Which Alliance Medicare PPO option 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
| |
Original
Medicare |
Alliance Medicare PPO
Option 1
In-network |
Alliance Medicare PPO Option 2
In-network |
Alliance Medicare PPO
(Both options)
Out-of-network |
Monthly plan
premium*
|
Medicare Part B
premium |
$147 |
$167 |
No additional premium |
Upfront deductible
(Must be paid before coverage begins. Not applicable to prescription drugs
or skilled nursing
facility)
|
$1,100 per hospital stay; medical services $155 annually
|
No deductible |
$250 deductible** |
No additional deductible |
Primary doctor's / specialist's
office visits
|
20% of Medicare-approved
amount |
$15/30 per visit |
$20/35 per visit |
20% |
Hospital coverage
|
150 day limit.
$1,100 deductible
Days 61-90: $275 per day
Days 91-150: $550 per day.
Doctor’s services not included. |
$100 per day up to 5 days
(Unlimited days)
Doctor’s services included
|
$200 per day up to 5 days
(Unlimited days)
Doctor’s services included
|
Skilled nursing
facility
|
Minimum 3-day prior hospital stay
Days 1-20: $0 per day
Days 21-100: $137.50 per day |
No prior hospital stay required.
Days 1-20: $0 per day
Days 21-100: $137.50 per day |
No prior hospital stay required.
Days 1-20: $100 per day
Days 21-100: $145.00 per day
|
Home health care
|
$0 |
$0 |
20% |
Standard x-rays and lab tests
|
20%‡ |
$0 |
20% |
Routine exams
|
Limited coverage§ |
Office visit copay per visit |
20% |
| Hospital outpatient |
20% co-insurance |
$0 to $75 facility copay, $25 copay for radiation/chemo/ESRD |
20% |
Eyeglasses or
contacts (Subject
to limitations) |
Not covered
(except for cataract
surgery) |
One pair every 2 years |
Worldwide
emergency/urgent
care coverage |
20% co-insurance.
Coverage only
within U.S.** |
$50 / $35
Copay is waived if you are admitted to the hospital |
| Ambulance |
20% co-insurance |
$75 |
20% |
| Flexible Health Options |
None |
Up to $25/month† ($300/year) |
Prescription coverage
Copays for 30-day supply |
None |
$6.00 generic
$40.00 preferred brand
$60.00 non-preferred
33% specialty
(Find out more about prescription coverage) |
$4.00 generic
$35.00 preferred brand
$55.00 non-preferred
33% specialty.
Coverage in gap
(Find out more about prescription coverage)
|
|
This benefit information is not comprehensive. Please review the Summary of Benefits to learn more about each plan option before making a decision about your coverage.
Benefits provided through individual plans and employer group plans may vary.
*You must continue to pay your Medicare Part B premium. Your monthly premium may be reduced if you qualify for extra financial assistance.
**Coverage is available only within the United States, except under limited circumstances for medical emergencies.
†Unused amounts cannot be carried over from month to month.
‡Except for approved lab services.
§Except for “Welcome to Medicare” physical exam, which is covered.
For more information
Learn more about our plans and plan premiums
Download the Alliance Medicare PPO booklet
(requires Adobe Reader)
Talk with an Alliance Medicare representative
Our experienced plan representative can answer questions about your coverage, medications, or pharmacies.
Enrollment and customer service, call toll-free:
(800) 868-3153 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.
Write to us at:
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. The Alliance Medicare PPO contract with Medicare is renewed annually. The availability of coverage beyond the end of the current contract year is not guaranteed.
Alliance Medicare PPO is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP.
