200 per year.
Dental Services See details
The Health Alliance Medicare HMO 20 Rx (HMO) plan covers dental services, including Medicare dental services with a $25 copay, oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery have a 20% coinsurance, while adjunctive general services, prosthodontics (removable, fixed), maxillofacial prosthetics, and implant services have a 40% coinsurance. Orthodontics are not covered. The plan has a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 0-15% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay 0-15% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Health Alliance Medicare HMO 20 Rx (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment with no copay and 0-20% coinsurance, prosthetics and medical supplies with no copay and 20% coinsurance, and diabetic equipment with varying coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay of $10, Lab Services have no copay, Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of at least $5, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Health Alliance Medicare HMO 20 Rx (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but some services are not covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Health Alliance Medicare HMO 20 Rx (HMO), requiring prior authorization and a doctor referral. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under Other Services, acupuncture is covered with a $20 copay for up to 15 treatments per year. Over-the-counter items are covered with a maximum benefit of $35 every three months. Meal benefits are also covered for chronic illnesses or medical conditions that require the enrollee to remain at home for a period of time. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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