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Hap Senior Plus PPO Option 3

Monthly Premium

$165*

Deductible

$0 Medical/$0 Rx

Max out of pocket

$5,000/ $7,000

Copays (PCP/Specialist)

$10/$35

Dental

$0 preventive - 2 cleanings; 2 exams & a set of bite-wing x-rays; 50% coinsurance for comprehensive services with $3,000 max benefit allowance.

Over-the-counter (OTC) benefit

$75 allowance/quarter and can rollover.

Vision

$0 routine exam. $130 yearly allowance for eyeglasses or contact lenses.

Hearing / Hearing Aids

$0 routine exam. Copays for hearing aids - 1 per ear/per year.

Inpatient Hospital

$225 Days 1-7; $0 Days 8-90

Preventive Care

No copay for services considered preventive.

Outpatient Diagnostic Labs, Procedures, Tests

$0 - $150 depending on service.

Emergency Room / Urgent Care

$90/$55 no limit; worldwide coverage

Physical, Occupational and Speech Therapy

$20 per visit; unlimited
* You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.
Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Medicare Complete Duals (HMO D-SNP) and HAP Medicare Complete Assist (PPO D-SNP) are Medicare health plans with Medicare contracts and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.