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Monthly Premium You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply. 
Part C: $0*, Part D: $8.80 TARGETED LIPSA
Max out of pocket
$9,050
Deductible
$0
Copays (PCP/Specialist)
$0**
Dental
$0 preventive - (eg, exams, cleanings, x-rays and fluoride) and comprehensive dental (eg, simple extractions, minor restorations, periodontics and other non-Medicare covered comprehensive dental services including extractions, crowns, implants, and dentures).
Over-the-counter (OTC) benefit
Flex card available
Vision
In-Network: No cost routine eye exam every 2 years. Eyeglasses and contacts are covered: 1 paid every 2 years.  
Hearing / Hearing Aids
$0 routine exam. Two hearing aids every 3 years. (limit 1 per year, every 3 calendar years).
Inpatient Hospital
$0; unlimited days
Preventive Care
No copay for services considered preventive
Outpatient Diagnostic Labs, Procedures, Tests
$0**
Emergency Room / Urgent Care
$0; worldwide coverage $10,000 limit
Physical, Occupational and Speech Therapy
$0
Flex Card

Members use Healthy Benefits+ debit card to purchase up to $210 per month for approved services and items from eligible locations, including: Food & Produce***, Over the Counter (OTC) Items, Utility Expenses+, Personal Care Items+, Pet Care Items+ (excluding veterinary care and grooming), Household Cleaning Items+, Pest Control Items+, Indoor Air Quality Items+, Home and Bathroom Safety Items+, and Dental, Vision and Hearing services and accessories. Unused amounts rollover to the following month and will expire at the end of the year.

+The benefits mentioned are part of special supplemental benefits for the chronically ill. Not all members qualify. Professional Services are not included for pest control, indoor air quality and home and bathroom safety devices.

Transportation
Unlimited one-way trips

*You must continue to pay your Medicare Part B premium.

**Depending on your level of Medicaid eligibility, you may not be responsible for the copayments, coinsurance or deductibles for these listed services.

***This benefit is a special supplemental benefit for the chronically ill (SSBCI) and is made available to members with one or more qualifying chronic conditions.  Not all members will qualify for this benefit. Qualifying chronic conditions include but are not limited to diabetes, cardiovascular disorders, chronic lung disorders, cancer, and dementia.  For a complete list of qualifying chronic conditions please see the plan’s Evidence of Coverage (EOC).

HAP CareSource™ MI Coordinated Health (HMO D-SNP) is a health plan that contracts with both Medicare and Michigan Medicaid to provide benefits of both programs to enrollees. Enrollment depends on contract renewal.

HAP Senior Plus (HMO-POS), HAP Medicare MedicalAccess (HMO), HAP Senior Plus Henry Ford Tiered Access (HMO), HAP Medicare Connect (HMO), HAP Medicare Superior (HMO), Henry Ford Select (HMO), HAP Senior Plus (PPO), HAP Medicare Explore (PPO), HAP Medicare Prime (PPO), HAP Member Assist (PPO), HAP Medicare Diabetes and Heart (HMO C-SNP), and HAP CareSource™ MI Coordinated Health (HMO D-SNP) has a contract with Medicare. Enrollment depends on contract renewal.