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HAP CareSource™ MI Coordinated Health (HMO D-SNP)
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Monthly Plan Premium
Your Part D prescription drug premium may be reduced or covered if you qualify for Extra Help (Low-Income Subsidy).
Part C: $0, Part D: $6.30*
Max Out-of-Pocket
$9,850
Deductible
$0
Primary Care Physician/Specialist Copays
$0
Dental
$0 preventive (e.g., exams, cleanings, x-rays and fluoride) and $0 comprehensive (e.g., simple extractions, minor restorations, periodontics and other non-Medicare covered comprehensive dental services including extractions, crowns, implants and dentures). Two fluoride treatments and dental implants are subject to $3,000 Medicare dental allowance annual maximum. Must use a Delta Dental provider.
Over-the-Counter Benefit
Helps pay for everyday health items, such as vitamins, toothpaste and pain relievers. Purchase from our online catalog or participating stores using your flex card. Please refer to Flex Card section below for more information.
Vision
$0 routine exam. Routine eye examinations are covered once every two years. $250 yearly allowance towards the purchase of eyeglasses and contact lenses. Must use an EyeMed provider.
Hearing and Hearing Aids
$0 routine exam. Covers one hearing aid per ear every three years. Must use a Nations Hearing provider.
Inpatient Hospital
$0 per day. Unlimited days.
Preventive Care
$0 copay for many preventive health services. These may include checkups, screenings, vaccines and health education. Please see the Member Handbook for more information on covered preventive services.
Outpatient Diagnostic Labs, Procedures and Tests
$0 lab tests. $0 copay depending on service.
Emergency and Urgent Care
$0 emergency room copay. $0 urgent care copay. $10,000 maximum plan benefit coverage amount every year for the worldwide benefit.
Physical, Occupational and Speech Therapy
$0 copay.
Prescription Coverage
Yes
Flex Card
$205 per month for qualifying over-the-counter (OTC), dental, vision and hearing items, services and accessories. Members approved for Special Supplemental Benefits for the Chronically Ill (SSBCI) benefits may use it for healthy food/produce**, utilities**, rent and mortgage assistance**, household cleaning supplies** and personal care items**. Unused amounts carry over to the next month and expire at the end of the year. Can be used at the register in participating retail stores.
Transportation
Unlimited non-emergency medical transportation for medically necessary Medicaid-covered services, pharmacy services, community/wellness services and SDOH (Social Determinants of Health)-related services including grocery stores and fitness program at participating gyms.

Call our licensed Medicare Advantage agents today.

Oct. 1 – March 31, 8 a.m. to 8 p.m., Seven days a week or April 1 – Sept. 30, 8 a.m. to 8 p.m., Monday through Friday

(888) 447-3850 (TTY: 711)
or
Schedule an appointmentScheduleEnroll now

Call our licensed Medicare Advantage agents today.

Oct. 1 – March 31, 8 a.m. to 8 p.m., Seven days a week or April 1 – Sept. 30, 8 a.m. to 8 p.m., Monday through Friday

(888) 447-3850 (TTY: 711)

*Your Part D prescription drug premium may be reduced or covered if you qualify for Extra Help (Low-Income Subsidy).

**The benefits mentioned are Special Supplemental Benefits for the Chronically Ill (SSBCI). You may qualify for SSBCI if you are at high risk for hospitalization and require intensive care coordination to manage one or more chronic conditions such as cardiovascular disorders, diabetes, overweight/obesity/metabolic syndrome, chronic and disabling mental health conditions or neurologic disorders. For a full list of qualifying chronic conditions or to learn more about other eligibility requirements for SSBCI, please contact Member Services or your Care Coordinator.