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Health Alliance Medicare POS Choice Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health Alliance Medicare POS Choice 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 Choice Rx (HMO-POS) in 2025, please refer to our full plan details page.
Health Alliance Medicare POS Choice Rx (HMO-POS) is a HMO-POS plan offered by The Carle Foundation available for enrollment in 2025 to people living in N. Cntrl, Cntrl, S IL, Quad Cities IL & E Cntrl IN. 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 Choice 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 Choice 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 Choice Rx (HMO-POS), 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.
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 $9000.00 (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 $9000.00 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 Choice Rx (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for standard generic drugs, you pay a $15 copay at the standard pharmacy or 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Health Alliance Medicare POS Choice Rx (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays and coinsurance depending on the specific service. Emergency, primary care, preventive, hearing, vision, and dental services are also included, with specific copays, coinsurance, and annual maximums for certain services. This plan also covers home health services with no copay and no coinsurance. Additional benefits include coverage for ambulance, partial hospitalization, and skilled nursing facility services, as well as medical equipment and dialysis services. The plan also covers diagnostic and radiological services, and other services like acupuncture and over-the-counter items. However, this plan does not cover cardiac rehabilitation services or certain other services such as long term care, private duty nursing, or orthodontics.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but upgrades and additional days for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, you'll pay a $290 copay for days 1-10, and no copay for days 11-90, and for Inpatient Hospital Psychiatric, you'll pay a $245 copay for days 1-10, and no copay for days 11-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $295, and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) services have no copay, while outpatient substance abuse services, including individual and group sessions, have a 20% coinsurance. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Health Alliance Medicare POS Choice Rx (HMO-POS) plan, but requires prior authorization. You will pay a 35% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Health Alliance Medicare POS Choice Rx (HMO-POS) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, but 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 $300 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services are covered, but routine care is not, and requires prior authorization with a $20 copay.
Preventive Services See details
Preventive Services, including Medicare-covered services, Annual Physical Exams, and Additional Preventive Services, are covered by the Health Alliance Medicare POS Choice Rx (HMO-POS) plan. Some services such as Health Education, In-Home Safety Assessment, and Counseling Services are not covered; however, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and other services are covered.
Hearing Services See details
Hearing Services includes hearing exams with a $45 copay, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are covered. Prescription Hearing Aids (all types) are covered with a copay between $699 and $999, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, nor are OTC Hearing Aids.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year. Eyewear is covered with a combined maximum benefit of $200 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $40 copay. Other Dental Services include Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery with 20% coinsurance, and Adjunctive General Services, Prosthodontics (removable, fixed), Maxillofacial Prosthetics, and Implant Services with 40% coinsurance. Orthodontics are not covered. There is a $3,000 maximum plan benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Health Alliance Medicare POS Choice Rx (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Health Alliance Medicare POS Choice Rx (HMO-POS) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 35%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have no copay, with a 25% coinsurance for both, and Diabetic Supplies have no copay with a coinsurance between 0% and 25%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by Health Alliance Medicare POS Choice Rx (HMO-POS). While all diagnostic services are covered with no copay, Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $210, and Therapeutic Radiological Services have a copay of at most $80. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Health Alliance Medicare POS Choice Rx (HMO-POS) 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 not covered under the Health Alliance Medicare POS Choice Rx (HMO-POS) plan. Specifically, 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 with prior authorization and a doctor referral. You will pay a $10 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with a $10 copay and a limit of 15 treatments per year, and over-the-counter items with a maximum benefit coverage amount of $35 every three months. Additionally, this plan does not cover 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.
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