Learn the different parts of Medicare and get to know the various options you have to choose from. (Video, 5:15)Open video transcript
Tips to understand Medicare and prepare for enrollment
Medicare coverage is made up of several “parts” – Original Medicare (Parts A and B), Medicare Advantage (Part C) and Medicare prescription drug plans (Part D) – designed to fit specific needs. We’ll help you understand how Medicare works, avoid potential penalties and compare plans.
Why choose HAP?
We’ve enhanced our Medicare Advantage benefits for 2019. With HAP you get more choice, easy-to-use and easy-to-understand plans, great preventive benefits and extras that you don’t pay for.
Medicare Parts Explained
Original Medicare: Part A and Part B
Medicare Part A helps cover hospital inpatient care. If you’ve been employed and paid Medicare taxes, you likely won’t have to pay a premium for Part A coverage.
Medicare Part B helps cover things such as doctor visits, outpatient services and preventive care. You’ll pay a monthly premium if you want Part B coverage.
Medicare Part C also is known as Medicare Advantage. These plans are offered by private companies such as HAP. They provide all the coverage available in Medicare Part A and Part B and may include additional benefits as well. They also can include Medicare Part D prescription drug coverage.
We offer a variety of Part C plans (available with and without Part D prescription drug coverage) to make sure you get the coverage that’s right for your lifestyle and budget.
- HAP Primary Choice Medicare (HMO)
- HAP Senior Plus Henry Ford Tiered Access® (HMO)
- HAP Senior Plus® (PPO)
- HAP Senior Plus Medical Only® (HMO-POS)
Medicare Part D is prescription drug coverage available only through private companies such as HAP. It helps lower prescription drug costs and protects against higher costs in the future. Our Medicare Advantage health plans offer prescription coverage.
Benefits of a HAP Medicare supplement plan:
- Competitive monthly premiums
- Freedom to choose any doctor or hospital that accepts Medicare
- No referrals needed to see a specialist
- $0 copays on Medicare-approved preventive services
Plan types at a glance
Now that you know more about Medicare parts, it’s important to understand the different types of plans we offer. We have four different types of Medicare plans.
HAP Senior Plus (HMO), HAP Senior Plus (HMO-POS), HAP Senior Plus (PPO) serves members with Medicare who reside in our 30-county service area:
- St. Clair
HAP Primary Choice Medicare (HMO) and HAP Senior Plus Henry Ford Tiered Access (HMO) serve members with Medicare who reside in Wayne, Oakland and Macomb counties.
Alliance Medicare Supplement plans serve Michigan residents with Original Medicare.
Health maintenance organization (HMO)
HMOs are typically more affordable than PPOs. HMO members get their care through their primary care physician, or PCP. If you need to see a specialist, all you have to do is make an appointment. Your doctor will handle the rest.
HAP Senior Plus (HMO)
HAP Senior Plus (HMO) offers Medicare Advantage plans with and without drug coverage. These plans offer members lower premiums and out-of-pocket medical and drug costs. All of your health care services will be coordinated between you and your designated primary care physician from a network of local healthcare providers who refer you when necessary to in-network specialists or hospitals. This network is made up of 30 counties (highlighted in orange²)
HAP Primary Choice Medicare (HMO)
Our Primary Choice Medicare plan gives Medicare Advantage members who reside in Wayne, Oakland and Macomb counties access to an integrated network of nearly 400 primary care physicians, along with open access to specialists.
HAP Senior Plus Henry Ford Tiered Access (HMO)
Our Henry Ford Tiered Access plan offers Medicare Advantage members who reside in Wayne, Oakland and Macomb counties the reassurance of seeing a Henry Ford Health System doctor or specialist, as well as the flexibility of seeing network doctors and specialists in our entire 30-county HMO service network.²
The “tiered access” refers to the costs associated with the doctors or specialists you see.
- “Tier 1 providers” are network providers who you will access at the highest benefit level or least amount of patient cost share.
- "Tier 2 providers” are the network doctors and other health care professionals, medical groups, hospitals, and other health care facilities who you will access at the lowest in network benefit level or highest patient cost share.
HMO point of service (HMO-POS)
Very similar to the HMO above with the added flexibility to see doctors outside your network, if needed. This type of plan is good for members who want extra coverage when traveling outside the HAP network. Members still get lower premiums and regularly managed care through their PCP. 1
Preferred provider organization (PPO)
PPOs offer more flexibility than HMOs but you’ll pay a little more for care. You don’t need to have a PCP (but you should pick one), and you can seek care in, or outside of, the network. 1
Medigap plans, also known as Medicare supplement plans, are offered by private companies such as Alliance Health and Life Insurance Company® as a a way to help pay some of the health care costs Original Medicare doesn’t cover like copays, coinsurance and deductibles. It only supplements your Original Medicare benefits. You’ll still need to have Medicare Parts A and B.
HAP offers Alliance Medicare Supplement Plans A, C, F, G and N.
When to enroll in Medicare
There are four scenarios that allow you to sign up for a Medicare plan:
If you don’t yet have a Medicare plan, can you enroll in one if:
- You’re turning 65
- You experience a disability that qualifies you for Medicare
If you already have a Medicare plan, you can enroll in a different plan:
- During the annual enrollment period, which is every year from Oct. 15 to Dec. 7
- If you experience a life event that qualifies you for a special enrollment period, or SEP
Learn more about when and how to enroll in Medicare.
Understanding your out-of-pocket costs
When weighing health plan costs, you need to look beyond your premium. As a health plan member, you’ll need to pay your part of the costs associated with your care through:
This is a set amount you pay each time you visit your doctor, get health care services, medications or health care supplies. The amount depends on the type of covered service. Often, copays don’t count toward your deductible. You’ll still pay copays after you’ve met your deductible, until you reach your out-of-pocket limit. In some cases, your deductible must be met before copays start.
The amount you owe for covered health care or prescription drugs before your plan starts to pay for them. There are individual deductible amounts and family deductible amounts. If you go out-of-network for care, your deductible will be much higher. Your deductible resets each benefit period, which is most often a calendar year.
The percentage of charges for certain covered health care that you pay after your deductible has been met.
The most you’ll have to pay out-of-pocket during your benefit period, which is usually a calendar year.
Still have questions?
Send us an email, or give us a call and speak with a licensed HAP Medicare sales representative.
You can join us at one of our free Medicare seminars to get the latest information and answers to your questions. Find a Medicare seminar.