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Health Alliance Medicare POS Basic Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health Alliance Medicare POS Basic Rx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health Alliance Medicare POS Basic Rx (HMO-POS) in 2025, please refer to our full plan details page.
Health Alliance Medicare POS Basic Rx (HMO-POS) is a HMO-POS 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 POS Basic Rx (HMO-POS) 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 POS Basic Rx (HMO-POS).
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 POS Basic Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $73.00. 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 combined Maximum Out-Of-Pocket cost of $11300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $11300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 POS Basic Rx (HMO-POS) plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a 25% coinsurance, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Health Alliance Medicare POS Basic Rx (HMO-POS) plan offers a range of benefits with varying cost-sharing. You'll have a copay for inpatient hospital stays, outpatient services, and emergency services, with coinsurance applying to certain services like outpatient services and dialysis. The plan also covers primary care, preventive, hearing, vision, and dental services, with specific copays and coinsurance amounts depending on the service. Additional benefits include ambulance, partial hospitalization, home health, and skilled nursing facility services. The plan covers diagnostic and radiological services and offers a meal benefit, as well as coverage for acupuncture, and over-the-counter items. However, some services, such as additional inpatient hospital days, certain hearing aids, and some dental and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $460 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you will pay a $395 copay for days 1-4, and no copay for days 5-90. Additional Days for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital-Acute are also covered. 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 0% - 25% coinsurance, and observation services with a $55 copay per stay. Ambulatory Surgical Center (ASC) services are covered with 0% - 25% coinsurance, and outpatient substance abuse services are covered with a $50 copay for both individual and group sessions. Outpatient blood services are also covered, including an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health Alliance Medicare POS Basic Rx (HMO-POS) plan and requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health Alliance Medicare POS Basic Rx (HMO-POS) plan. Ground ambulance services have a $350 copay, while air ambulance services have a $425 copay; there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed and worldwide emergency services, are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a copay between $350 and $425.
Primary Care See details
Primary Care Physician Services and Chiropractic Services are covered with a $15 copay, while Occupational Therapy Services and Mental Health Specialty Services have a $40 copay. Physician Specialist Services have a $50 copay, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $50, and Opioid Treatment Program Services have a $50 copay. Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
The Health Alliance Medicare POS Basic Rx (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services, some of which are not typically covered by Medicare. Additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies are also covered. However, health education, in-home safety assessments, and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, as well as fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $699 and $999 for up to two visits per year, while inner ear, outer ear, and over-the-ear hearing aids are not covered; OTC hearing aids are also not covered.
Vision Services See details
Vision Services include routine eye exams covered annually, and eyewear benefits with a $25 copay for contact lenses, with a combined maximum benefit of $200 per year. Eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Health Alliance Medicare POS Basic Rx (HMO-POS) plan covers dental services, including a $20 copay for Medicare dental services. 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 a maximum benefit of $2,000 per year. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery have a 20% coinsurance, while adjunctive general services, prosthodontics (removable and fixed), maxillofacial prosthetics, and implant services have a 40% coinsurance; orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Health Alliance Medicare POS Basic Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a $20 copay, lab services with no copay, diagnostic radiological services with a $50 copay, therapeutic radiological services with a $50 copay, and outpatient X-ray services with a $25 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered 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 none of the sub-services are 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 the Health Alliance Medicare POS Basic Rx (HMO-POS) plan, with prior authorization and a doctor's referral required. You will have a $10 copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $15 copay per visit, and is limited to 15 treatments per year. OTC items are covered up to $35 every three months. The meal benefit is for a chronic illness or a medical condition that requires the enrollee to remain at home for a period of time. Dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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