A health plan made just for you
The Medicare Advantage POS Rx plan from Health Alliance™
See Details EnrollMedicare Prescription Payment Plan (M3P)
Starting January 2025, enrollees in Medicare Part D plans (both stand-alone prescription drug plans and Medicare Advantage plans with drug coverage) can choose the new Medicare Prescription Payment Plan (M3P). This program allows you to spread your out-of-pocket Part D drug costs over monthly payments throughout the plan year (January-December) instead of paying at the pharmacy. You can opt in at the start of the plan year or any following month, and can opt out at any time.
Learn MorePlan Summary
Thanks for being an FEHB member. We're happy to provide your health coverage and encourage you to consider our FEHB Medicare Advantage POS Rx plan. FEHB members who have Medicare Part B are eligible for this plan at no additional premium cost and receive benefits like:
- An up to $100-per-month reduction to your Part B premium.
- A fitness benefit where you get $360/year to use on a variety of fitness activities.
- A routine hearing exam and lowered rates on hearing aids through TruHearing®.
- Benefit to help pay for commonly used over-the-counter products.
The FEHB Open Enrollment Period was from November 11 to December 9, 2024. If you're already an FEHB member and have Medicare Part A & B, you can still enroll in our Health Alliance Medicare Advantage POS Rx plan by clicking the link below or calling us at (855) 291-9335.
Review Previous Year Enroll NowPharmacy Coverage
Our Medicare Part D (drug coverage) formulary lists the drugs we cover. (Generally, we only cover drugs that are listed.)
Federal Medicare FormularySee our Pharmacy Coverage Requirements for more details.
Compare Plans
Please see the information in the chart below, which provides important details on the difference between the Medicare Advantage POS Rx plan and the FEHB plan.
| Medicare Advantage POS Rx Plan | FEHB Plan | |
|---|---|---|
| Open Season | On-going based on eligibility. | Nov 11 – Dec 9, 2024 |
| Premium | No additional premium | You pay your FEHB premium |
| Part B Premium Reduction | Receive a $100/mo reduction to premium | None |
| Provider Network | Similar to the FEHB Network (View Directory) | Access to Our Broad Network of Doctors and Hospitals (View Directory) |
| Pharmacy Network | Access to Our Broad Network of Pharmacies (Find a Pharmacy) | Access to Our Broad Network of Pharmacies |
| Pharmacy Formulary | Medicare Advantage POS Formulary (View Formulary) | FEHB Formulary (View Formulary) |
| How Benefits are Paid | POS Rx plan pays in place of original medicare. You pay out-of-pocket costs after the plan pays. | Original medicare is the primary payor. You pay out-of-pocket costs after original medicare pays. |
Compare Benefits
Please see the information in the chart below, which provides important details on the difference in benefits between the new Medicare Advantage POS Rx plan and the FEHB plan.
Medicare Advantage POS Rx
| In Network | Out of Network | |
|---|---|---|
| Medical Deductible | $0 | $0 |
| Out-of-Pocket Max | $2,000 | $2,000 |
| Primary Care Office Visit | $0 | 30% |
| Specialty Office Visit | $0 | 30% |
| Inpatient Hospital | $0 | 30% |
| Outpatient Hospital | $150 | 30% |
| Part B Premium Reimbursement | $100/mo | $100/mo |
| Emergency Care | $140 | $140 |
| Urgent Care | $40 | $40 |
| Out-of-Pocket Waived | Yes | Yes |
| Ambulance (Ground) | $100 | $100 |
| Doctor Costs Inpatient Surgery | $0/Days 1-5, $0/Days 6-90 | 30% |
| Hospital Inpatient Cost / Admission | $0/Days 1-5, $0/Days 6-90 | 30% |
| Doctor Costs Outpatient Surgery | $150 | 30% |
| Chiropractic | $20 | 30% |
| Physical Therapy | $40 | 30% |
| Simple Diagnostic Tests/Procedures (X-Ray) | $25 | 30% |
| Complex Diagnostic Tests/Procedures (CT/MRI) | $100 | 30% |
| Enhanced Lab Network | $0 | $0 |
| Pharmacy Out-of-Pocket Max | None | None |
| Pharmacy Deductible | None | None |
| Tier 1: Preferred Genereic and Preventive Drugs (Retail Generic) | $0 | $0 |
| Tier 2: Nonpreferred Generics (Retail Generic) | $10 | $10 |
| Tier 3: Preferred Brand (Retail Brand) | $40 | $40 |
| Tier 4: Nonpreferred Brand (Retail Brand) | $100 | $100 |
| Tier 5: Specialty | 25% | 25% |
| Tier 6: Nonpreferred Specialty | N/A | N/A |
| Mail Service Pharmacy Benefit | Tiers 1-3: 2 x 30-day copayment Tier 4: 2.5 x 30-day copayment |
N/A |
2025 FEHB HMO-POS (Standard)
| In Network | Out of Network | |
|---|---|---|
| Medical Deductible | $750 | $1,500 |
| Out-of-Pocket Max | $7,350 | $14,700 |
| Primary Care Office Visit | $30 | 50% |
| Specialty Office Visit | $60 | 50% |
| Inpatient Hospital | 25% | 50% |
| Outpatient Hospital | 25% | 50% |
| Part B Premium Reimbursement | None | None |
| Emergency Care | $300 | $300 |
| Urgent Care | $60 | $60 |
| Out-of-Pocket Waived | No | No |
| Ambulance (Ground) | $100 | $100 |
| Doctor Costs Inpatient Surgery | 25% | 50% |
| Hospital Inpatient Cost / Admission | 25% | 50% |
| Doctor Costs Outpatient Surgery | 25% | 50% |
| Chiropractic | $60 | 50% |
| Physical Therapy | $60 | 50% |
| Simple Diagnostic Tests/Procedures (X-Ray) | 25% | 50% |
| Complex Diagnostic Tests/Procedures (CT/MRI) | 25% | 50% |
| Enhanced Lab Network | 25% | 50% |
| Pharmacy Out-of-Pocket Max | None | None |
| Pharmacy Deductible | None | None |
| Tier 1: Preferred Genereic and Preventive Drugs (Retail Generic) | $0 | 50% |
| Tier 2: Nonpreferred Generics (Retail Generic) | $10 | 50% |
| Tier 3: Preferred Brand (Retail Brand) | $40 | 50% |
| Tier 4: Nonpreferred Brand (Retail Brand) | $140 | 50% |
| Tier 5: Specialty | $200 | 50% |
| Tier 6: Nonpreferred Specialty | 50% | 50% |
| Mail Service Pharmacy Benefit | All Tiers: 2.75 x 30-day copayment | No |
Enrollees in other Federal Programs such as Medicare and Medicaid are statutorily prohibited from participating in pharmacy incentive programs under section 1320a-7b of title 42, United States Code (“the Anti-Kickback Act). For more information, visit OPM.gov/Healthcare-Insurance/Healthcare