Plan Basics

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?

Our leading network of doctors and hospitals, fitness benefits, a personal service coordinator and nationwide and worldwide coverage are just a few reasons.

Medicare parts explained

  • Original Medicare: Part A and Part B

    Part A

    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.

    Part B

    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.

  • Part C

    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 Senior Plus Henry Ford Tiered Access®
    • HAP Senior Plus®
    • HAP Senior Plus Medical Only®

    Compare Medicare Advantage plans.

  • Part D

    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.

    Find a Medicare plan with Part D coverage.

  • Medigap plans

    Medicare supplement plans, also known as Medigap plans, are offered by private companies such as Alliance Health and Life Insurance Company® as a way to pay for costs not covered by Original Medicare. You must have Medicare Parts A and B to buy a Medicare supplement plan.

    Learn more about Medicare supplement plans.

    Ready to pick a plan? Compare Alliance Medicare supplement plans.

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.

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. Find a doctor in our network.

HAP Senior Plus Henry Ford Tiered Access (HMO)

Our Henry Ford Choice Network is made up of Oakland, Macomb and Wayne counties. The service area is highlighted in gray below. It offers Medicare Advantage members who reside in those three 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 22-county HMO service network.¹

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.

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 22 counties. It’s highlighted in orange below.²

HMO point of service (HMO-POS)

Very similar to the HMO above with the 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. 3

22 county medicare map

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. 4

22 county medicare map

Medigap

Medigap plans 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.

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. Or enroll in a HAP Medicare plan.

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:

  • Copays
  • Coinsurance
  • Deductibles

Copay

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.

Deductible

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.

Coinsurance

The percentage of charges for certain covered health care that you pay after your deductible has been met.

Out-of-pocket limit

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. Contact us.

You can join us at one of our free Medicare workshops to get the latest information and answers to your questions. Find a Medicare workshop.

We can also mail you our “Getting Started With Medicare” brochure, which includes information you need to select Medicare coverage with confidence. Request the brochure.

Understanding Medicare basics

Learn the different parts of Medicare and get to know the various options you have to choose from. (Video, 5:15)

Open video transcript
 

Turning 65? Join one of our free, online Medicare workshops

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1 HAP Senior Plus Henry Ford Tiered Access (HMO) is available only to residents of Macomb, Oakland, or Wayne counties. HAP Senior Plus Henry Ford Tiered Access (HMO) Tier 1 providers are Henry Ford Health System doctors and providers located in Macomb, Oakland, and Wayne counties. HAP Senior Plus Henry Ford Tiered Access (HMO) Tier 2 providers are within HAP’s 22-county HMO service network which include Arenac, Bay, Clare, Genesee, Gladwin, Gratiot, Huron, Iosco, Jackson, Lapeer, Livingston, Macomb, Midland, Monroe, Oakland, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw or Wayne counties. 

2 HAP Senior Plus (HMO) is a health plan with a Medicare contract. Enrollment in the plan depends on contract renewal. HAP Senior Plus (HMO) serves members with Medicare who reside in Arenac, Bay, Clare, Genesee, Gladwin, Gratiot, Huron, Iosco, Jackson, Lapeer, Livingston, Macomb, Midland, Monroe, Oakland, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw or Wayne counties.

3 HAP Senior Plus (HMO-POS) Expanded Network is a health plan with a Medicare contract. Enrollment in the plan depends on contract renewal. HAP Senior Plus (HMO-POS) serves members with Medicare who reside in Arenac, Bay, Clare, Genesee, Gladwin, Gratiot, Huron, Iosco, Jackson, Lapeer, Livingston, Macomb, Midland, Monroe, Oakland, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw or Wayne counties.

4 HAP Senior Plus (PPO) is a health plan with a Medicare contract. Enrollment in the plan depends on contract renewal. HAP Senior Plus (PPO) is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of Health Alliance Plan (HAP). HAP Senior Plus®(PPO) serves members with Medicare who reside in Arenac, Bay, Clare, Genesee, Gladwin, Gratiot, Huron, Iosco, Jackson, Lapeer, Livingston, Macomb, Midland, Monroe, Oakland, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Washtenaw or Wayne counties.

Alliance Medicare Supplement and Alliance Medicare PPO are products of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP.

Neither Alliance Medicare Supplement nor its agents are connected with Medicare and are not connected with or endorsed by the United States government or the federal Medicare program

This is a solicitation of Alliance Medicare Supplement insurance and you may be contacted by a licensed, authorized HAP Medicare Sales Person.

The provider network may change at any time. You will receive notice when necessary.

Copyright © 2017 HAP
2017 Health Alliance Plan of Michigan
Y0076_ALL_2018029 Website MP
CMS Approved: 6/26/2017
Last Update: 6/21/2017

HAP Senior Plus HMO, HMO-POS, and PPO are health plans with a Medicare contract. Enrollment in these plans depends on contract renewal. HAP Senior Plus PPO is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP. Alliance Medicare Supplement is a product of Alliance Health and Life Insurance Company, a wholly owned subsidiary of HAP.

This information is not a complete description of benefits. Contact the plan for more information. Limitation, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. The formulary, pharmacy network, and or provider network may change at any time. You will receive notice when necessary.

Contact us

  • (800) 868-3153 TTY: 711

  • HAP Senior Plus®

    (800) 801-1770 TTY: 711

  • HAP Senior Plus® (PPO)

    (888) 658-2536 TTY: 711

  • Alliance Medicare Supplement:

    (800) 873-7526 TTY: 711