Understanding Medicare

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.

Medicare Parts Explained

Plan types at a glance

Medicare Advantage Plans 

With a Medicare Advantage plan, you'll have access to a network or doctors and hospitals as well benefits and services that go above and beyond such a dental, hearing, vision and over-the-counter benefits. HAP Medicare Advantage health insurance plans start at $0 per month*.

Health maintenance organization (HMO) plans

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.

HMO point of service (HMO-POS) plans

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. 

Preferred provider organization (PPO) plans

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. 

Medicare Supplement (Medigap)

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, D, 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:

  • 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.

As you explore your Medicare choices, you may run across unfamiliar words or phrases. Check out our Medicare glossary to understand what common Medicare terms mean.
 

Still have questions?

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

Send us an email, or give us a call and speak with a licensed HAP Medicare sales representative.

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
 

Attend a free seminar to get answers to your Medicare questions.

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


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2019 Health Alliance Plan of Michigan
Y0076_ALL 2020 HAP Website_M
CMS Accepted 9/29/2019

 Last Updated 9/26/2019

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

This information is not a complete description of benefits. For more information call Medicare Michigan customer service at (800) 868-9885 (TTY: 711) 8 a.m. to 8 p.m., seven days a week (Oct. 1 – March 31) / 8 a.m. to 8 p.m., Monday through Friday (April 1 - Sept. 30).


Contact us

  • HAP Medicare Sales:

    (800) 868-9885 (TTY: 711)

  • (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)