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Service area 
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Monthly Premium
Part C: $0*, Part D: $8.80, TARGETED LIPSA
Max Out-of-Pocket
$5,200
Deductible
$0
Copays (PCP / Specialist)
$0/$30
Dental
$0 preventive - 2 cleanings, 2 exams, 2 fluoride treatments and a set of bite-wing x-rays per year. Full mouth x-rays are covered once every 5 years. $0 copay, no deductible, maximum benefit of $2,000 per calendar year. Comprehensive dental covered 100%. Implants and dentures are not covered. PPO only network.
Over-the-Counter Benefit
Flex card available
Vision
$0 routine exam. $150 yearly allowance for eyeglasses or contact lenses. 20% discount over $150 base allowance for frames, lenses and lens options. 40% discount applies on the purchase of any additional eyeglasses; Must use EyeMed provider.
Hearing / Hearing Aids
$0 routine exam. Copays for hearing aids - 1 per ear, per calendar year; Must use NationsHearing.
Inpatient Hospital
$250 for days 1-5, $0 for days 6-90; Unlimited days
Preventive Care
No copay for services considered preventive.
Outpatient Diagnostics Labs, Procedures, Tests
$0 lab tests. $0 - $65 copay depending on service.
Emergency Room / Urgent Care
$130/$45; Worldwide coverage
Physical, Occupational and Speech Therapy
$20 copay
Prescription Coverage
Yes
Flex Card
$116 per quarter with rollover. Use towards over-the-counter (OTC), healthy food/produce** and copay assist for plan covered services such as: physician services, lab work and PT/OT/ST; Excludes services provided by a vendor and prescription drugs; Includes retail over-the-counter
Transportation
12 one-way trips

Call HAP's licensed Medicare Advantage agents today.

Oct. 1 – March 31, 8 a.m. to 8 p.m., Seven days a week; 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 HAP's licensed Medicare Advantage agents today.

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

(888) 447-3850 (TTY: 711)

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

**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).

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

Health Alliance Plan (HAP) has HMO, HMO C-SNP, HMO-POS, and PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP), HAP Medicare Complete Assist (PPO D-SNP), and HAP CareSourceTM MI Coordinated Health (HMO D-SNP) are Medicare health plans with a Medicare contract and a contract with the Michigan Medicaid Program that provides benefits of both programs to enrollees. Enrollment depends on contract renewals.