Which Alliance Medicare PPO plan is right for you? This chart summarizes the key hospital and medical benefits for each plan.
Download the Summary of Benefits (requires Adobe Reader)
| |
Alliance Medicare PPO
Value Plan
In-network
|
Alliance Medicare PPO Plan
In-network |
Alliance Medicare PPO
(Both plans)
Out-of-network
|
Monthly plan
premium*
|
Without drug coverage:
$38
With drug coverage:
Basic plan
$61
Enhanced plan $87 |
Without drug coverage:
$82
With drug coverage:
Basic plan
$105
Enhanced plan
$131 |
No
additional premium |
Upfront deductible
(Not applicable to prescription drugs
or skilled nursing
facility)
|
$500 deductible**
(in- and out-of-network combined) |
No deductible |
No
additional deductible |
Doctor’s/specialist’s
office visits
|
$10/$25 per visit |
20% |
Hospital coverage
|
Unlimited days. $250 per admission |
Unlimited days.
$500
per
admission |
Skilled nursing
facility
|
$0 for days 1-20
$128 for days 21-100† |
$100 for days 1-20
$130 for days 21-100† |
Home health care
|
$0 |
20% |
X-rays and lab tests
|
$0 |
20% |
Routine physical,
eye,
and hearing
exams. Mammograms, pelvic
exams, prostate
cancer and colorectal screening exams***
|
$0 |
20% |
Eyeglasses or
contacts (Subject
to limitations)
|
One pair every 2 years |
20% |
Worldwide
emergency/urgent
care coverage |
$50 /$30
Copay is waived if you are admitted to the hospital |
| Hearing aids |
Covers $400 per year |
Flexible fitness
program |
Up to $20/ month
($240/ year)**** |
* You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Your monthly premium may be reduced if you qualify for extra financial assistance.
**Value Plan’s upfront deductible of $500 must be met before benefits begin.
***When services are rendered in a physician’s office, office visit copay may apply.
****Unused amounts cannot be carried over from month to month
†No prior hospital stay required.
What level of prescription drug benefits do you need?
Alliance Medicare PPO offers three levels of prescription drug coverage:
You choose the level of protection that’s right for you.
Compare choices for Alliance Medicare PPO prescription drug coverage
Is dental coverage important to you?
Maintaining good oral and dental health is important to your overall health. Our plan helps ensure you’re covered for routine care as well as unexpected expenses. Find out more about our optional dental coverage
For more information (requires Adobe Reader)
Download the Alliance Medicare PPO booklet to learn more about our plans and plan premiums.
Download the Summary of Benefits to learn details and key components of our plans.
Talk with a plan representative
Our experienced representatives can answer questions about your Alliance Medicare Rx coverage, our formulary, or our pharmacy network.
For enrollment and customer service, call:
(800) 868-3153 TOLL-FREE
or TDD (313) 664-8000
Monday through Friday, 8:30 a.m. to 5:00 p.m.
You can also write to us at:
HAP Client Services
Attn: Medicare
2850 West Grand Boulevard
Detroit, Michigan 48202
Important information
Our Alliance Medicare PPO contract with CMS is renewed annually. The availability
of coverage beyond the end of the current contract year is not guaranteed.
