Which Alliance Medicare PPO plan is right for you? This chart summarizes the key hospital and medical benefits for each plan.

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Alliance Medicare PPO

Alliance Medicare PPO Value Plan

	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: $48 With drug coverage: Basic plan $72 Enhanced plan $98 Compare choices for  prescription drug coverage	Without drug coverage: $92 With drug coverage: Basic plan $116 Enhanced plan $142 Compare choices for  prescription drug coverage	No additional premium Compare choices for  prescription drug coverage
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 $133.50 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 preventive screenings (such as routine physicals, eye and hearing exams, and mammograms)	$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 health options benefit	Up to $20/ month ($240/ year)***
Optional dental coverage	Find out more about our optional dental coverage

*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.

Benefits provided through individual plans and employer group plans may vary.

**Deductible must be paid before coverage begins.

**Office visit copay may apply when services are rendered in a physician’s office.

***Unused amounts cannot be carried over from month to month.

† No prior hospital stay required.

For more information

Learn more about our plans and plan premiums

Download the Alliance Medicare PPO booklet
(requires Adobe Reader)

Talk with a plan representative
Our experienced plan representative can answer questions about your coverage, medications, or pharmacies.

Enrollment and customer service, call:
(800) 868-3153 toll free or
TDD (800) 956-4325 toll free
Monday through Friday
8:30 a.m. to 5 p.m.

Write to us at:
HAP Client Services
Attn: Medicare
2850 West Grand Boulevard
Detroit, Michigan 48202

Important information
The Alliance Medicare PPO contract with CMS is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.