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Health Alliance Medicare HMO Basic (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health Alliance Medicare HMO Basic (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 Basic (HMO) in 2025, please refer to our full plan details page.
Health Alliance Medicare HMO Basic (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 Basic (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Health Alliance Medicare HMO Basic (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 Basic (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6700.00 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
Prescription drugs are not covered by Health Alliance Medicare HMO Basic (HMO).
Additional Benefits
The Health Alliance Medicare HMO Basic (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services may have coinsurance. The plan also covers primary care visits with a $10 copay, and offers hearing, vision, and dental services with copays and coinsurance. Additional benefits include ambulance services, emergency services, and home health services, with specific copays and coinsurance applying. The plan covers preventive services with no copay, and offers coverage for medical equipment, diagnostic services, and skilled nursing facilities, each with its own cost-sharing structure. There are also some services that are not covered by the plan.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $250 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Upgrades and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered under the Health Alliance Medicare HMO Basic (HMO) plan. Outpatient hospital services have a coinsurance of 0% to 20%, while observation services have a $55 copay per stay. Individual and group sessions for outpatient substance abuse have a 20% coinsurance. Outpatient blood services include a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health Alliance Medicare HMO Basic (HMO) plan, but requires prior authorization. This benefit has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health Alliance Medicare HMO Basic (HMO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $275 copay, while air ambulance services have a $450 copay, and there is no coinsurance for ambulance services. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $55 copay, and Worldwide Emergency Transportation has a copay between $275 and $450.
Primary Care See details
The Health Alliance Medicare HMO Basic (HMO) plan covers primary care physician services for a $10 copay. Chiropractic services have a $15 copay, but routine care is not covered, and occupational therapy services have a $40 copay. Physician specialist services have a $45 copay, and individual and group mental health sessions have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a $0-$45 copay. Opioid treatment program services have a $50 copay.
Preventive Services See details
The Health Alliance Medicare HMO Basic (HMO) plan covers preventive services, including annual physical exams, with no copay. Additional services such as health education, in-home safety assessments, and home and bathroom safety devices are not covered. Some services, like the fitness benefit, have a maximum plan benefit coverage amount.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, and prescription hearing aids (all types) with a copay between $699 and $999, limited to 2 per year. Fitting/Evaluation for Hearing Aid is covered, and Routine Hearing Exams are covered once per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Health Alliance Medicare HMO Basic (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a $25 copay for contact lenses, with a combined maximum benefit of $150 every year for eyewear.
Dental Services See details
The Health Alliance Medicare HMO Basic (HMO) plan covers Medicare Dental Services with a $25 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services with no copay, and restorative services, endodontics, periodontics, and oral and maxillofacial surgery with 20% coinsurance, and adjunctive general services, prosthodontics (removable), maxillofacial prosthetics, implant services, and prosthodontics (fixed) with 40% coinsurance. Orthodontics is not covered. There is a $1500 maximum plan benefit coverage per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Health Alliance Medicare HMO Basic (HMO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Prosthetics/Medical Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies has a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Health Alliance Medicare HMO Basic (HMO) plan. Diagnostic Procedures/Tests and Lab Services have no copay and up to 20% coinsurance, while Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services and Outpatient X-Ray Services have up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Health Alliance Medicare HMO Basic (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Health Alliance Medicare HMO Basic (HMO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and meal benefits. Acupuncture has a $25 copay for up to 15 treatments per year. OTC items are covered with a maximum benefit coverage amount of $35 every three months. The plan also provides a meal benefit for chronic illnesses and medical conditions that require the enrollee to remain at home. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management are not covered.
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