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HAP Medicare Complete Duals (HMO D-SNP)

HAP is here with more benefits

HAP Medicare Complete Duals, formerly HAP Empowered Duals is a Medicare Advantage special needs plan designed for people who have qualified for both Medicare and Medicaid assistance. This plan is for individuals who reside in Genesee, Macomb, Oakland and Wayne counties.

Enjoy Medicare medical and hospital benefits, plus prescription drug benefits and coverage for dental, vision and hearing, as well as additional help and benefits such as transportation. There are also no copays for primary care office visits, specialist office visit and outpatient services. 

Call us at (833) 923-1652 (TTY: 711) and a licensed HAP Medicare sales representative can walk you through the information and/or schedule an appointment. 

Because you get assistance from Medicaid with cost-sharing for Medicare Part A and B expenses such as deductibles, copayments and coinsurance, you may pay nothing for Medicare healthcare services. Medicaid also provides other benefits to you, by covering healthcare services and prescription drugs not usually covered under Medicare. You also get extra help from Medicare to pay for your Medicare prescription drugs.

As a member of HAP Medicare Complete Duals, we'll manage all of these benefits for you, so you're sure to get all the healthcare services and payment assistance you're entitled to.

Monthly Premium

$0-$32.70*

Deductible

$1,484 medical/
$203 Part B

Max out of pocket

$6,700

Copays (PCP/Specialist)

20%

Dental

 2 exams, 2 cleanings, 2 fluoride treatments, 1 set of bitewing x-rays/1x per calendar year. Full mouth x-rays are covered once every 5 years. $0 copay, no deductible, maximum benefit of $2000 per calendar year. Comprehensive dental covered 100% except, dentures, crowns or onlays are covered at 70%. Implants are not covered. Doesn't apply to deductible or max out of pocket. No prior auth or referral required. 

Over-the-counter (OTC) benefit

$65 allowance/quarter and can rollover.

Vision

$0 routine exam. $200 yearly allowance for eyeglasses or contact lenses.

Hearing / Hearing Aids

$0 routine exam. $1,000 allowance for hearing aids - 1 per ear/per year; hearing aids must be purchased from a NationsHearing provider.

Flex Card

$525 flexible benefit allowance per year with no rollover. This can be used to purchase healthy foods or for home safety modifications. 

Inpatient Hospital

$1484 deductible, days 1-60 0% coinsurance: days 61-90: $371, days 91+ $742, beyond lifetime reserve: all costs.

Preventive Care

No copay for services considered preventive.

Outpatient Diagnostic Labs, Procedures, Tests

20%

Emergency Room / Urgent Care

20%

Physical, Occupational and Speech Therapy

20%; $2,110 maximum benefit for PT/ST; $2,110 maximum benefit for OT.

Transportation

Need a ride? Our partners can pick you up (12 one-way rides. Based on availability.) Wheelchair vans and car seats are available upon request. Or, if you have a friend or family member who can drive, we can reimburse them. For more information, call

Your health and wellbeing

  • Expanded telehealth options for behavioral health and dermatology
  • Identity theft protection and global travel emergency services through Assist America
  • Mom's Meals - members that have congestive heart failure, hypertension or diabetes can receive 14 days of fresh, nutritious, ready-to-heat meals delivered to their home after discharge from the hospital.
  • $65 allowance per quarter on over-the-counter items through your medical benefit; must use Nations OTC. 

Supplemental benefits

  • NationsBenefits provides D-SNP members with a $525 flexible benefit prepaid card to purchase healthy food and pay for home modifications
  • NationsResponse Personal Emergency Response System (PERS) Benefit provides eligible members PERS devices
  • NationsCare Optimized Companion Care benefit provides up to 8 hours a month of companion care for eligible members. 

Help with doctor's appointments and screenings

HAP has a care team who will work with you to get to doctor's appointments and give you tools to manage your health. Our care team will help you get started on programs created to meet the needs of members with chronic medical conditions such as diabetes, high blood pressure, high cholesterol, asthma and more. A Nurse Case Manager can discuss our programs with you to help identify any health needs you may have.

  • Livongo® - Linongo® combines advanced technology with 24/7 coaching to help make managing diabetes easier. Members with diabetes who opt into the program will receive a free smart glucose meter along with test strips and lancets (shipped directly to the member). The smart meter can be used to communicate with Linongo® diabetes health care professionals to make it easier to stay healthy.
    •  Members with diabetes also have $0 copays for foot doctor appointments and $0 copays for most preventive vaccines.
  • In-home screenings and health assessments - HAP partners with a variety of vendors that provide free health care services to our valued members from the comfort of their homes. To learn more about who HAP partners with, visit our health partners page.

Great customer service

We train our customer service representatives to be helpful and friendly. They know how to answer your questions so you can make the right choices about your healthcare. Our representatives speak English, Spanish and Arabic, and we have translators for other languages.

Care from your local community

HAP Medicare Complete Duals is available in Genesee, Macomb, Oakland and Wayne counties and connected to the communities we serve. We're here to help you, as well as work with your neighborhood providers.

* You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.

This information is not a complete description of benefits. Call (833)-923-1652 (TTY:711) for more information. HAP Medicare Complete Duals (HMO D-SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment in the plan depends on contract renewal.

Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.

Have Medicare questions?

(800) 868-9885 (TTY:711)

Monday-Friday; 8 am to 8 pm