Health Alliance Medicare POS Enrich Rx (HMO-POS) 2024 Benefit Details for Plan H1463-042-0 by Health Alliance Medicare
Health Alliance Medicare POS Enrich Rx is a 2024 HMO-POS Medicare Advantage plan {with_without_pdp} Part D.
This Health Alliance Medicare option offers the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may also include additional, valuable benefits not covered by Part A or Part B.
Plan Basics | |
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Plan ID: | H1463 042 0 |
Plan Type: | Local HMO |
Plan Year: | 2024 |
Premium: | $165.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $0/yr |
Part B Reduction: | $0.00/mo |
Drug Plan Benefit: | Enhanced, $250.00 deductible |
Rx Gap Coverage: | Yes |
Supplemental Benefits: | Dental |
Availability: | See List |
Insured By: | Health Alliance Medicare |
Summary of Benefits |
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Health Plan Cost Sharing
This Health Alliance Medicare Medicare Advantage plan has cost-sharing. These are costs you must pay out-of-pocket when you use approved health services.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
The following table summarizes the most common out-of-pocket costs you will incur if you join this plan unless you go out-of-network:
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $0 |
Specialist: | $0 |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $0 |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $0 |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $0 |
Urgent care: | $0 |
Ground ambulance: | $0 |
Inpatient hospital coverage: | |
Outpatient hospital coverage: | $0 |
Skilled Nursing Facility: | |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $0 |
Outpatient group therapy visit with a psychiatrist: | $0 |
Inpatient hospital - psychiatric: | |
Outpatient group therapy visit: | $0 |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $0 |
Occupational therapy visit: | $0 |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment (e.g., wheelchairs, oxygen): | $0 |
Prosthetics (e.g., braces, artificial limbs): | $0 |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $0 |
Lab services: | $0 |
Outpatient x-rays: | $0 |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | $0 |
Other Part B drugs (Medicare-covered) | $0 |
Feel free to download our Health Alliance Medicare POS Enrich Rx Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Health Alliance Medicare includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | Maximum dental benefit: | $2,000.00 Every year |
Oral exam (In-Network) | Covered |
Fluoride treatment (In-Network) | Covered |
Dental x-ray(s) (In-Network) | Covered |
Cleaning (In-Network) | Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Covered |
Non-routine services (In-Network) | Covered |
Diagnostic services (In-Network) | Covered |
Extractions (In-Network) | Covered |
Endodontics (In-Network) | Covered |
Restorative services (In-Network) | Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Not Covered |
Hearing aids (In-Network) | Not Covered |
Hearing exam (In-Network) | Not Covered |
Vision | |
Eyeglasses (frames and lenses) (In-Network) | Not Covered |
Routine eye exam (In-Network) | Not Covered |
Contact lenses (In-Network) | Not Covered |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Health Alliance Medicare POS Enrich Rx includes an enhanced benefit Medicare Part D plan (PDP). Enhanced plans have a higher actuarial value than basic plans. Actuarial value simply refers to the percentage of cost that's covered by the plan.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. LIS, also known as Extra Help, is a Social Security program that helps people with limited income and resources lower or cut Part D costs.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $21.80 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $21.80 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $250.00. This is the amount you must pay at the pharmacy before Health Alliance Medicare begins paying its share.
NOTE: The deductible does not apply to one or more drug tiers in this plan (see "Prescription Drug Plan Out-of-Pocket Costs" below).
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Health Alliance Medicare POS Enrich Rx has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $2.00 copay (deductible does not apply) |
2 (Generic) | N/A | $15.00 copay |
3 (Preferred Brand) | N/A | $47.00 copay |
4 (Non-Preferred Drug) | N/A | 50% |
5 (Specialty Tier) | N/A | 29% |
CMS Rating Marks for 2024
Each year Medicare rates health plans (Part C) and drug plans (Part D) in several major categories based on a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join this Health Alliance Medicare plan.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
This Medicare Advantage HMO-POS plan is way better than average. Here's how we can make this claim. Staying healthy is the best way to save money on health care, and Health Alliance Medicare POS Enrich Rx does a good job keeping its members in top health through preventive care, including screenings, tests, and vaccines. When it comes to helping members manage their chronic health conditions, this plan does an average job.
Overall, members say their experience with this Health Alliance Medicare HMO-POS plan is excellent. When it comes to complaints and changes in performance, this plan gets the highest marks. Not the best or the worst when it comes to customer service, this health plan's customer service is average.
Health Alliance Medicare POS Enrich Rx does not offer any additional popular benefits, like dental, vision, or hearing.
This plan has an additional premium of $165.00 dollars per month. The additional cost may be worth it if you fully use the plan's benefits. Health Alliance Medicare POS Enrich Rx has an exceptionally low maximum out-of-pocket (MOOP) limit. It's just $0 per year. With a MOOP this low, your out-of-pocket costs for a 5-day stay in the hospital are much lower than Original Medicare. With no annual deductible, members of this health plan have first dollar coverage, which is comforting on a fixed budget.
Plan Availability
Health Alliance Medicare POS Enrich Rx (H1463-042-0) is available in the following locations (click to open):
Additional Medicare Advantage Plan Options
The Medicare Advantage program offers a myriad of options, including these plans:
- H1463-044-0: Health Alliance Medicare POS Choice Rx (HMO-POS)
- H1463-003-0: Health Alliance Medicare HMO 20 Rx (HMO)
- H1463-041-0: Health Alliance Medicare HMO Basic Rx 2 (HMO)
- H1463-008-0: Health Alliance Medicare HMO Basic (HMO)
- H1463-015-0: Health Alliance Medicare POS Basic Rx (HMO-POS)
Contact Health Alliance Medicare
Plan Website: | http://www.healthalliancemedicare.org |
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Formulary Information: | http://www.healthalliancemedicare.org |
Pharmacy Information: | Health Alliance Medicare Pharmacy Page |
Prospective Members: | (888)382-9771 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
Citations & References
- Health Alliance Medicare, http://www.healthalliancemedicare.org, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Your Medicare Coverage", Last Accessed April 11, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
About This H1463-042-0 Plan Detail Page
The data on this Health Alliance Medicare POS Enrich Rx plan detail page is derived from the 2024 Landscape Source Files, Plan Benefit Package, and Medicare Part C and Part D Performance Data published by CMS.
The author interprets these files, and their associated data dictionary, with great care, making every attempt to communicate the data submitted by Health Alliance Medicare to CMS as clearly and accurately as possible. Given the complexity of the data, the author recommends that all potential enrollees request an official Summary of Benefits from Health Alliance Medicare, at (888)382-9771, prior to enrollment.