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Health Alliance Medicare POS 10 Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health Alliance Medicare POS 10 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 10 Rx (HMO-POS) in 2025, please refer to our full plan details page.
Health Alliance Medicare POS 10 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 10 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 10 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 10 Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $188.00. 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 $5750.00 (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 $5750.00 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 10 Rx (HMO-POS) 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. For example, you will pay a $15 copay for preferred generic drugs at a standard pharmacy or 25% coinsurance for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium will be reduced.
Additional Benefits
The Health Alliance Medicare POS 10 Rx (HMO-POS) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a copay, outpatient services with copays ranging from $0-$300, and ambulance services with copays based on the type of service. This plan also includes coverage for primary care with a $10 copay, hearing exams with a $25 copay, and routine eye exams. Dental services are covered with a combination of copays and coinsurance, and the plan offers a $2,000 annual maximum benefit for dental services.
Inpatient Hospital See details
Inpatient Hospital-Acute services require prior authorization and have a $250 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric services also require prior authorization and have a $175 copay for days 1-9, and no copay for days 10-90. Additional Days for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital-Acute are covered, but upgrades, 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 between $0 and $300, observation services with a $30 copay, and ambulatory surgical center services with no copay. This plan also covers outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan, but requires prior authorization. You will have a $30 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan, with prior authorization required for all ambulance services. Medicare-covered ground ambulance services have a $275 copay, while Medicare-covered air ambulance services have a $400 copay, with no coinsurance for either service. 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 under the Health Alliance Medicare POS 10 Rx (HMO-POS) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $30 copay; both have no coinsurance. Worldwide Emergency Coverage has a $140 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a copay between $275 and $400; all three have no coinsurance.
Primary Care See details
Primary care physician services have a $10 copay, while chiropractic services have a $20 copay, and require prior authorization. Occupational therapy services have a $20 copay, while physician specialist services have a $30 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay and require prior authorization. Additional Telehealth Benefits have a copay between $0 and $30.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services, Annual Physical Exams, and additional preventive services. Additional sessions of smoking and tobacco cessation counseling, as well as fitness benefits, are covered. Other services, such as Health Education and Counseling Services, are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $699 and $999 for 2 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include routine eye exams and eyewear. Routine eye exams are covered once per year, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with a $25 copay for contact lenses.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 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 and fixed), maxillofacial prosthetics, and implant services have a 40% coinsurance. Orthodontics is not covered. The plan has a maximum benefit of $2,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan, with a $35 copay for Medicare Part B Insulin Drugs. Coinsurance applies to all other services, with a minimum of 0% and a maximum of 15%.
Dialysis Services See details
Dialysis Services are covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies have a 20% coinsurance; however, 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 under the Health Alliance Medicare POS 10 Rx (HMO-POS) plan, but some services are not covered, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for these services.
Home Health Services See details
Home Health Services are covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Health Alliance Medicare POS 10 Rx (HMO-POS) plan, but require prior authorization and a doctor's referral. The copay is $10 for days 1-20, and $214 for days 21-100, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Health Alliance Medicare POS 10 Rx (HMO-POS) plan covers acupuncture with a $20 copay, and covers over-the-counter (OTC) items up to $35 every three months, as well as a meal benefit. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Private Duty Nursing Services are not covered.
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