2010 Medicare Solutions

A closer look at Medicare Part D prescription drug benefits for Alliance Medicare PPO

Each Alliance Medicare PPO option provides different medical and prescription drug benefits. Choosing an option with Part D benefits ensures you have coverage for today’s needs as well as protection for unexpected expenses tomorrow.

	Alliance Medicare PPO Prescription Benefits
	Option 1	Option 2
Deductible	$0	$0
Initial coverage: Annual drug costs paid by you and the plan up to a combined total of $2,830 (excludes premiums and costs of non-covered drugs, including drugs purchased outside the U.S.)	Copay for 30-day supply: $6.00 generic $40.00 preferred brand $60.00 non-preferred 33% specialty Copay for 90-day supply and mail-order: $15.00 generic $100.00 preferred brand $150.00 non-preferred 33% specialty	Copay for 30-day supply: $4.00 generic $35.00 preferred brand $55.00 non-preferred 33% specialty Copay for 90-day supply and mail-order: $10.00 generic $87.50 preferred brand $137.50 non-preferred 33% specialty
Coverage gap (Donut hole)	Alliance negotiated prices	Copay for 30-day supply: $4.00 generic Copay for 90-day supply: $10.00 generic Alliance negotiated prices on all other drugs
Catastrophic coverage: After you reach $4,550 in annual total out-of-pocket costs (excludes premiums and costs of non-covered drugs, including drugs purchased outside the U.S.)	Copay $2.50 generic or 5% (whichever is greater) $6.30 all other drugs or 5% (whichever is greater)

Convenient pharmacies

As a plan member with prescription drug benefits, you fill your prescriptions at any pharmacy in our network of more than 1,500 pharmacies, which includes:

Retail (some provide free home delivery)
Mail-order
Medical center
Long-term care
Indian Health, Tribal, and Urban pharmacies

If you travel, you can get your prescription drugs at any network pharmacy with nationwide locations (like Walgreens or Kmart) that contracts with HAP.

Generally, you must get your prescription drugs at a pharmacy in our network, except in emergency or urgent care situations.

PDF Pharmacy Directory
View our affiliated pharmacy directory online.

Getting extra help for prescription drug coverage

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for getting extra help, call:

800-MEDICARE (800-663-4227), TTY/TDD users should call (877) 486-2048. You can call this number 24 hours a day, seven days a week, or
The Social Security Administration at (800) 772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY/TDD users should call (800) 325-0778 or
Your state Medicaid office

Learn more about getting extra help

Your HAP representative can help you with:

Your options
Our formulary
Our pharmacy network

For more information about our prescription drug benefits, call us toll-free at:

Phone (800) 868-3153 or
TDD (800) 956-4325

For pharmacy and mail-order pharmacy information, call toll-free:

Phone Alliance Medicare PPO
(888) 658-2536 or
TDD (800) 956-4325

Office Hours:
Monday - Friday 8 a.m. to 8 p.m.
Saturday 8 a.m. to noon.
At all other times, you may access our Interactive Voice Recording system at the same number.

Extended hours from November 15 - March 1:
7 days a week, including holidays, 8 a.m. to 8 p.m.

You can also write to us at:
Mail HAP Client Services
Attn: Medicare
2850 West Grand Boulevard
Detroit, Michigan 48202

Important information

Alliance Medicare PPO is a health plan with a Medicare contract. Generally, your Alliance Medicare PPO prescription drug benefits are only available at contracted network pharmacies, except in emergency or urgent care situations. Also, the prescription drug benefit is only available to members of our plan. Alliance Medicare PPO members must receive prescription drug coverage through their plan. If you enroll in a stand-alone prescription drug plan, you will lose your Alliance Medicare PPO benefits.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. Additional information about benefits is available to assist you in making a decision about your coverage. This is an advertisement; for more information contact the plan.