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Determinations

Learn how we make decisions about coverage and payments

A coverage determination is the initial decision we make about your coverage or payment for a prescription drug request. An organization determination is the initial decision we make about your coverage or payment for a Part B drug or medical services.

With these decisions, we inform you whether we’ll provide the care or services you request (a pre-service decision), or pay for a service you’ve already received.

HAP medicare member

Manage your Medicare benefits and view personalized plan information

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Last updated 10/1/2021

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2021 Health Alliance Plan of Michigan
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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.