HAP has moved from its Southfield location. Effective November 26, 2018, our new address is 1414 E. Maple in Troy

Plan details

HAP Senior Plus (PPO)

  • Overview
    Plan year
    2019
    Premium
    $15
    Medical deductible
    $0 (In network)
    $275 (Out of network)
    Prescription coverage
    Yes
    Maximum out-of-pocket cost
    $5,500
    (In network)
    $7,000
    (Combined)
    Choice of doctors
    HAP Senior Plus (PPO)
    Primary doctor office visit
    $25 copay
    (In network)
    30% Coinsurance
    (Out of network)
    Specialist office visit
    $50 copay
    (In network)
    30% Coinsurance
    (Out of network)
    Telehealth
    $0 copay
    Outpatient diagnostics
    $0 - $200 diag proc/tests / $0 Lab
    (In network)
    30% Coinsurance
    (Out of network)
    Standard x-rays
    $35
    (In network)
    30% Coinsurance
    (Out of network)
    Hospital stay copay
    $250 per day (days 1-6)/ $0 per day (days 7-90)
    (In network)
    30% Coinsurance
    (Out of network)
  • Prescription coverage
    Brand-name and generic prescription drugs are covered at thousands of pharmacies in our network, including those with nationwide locations.
    Prescription deductible
    $0 deductible
    Coverage in gap
    No
    Tier 1 - Rx preferred generic
    $0 copay (Preferred pharmacy)
    $7 copay (Standard pharmacy)
    Tier 2 - Rx generic
    $10 copay (Preferred pharmacy)
    $15 copay (Standard pharmacy)
    Tier 3 - Rx preferred brand
    $42 copay (Preferred pharmacy)
    $47 copay (Standard pharmacy)
    Tier 4 - Rx non-preferred drug
    45% coinsurance (Preferred pharmacy)
    48% coinsurance (Standard pharmacy)
    Tier 5 - Rx specialty
    33% coinsurance
  • Preventive care coverage
    Welcome to Medicare exam/annual wellness visit
    Covered
    Medicare covered immunizations
    Covered
    Diagnostic lab services
    Covered
    Cardiovascular screening
    Covered
    Diabetes screening
    Covered
  • Inpatient services
    Hospital stay copay
    $250 per day (days 1-6)/ $0 per day (days 7-90)
    (In network)
    30% Coinsurance
    (Out of network)
    Skilled nursing facility
    $0 per day (days 1-20) / $172.00 per day (days 21-100)
    (In network)
    30% Coinsurance
    (Out of network)
  • Outpatient services
    Hospital outpatient facility
    $200 copay
    (In network)
    30% Coinsurance
    (Out of network)
    Ambulatory surgery center
    $100 copay
    (In network)
    30% Coinsurance
    (Out of network)
    Rehabilitation services - outpatient
    You pay a $40 copay for each Medicare covered visit for cardiac rehabilitation; You pay a $30 copay for each Medicare covered visit for pulmonary rehabilitation; You pay a $25 copay for each Medicare covered physical, speech or occupational therapy services.
    (In network)
    You pay a 30% coinsurance for each Medicare covered visit for cardiac or pulmonary rehabilitation; physical, speech or occupational therapy services.
    (Out of network)
  • Other health care services
    Home health care
    $0
    (In network)
    30% Coinsurance
    (Out of network)
    Chiropractic care
    $20
    (In network)
    30% Coinsurance
    (Out of network)
    Routine hearing and eye exams
    Hearing exam: $0 copay/exam; 1x per calendar year
    (In network)
    Hearing exam: 30% Coinsurance
    (Out of network)
    Eye exam: $0 copay/exam; 1x per calendar year
    (In network)
    Eye exam: 30% Coinsurance
    (Out of network)
    Hearing aids
    $689 to $2039 copay/hearing aid; 2 hearing aids (one per ear)/year
    Learn more about hearing aid coverage. (PDF)
    Over the counter (OTC) coverage
    Over the counter (OTC) items and medication coverage is also included with this plan. HAP will cover $45 per quarter for OTC items and medication.
    Explore the OTC product catalog to see what you can order. (PDF)
  • Urgent and emergency services
    Urgent care
    $50 copay
    Emergency room
    $90 copay *Copayment is waived if admitted to hospital;
    Ambulance
    $200 copay
    (In network)
    30% Coinsurance
    (Out of network)
  • Dental coverage
    Preventive - 1 oral exam, 1 prophylaxis, 1 set of bitewing x-rays/1x per calendar year. Preventive dental coverage is built into all individual HAP Senior Plus plans. We also have two optional supplemental packages available for purchase through Delta Dental.
  • Vision coverage
    A $100 combined benefit max is available towards the purchase of contact lenses, eyeglass lenses or eyeglass frames every calendar year in or out-of-network. No restriction or limit to the amount of eyewear purchased, but member is responsible for any amount above the eyewear coverage limit. One pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens is available at no cost to the member.
  • Silver&Fit®
    $0 fitness programs through Silver&Fit® that provide access to gym memberships or home fitness kits

HAP Senior Plus (PPO)

Copyright © 2018 HAP
2018 Health Alliance Plan of Michigan
Y0076_2019 HAP Website
CMS Accepted: 10/1/18

* Premium for male nonsmoker at age 65. For additional premiums, contact HAP.

HAP Senior Plus (HMO)/(HMO-POS)/(PPO) and HAP Primary Choice Medicare (HMO) are health 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 in the plans depends on contract renewals. HAP Senior Plus (PPO) 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. 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).

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Contact us

  • Membership

    Current members

    (800) 422-4621

     

    Prospective - Medicare eligible

    (800) 868-9885 (TTY: 711)

    M - F 8 a.m. to 8 p.m. ET

    Seven days a week

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