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Hap Senior Plus PPO Option 4

Monthly Premium

$180*

Deductible

$0 Medical/$0 Rx

Max out of pocket

$4,000/ $6,100

Copays (PCP/Specialist)

$0/$25

Dental

$0 preventive - 2 cleanings; 2 exams & a set of bite-wing x-rays; 50% coinsurance for comprehensive services with $3,000 max benefit allowance.

Over-the-counter (OTC) benefit

$100 allowance/quarter and can rollover.

Vision

$0 routine exam. $130 yearly allowance for eyeglasses or contact lenses.

Hearing / Hearing Aids

$0 routine exam. Copays for hearing aids - 1 per ear/per year.

Inpatient Hospital

$145 Days 1-7; $0 Days 8-90

Preventive Care

No copay for services considered preventive.

Outpatient Diagnostic Labs, Procedures, Tests

$0 - $100 depending on service.

Emergency Room / Urgent Care

$90/$55 no limit; worldwide coverage

Physical, Occupational and Speech Therapy

$0 per visit; unlimited

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

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.