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Health Alliance Medicare POS Enrich Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health Alliance Medicare POS Enrich 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 Enrich Rx (HMO-POS) in 2025, please refer to our full plan details page.
Health Alliance Medicare POS Enrich Rx (HMO-POS) is a HMO-POS plan offered by The Carle Foundation available for enrollment in 2025 to people living in West Central and Northern IL contracted counties. 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 Enrich 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 Enrich 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 Enrich Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $177.00. 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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $500.00 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 POS Enrich Rx (HMO-POS) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you may pay a $15 copay for a preferred generic drug at a standard or mail-order pharmacy. Standard generic drugs have a 25% coinsurance, while preferred brand drugs have a 50% coinsurance.
Additional Benefits
The Health Alliance Medicare POS Enrich Rx (HMO-POS) plan offers a range of benefits with varying cost-sharing. Many services, such as emergency care, primary care, ambulance services, home health, and dialysis, come with no copay or coinsurance. Dental coverage is included, with a $2,000 annual maximum benefit, and some vision and hearing services are also covered. This plan provides benefits for inpatient and outpatient services, diagnostic and radiological services, and medical equipment with no copay. However, it's important to note that some services like cardiac rehabilitation, orthodontics, and certain preventive services are not covered. Additionally, some services require prior authorization, and some have coinsurance or annual maximums.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital-Acute are covered, while Upgrades and Additional Days/Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered; individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization benefits are covered with prior authorization required. There is no information about the cost of these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, but ground ambulance services, air ambulance services, transportation services to a plan-approved health-related location, and transportation services to any health-related location are not covered. All ambulance services have no copay and no coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Health Alliance Medicare POS Enrich Rx (HMO-POS) plan. There is no copay or coinsurance for these services.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, all with no coinsurance and no copay. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services are partially covered, with routine chiropractic care, individual sessions, and group sessions not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, but the annual physical exam, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers fitness benefits, with a maximum plan benefit coverage amount of $360 every year, and remote access technologies.
Hearing Services See details
Hearing services are partially covered, with hearing exams covered but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids not covered. There is no deductible for the hearing exams.
Vision Services See details
Vision services are partially covered, and there is no deductible. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Health Alliance Medicare POS Enrich Rx (HMO-POS) plan covers dental services with a maximum benefit of $2,000 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no coinsurance, while restorative services, endodontics, periodontics, and oral and maxillofacial surgery have a 20% coinsurance, and adjunctive general services, prosthodontics (removable and fixed), maxillofacial prosthetics, and implant services have a 40% coinsurance. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Health Alliance Medicare POS Enrich Rx (HMO-POS) plan, including Insulin and Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by this plan. There is no copay or coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, with no copay and no coinsurance for Durable Medical Equipment (DME) and Prosthetics/Medical Supplies. However, Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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 the covered services.
Home Health Services See details
Home Health Services are covered by Health Alliance Medicare POS Enrich Rx (HMO-POS) 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 not covered by the Health Alliance Medicare POS Enrich Rx (HMO-POS) plan. The plan 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 additional days beyond Medicare-covered SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization and a doctor referral are required.
Other Services See details
Other Services are not covered by the Health Alliance Medicare POS Enrich Rx (HMO-POS) plan. Specifically, acupuncture, over-the-counter (OTC) items, meal benefits, 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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