2018 HAP Senior Plus Option 1 (PPO) H2322-011 By HAP Senior Plus (PPO)

2018 Medicare Advantage HAP Senior Plus Option 1 (PPO)

HAP Senior Plus Option 1 (PPO) H2322-011 is a 2018 Medicare Advantage or Medicare Part-C plan by HAP Senior Plus (PPO) available to residents in Michigan. This plan includes additional Medicare prescription drug (Part-D) coverage. The HAP Senior Plus Option 1 (PPO) has a monthly premium of $15.00 and has a in-network Maximum Out-of-Pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure your co-pays are capped once you pay out of pocket $5,500 this can be a very nice safety net.

HAP Senior Plus Option 1 (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

HAP Senior Plus (PPO) works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for HAP Senior Plus Option 1 (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from HAP Senior Plus (PPO) and not Original Medicare. With Medicare Advantage your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from HAP Senior Plus (PPO) except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2018 HAP Senior Plus (PPO) Medicare Advantage Plan Details

Name:
HAP Senior Plus Option 1 (PPO)
ID:
H2322-011
Provider:HAP Senior Plus (PPO)
Year:2018
Type: Local PPO
Monthly Premium C+D: $15.00
MOOP: $5,500




Plan Services






Health plan deductible


$275 annual deductible



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures In-Network $200
Diagnostic tests and procedures Out-of-Network 30%
Lab services In-Network $20
Lab services Out-of-Network 30%
Diagnostic radiology services (e.g., MRI) In-Network $200
Diagnostic radiology services (e.g., MRI) Out-of-Network 30%
Outpatient x-rays In-Network $35
Outpatient x-rays Out-of-Network 30%



Hearing


Hearing exam In-Network $35-50
Hearing exam Out-of-Network 30%
Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam Not covered
Cleaning Not covered
Fluoride treatment Not covered
Dental x-ray(s) Not covered



Comprehensive dental


Non-routine services Not covered
Diagnostic services Not covered
Restorative services Not covered
Endodontics Not covered
Periodontics Not covered
Extractions Not covered
Prosthodontics, other oral/maxillofacial surgery, other services Not covered



Vision


Routine eye exam In-Network $35-50
Routine eye exam Out-of-Network 30%
Other Not covered
Contact lenses In-Network $0 copay
Contact lenses Out-of-Network 50%
Eyeglasses (frames and lenses) Not covered
Eyeglass frames In-Network $0 copay
Eyeglass frames Out-of-Network 50%
Eyeglass lenses In-Network $0 copay
Eyeglass lenses Out-of-Network 50%
Upgrades Not covered



Mental health services


In-Network $250 for days 1 through 6
$0 for days 7 through 90
Out-of-Network 30% per stay
Outpatient group therapy visit with a psychiatrist In-Network $35
Outpatient group therapy visit with a psychiatrist Out-of-Network 50%
Outpatient individual therapy visit with a psychiatrist In-Network $35
Outpatient individual therapy visit with a psychiatrist Out-of-Network 50%
Outpatient group therapy visit In-Network $35
Outpatient group therapy visit Out-of-Network 50%
Outpatient individual therapy visit In-Network $35
Outpatient individual therapy visit Out-of-Network 50%



Skilled Nursing Facility


In-Network Coming soon
Out-of-Network 30% per stay



Rehabilitation services


Occupational therapy visit In-Network $40
Occupational therapy visit Out-of-Network 30%
Physical therapy and speech and language therapy visit In-Network $40
Physical therapy and speech and language therapy visit Out-of-Network 30%



Ambulance


In-Network $200
Out-of-Network 30%



Transportation


Not covered



Other health plan deductibles?


In-Network No



Foot care (podiatry services)


Foot exams and treatment In-Network $50
Foot exams and treatment Out-of-Network 30%
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 20% per item
Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 50% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 20% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 50% per item
Diabetes supplies In-Network $0 copay
Diabetes supplies Out-of-Network 30% per item



Wellness programs (e.g., fitness, nursing hotline)


Covered



Medicare Part B drugs


Chemotherapy In-Network 20%
Chemotherapy Out-of-Network 30%
Other Part B drugs In-Network 20%
Other Part B drugs Out-of-Network 30%



Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)


$7,000 In and Out-of-network
$5,500 In-network



Optional supplemental benefits


Yes



Inpatient hospital coverage


In-Network $250 for days 1 through 6
$0 for days 7 through 90
Out-of-Network 30% per stay



Outpatient hospital coverage


In-Network $200 per visit
Out-of-Network 30% per visit



Doctor visits


Primary In-Network $35 per visit
Primary Out-of-Network 30% per visit
Specialist In-Network $50 per visit
Specialist Out-of-Network 30% per visit



Preventive care


In-Network $0 copay
Out-of-Network 30%



Emergency care/Urgent care


Emergency $80 per visit (always covered)
Urgent care $50 per visit (always covered)






Ratings for HAP Senior Plus Option 1 (PPO) H2322

2018 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in HAP Senior Plus Option 1 (PPO) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Beneficiary Access
Health Plan Quality Improvement


Health Plan Customer Service Rating for HAP Senior Plus Option 1 (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Beneficiary Access
Drug Plan Quality Improvement


HAP Senior Plus Option 1 (PPO) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language


Part-C Premium

HAP Senior Plus (PPO) plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



Part-D Deductible and Premium

HAP Senior Plus Option 1 (PPO) has a monthly drug premium of $15.00 and a $0.00 drug deductible. This HAP Senior Plus (PPO) plan offers a $15.00 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by HAP Senior Plus (PPO) above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $15.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The HAP Senior Plus Option 1 (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%.



Part C Premium: $0.00
Part D (Drug) Premium: $15.00
Part D Supplemental Premium $0.00
Total Part D Premium: $15.00
Drug Deductible: $0.00
Tiers with No Deductible: 0
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0.00
75% LIS Premium: $3.70
50% LIS Premium: $7.50
25% LIS Premium: $11.20
Initial Coverage Limit:$3750
Gap Coverage: No


Gap Coverage

In 2018 once you and your plan provider have spent $3750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This HAP Senior Plus (PPO) plan does not offer additional coverage through the gap.



Coverage Area for HAP Senior Plus Option 1 (PPO)

(Click county to compare all available Advantage plans)





Source: CMS.

Data as of September 2, 2017.

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change as contracts are finalized. For 2018, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.

Includes 2018 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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