FLASH: Changes Coming to Health Alliance Medicare

This year, we’re offering Medicare Advantage point of service (POS) plans rather than preferred provider organization (PPO) plans. Since these members are already your patients, the transition for you will be easy.

Members on our 2016 PPO plans were sent letters telling them their PPO plan would be ending on December 31. If you get questions from these members, please tell them to call the number on the back of their ID cards and our customer service team can help walk them through the changes.

These members must enroll in an HMO or POS plan to keep their coverage with Health Alliance Medicare. We will host several meetings to help guide them through this transition, and our customer service and sales teams are also ready to help them make the transition.

Our POS plans are a good alternative for these members. A POS plan is a blend of an HMO and PPO. Like an HMO, members get the comfort of having an in-network primary care provider (PCP) to oversee their care, but like a PPO, they have the freedom to see out-of-network doctors.

We’ve always believed medical care is at its highest quality when it’s guided by a PCP. Based on that and a national trend toward higher costs in PPOs, we are moving to plans that require PCPs. Both HMO and POS plans accomplish that.

DSNP Plans to End December 31

We will not offer our Dual Eligible Special Needs Plans (DSNP) for 2017. Our 2016 DSNP will end on December 31, 2016.

The Illinois Department of Healthcare and Family Services (HFS) will no longer contract with Special Needs Plans after 2018 and will not allow any new enrollment in those existing plans in 2017.

People are normally allowed to enroll in our DSNP throughout the year, but this change restricts that ability. Rather than turn away new enrollees in 2017 who are accustomed to being able to enroll anytime throughout the year, we decided it would minimize confusion to end our plan before the rules change.

Members currently covered by our DSNP may be auto-enrolled in a Medicare-Medicaid Plan (MMP) by HFS, or they may be able to choose to enroll in another MMP or a Medicare Advantage plan. Options for these members will vary depending on the MMP(s) available in their county. We will send communication to members informing them of their options and will do our best to help make sure they have a smooth transition.

2017 Expansion

We continue to be committed to serving the needs of Medicare beneficiaries, and we are expanding into new counties for 2017. If you or someone you know has questions about our plans, go to HealthAllianceMedicare.org.