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HAP Medicare Complete Assist (PPO-DSNP)

4
Service Area
(888) 447-3850 Schedule virtual appointment
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Monthly Premium You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.
$0-$26.60*
Max out of pocket $2.30 Part B Premium Reduction
$9,350 / $14,000**
Deductible
$0 or $263**
Copays (PCP/Specialist)
$0 or 20%**
Dental
$0 preventive - 2 cleanings, 2 exams, 2 fluoride treatments & a set of bite-wing x-rays per year. $0 copay, no deductible, maximum benefit of $2000 per calendar year. Comprehensive dental covered 100%. Crowns, implants & dentures are not covered. Delta Dental PPO only network.
Vision
$0 routine exam. $300 yearly allowance for eyeglasses or contact lenses. 20% discount over $300 base allowance for frames, lenses, lens options. 40% discount applies on the purchase of any additional eyeglasses; must use EyeMed provider.
Hearing / Hearing Aids
$0 routine exam. $1,000 allowance; 2 hearing aids/calendar year; must use NationsHearing.
Inpatient Hospital You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0 or $2,185**
Preventive Care
No copay for services considered preventive.
Outpatient Diagnostics Labs, Procedures, Tests You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0 or 20%**
Emergency Room / Urgent Care
$0 or $110/$0 or $45; worldwide coverage**
Physical, Occupational and Speech Therapy You do not pay anything for services listed, as long as you are eligible for cost-sharing assistance under Medicaid.
$0 or 20%**
Prepaid Benefits Mastercard
$138 per month with rollover for retail OTC, home modifications, pest control, utilities, fuel at the pump, healthy food, plan covered services such as physician services, lab work and physical, occupational and speech therapy (excludes services provided by a vendor). 

Because we participate in the Value Based Insurance Design (VBID) Model, only those members who are eligible for "Extra Help" may use the Flex Card benefit towards healthy food and produce, home modifications, pest control, utilities and fuel at the pump or ride share services.
Call (888) 447-3850 to speak with a HAP Medicare Expert
* You must continue to pay your Medicare Part B premium. If you have a late enrollment penalty, it will still apply.

**Depending on your level of Medicaid eligibility, you may not be responsible for the copayments, coinsurance or deductibles for these listed services.
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.