2018 alliance medicare supplement brochure€¦ · with alliance medicare supplement (medigap)...

MED SUPP 2018 PROD BRO

2018 Alliance Medicare Supplement Brochure

Find the right plan for you.Alliance Medicare Supplement offers a choice of plans – Plan A, Plan C, Plan F, Plan G and Plan N. The benefits

of each of these plans are standardized by the federal government. Plan A provides basic benefits. Plans C,

F, G and N provide coverage over and above the basic benefits.

Take a look at the chart in your Outline of Coverage and choose the plan that best meets your needs.

All five plans offer the basic benefits.

The basic benefits include:

• Hospitalization: Coverage for Medicare

Part A daily copays, plus 365 additional

days (lifetime) after Medicare benefits end

• Medical e xpenses: Coverage for Medicare

Part B coinsurance (20 percent of Medicare-

approved costs) or copays for doctors’

services, hospital outpatient services and

other medical services

• Bl ood: First three pints of blood each year

• Hospic e: Coinsurance for inpatient respite

care and copays for hospice outpatient

prescription drugs

Note: Plans do not include Medicare Part D prescription drug benefits.

Take a closer look at HAP’s Alliance Medicare Supplement plans.

Alliance Medicare Supplement plan is not connected with or endorsed by the United States government or the

federal Medicare program. Neither Alliance Medicare Supplement nor its agents are connected with Medicare.

The outline of coverage in the back of this brochure is thorough but does not cover every detail. Contact your

local Social Security office or consult the booklet “Medicare & You” for more details.2

Alliance Medicare Supplement helps f ill the gaps in Original Medicare.With Original Medicare, you are covered for many hospital and medical expenses, but there are some

gaps in that coverage that you may have to pay – such as deductibles, coinsurance and copays – and

those costs can add up quickly:

• Medicar e Part A has an upfront deductible

of $1,340 for hospitalization – a deductible you

pay each benefit period before your Medicare

coverage begins.

• If y ou stay in the hospital more than 60 days,

you begin paying a copay of $335 per day.

• A fter 90 days in the hospital, your copay

increases to $670 per day.

• Y ou pay 20 percent coinsurance for most

doctors’ services after you pay your Part B

deductible each year.

• Y ou pay 100 percent for emergency care

received outside the U.S., except under

limited circumstances.

Protect your health with Alliance Medicare Supplement.

With Alliance Medicare Supplement (Medigap) plans, you can fill the coverage gaps listed above and

know that you are protected with a plan from Alliance Health and Life Insurance Company (Alliance).

With Alliance Medicare Supplement, you can receive care any place in the U.S. that accepts Medicare,

and with some plans, you have emergency care anywhere in the world.

A dependable, Michigan-based partner.

Medicare beneficiaries have relied on us and our Medicare plans for over 25 years. By listening carefully to our

members, we have been able to make our health plans and services more responsive. With Alliance, you’ll have

the comfort that comes from knowing you have a partner in Michigan that is dedicated to delivering inspired

customer service. Alliance is a wholly owned subsidiary of Health Alliance Plan (HAP), a Michigan-based

company that has been serving the community for more than 50 years.

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Reliable, easy-to-use coverage.

Freedom and choice.

With an Alliance Medicare Supplement plan, you are covered wherever you go.

• Y ou can visit any doctor, specialist or hospital that participates in Medicare, anywhere in the U.S.

• No referrals are necessary or required to see a specialist.

• Y our benefits start on day one – there is no waiting period for protection to begin.*

• You get worldwide emergency coverage.**

Convenient and simple.

When you enroll in an Alliance Medicare Supplement plan:

• There is virtually no paperwork for you with our automatic claims processing.

• Your health claims are processed quickly.

• Y our benefits through Alliance Medicare Supplement change automatically when Original Medicare

deductibles, coinsurance or copays change, so you know you’re covered.

• Your coverage renews automatically every year as long as you continue to pay your premiums.

*If y ou delay enrollment and have a health problem that is diagnosed before your Medigap policy starts, the insurance company can refuse to cover that health problem for up to six months. However, you will still be covered under Original Medicare.

** Pl an C, Plan F, Plan G and Plan N.

4

Inspired customer service.

Customer service is deeply rooted in the HAP culture. It is what each HAP employee strives for each day with

every phone call, every email, every member touchpoint. We make it easy for you to focus your attention on

doing what’s best for you and your family.

Our Medicare customer Service representatives specialize in Medicare, work right here in Michigan, and can

access your plan records immediately to help provide assistance, answer questions and explain plan details.

5

Whenever you need help, your HAP Medicare customer service representative is always just a phone call away.

Answers to some of the top questions.

How do I know if I am eligible for Alliance Medicare Supplement?

Generally, if you are a Michigan resident enrolled in both Medicare Parts A and B, you are eligible for Alliance

Medicare Supplement. You will have to continue to pay the monthly Medicare Part B premium. In addition,

you will have to pay a premium for your Alliance Medicare Supplement policy.

When can I sign up for Alliance Medicare Supplement?

You can purchase Alliance Medicare Supplement at any time. The best time to purchase your policy is when

you become eligible for Medicare and enroll in Medicare Part B.

Am I covered when I travel?

Yes. Your coverage goes with you anywhere in the United States. With Plan C, Plan F, Plan G and Plan N, you

also have worldwide emergency coverage, with limitations.

6

Do I need a referral to see a specialist?

No. Referrals are not required. You can see any

doctor or specialist who participates in Medicare.

Can my coverage be denied?

When you turn 65, participate in Medicare Part A

and enroll in Medicare Part B, you have a guaranteed

right to buy an Alliance Medicare Supplement plan

for six months. You cannot be refused if you sign up

during this open enrollment period.

If you try to enroll in a Medicare Supplement plan

after your first six months of eligibility, an insurance

company can refuse to sell you a policy or charge you

higher premiums based on certain health conditions.

In some cases, if you have a health problem that

was diagnosed before your Medicare Supplement

policy starts, the insurance company can refuse to

cover that health problem for up to six months. This

is called a “pre-existing condition waiting period.”

The insurance company can only use this kind of

waiting period if your health problem was diagnosed

or treated during the six months before the policy

started. If you buy a Medigap policy when you have

special Medigap protections or guaranteed issue

rights, you will not be subject to a pre-existing

condition waiting period.

Once you are enrolled in a Medicare Supplement

plan, your coverage will continue to be renewed as

long as you pay the premium.

Can I keep my Alliance Medicare Supplement policy if I move out of state?

You must be a permanent resident of the State of

Michigan and physically reside in Michigan at least

six (6) months of every year.

Do Alliance Medicare Supplement plans include prescription drug coverage?

No. Medigap plans do not offer prescription drug

coverage. If you are interested in a type of plan that

may also cover prescription drugs, just give us a call

at (800) 868-3153 (TTY: 711). We will be happy to

discuss your options with you.*

Or, you may call your State Health Insurance

Assistance Program.

* These plans are subject to CMS enrollment period restrictions.

7

Enroll today.To enroll in our Medicare plan, you can use one of the following four options:

1. Enr oll online at the HAP website at hap.org/medicare

2. Call a lic ensed HAP Medicare sales representative at:

(800) 868-3153 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m.

3. C ome to a HAP Medicare workshop where you can talk with other

Medicare beneficiaries. Call or go online to find out about workshop

dates and information.

A licensed, Michigan-based HAP Medicare salesperson will be present with

information and applications to assist you. Call us for dates and locations or

for accommodation for persons with special needs at sales meetings:

(800) 868-3153 (TTY: 711), Monday through Friday, 8 a.m. to 6 p.m. ET.

4. Mail a completed enrollment form to:

HAP Medicare Division

2850 W. Grand Blvd.

Detroit, MI 48202

Prospective Members:

If you have questions, or if you are looking for more information about our benefits or enrollment periods, just call a licensed, Michigan-based HAP Medicare Sales Representative at:

(800) 868-3153 (TTY: 711)Sales hours: Monday through Friday, 8 a.m. to 8 p.m.

Current Members:

If you have questions, contact Customer Services at (800) 873-7526 (TTY: 711).

For your convenience, our Customer Services office hours are:

April 1 through September 30 Monday through Friday, 8 a.m. to 8 p.m.

October 1 through February 14 Seven days a week, 8 a.m. to 8 p.m.

February 15 through March 31 Monday through Friday, 8 a.m. to 8 p.m.;

Saturday, 8 a.m. to noon

Outside of those business hours, you may access our Interactive Voice Recording system at the same number

and leave your name and phone number. A HAP Medicare customer service representative will return your

phone call the next business day.

You can also mail your questions to:

HAP Customer Services

Attn: Medicare

2850 W. Grand Blvd.

Detroit, MI 48202

Or visit us on the Web at hap.org/medicare

This is a solicitation of Alliance Medicare Supplement insurance and you may be contacted by a licensed, authorized HAP Medicare salesperson.

Outline of Coverage for Plans A, C, F, G and N

Medicare Supplement 2018

MED SUPP OutL of Cov Revised December, 2017

U nderstanding Your Options.Health Alliance Plan (HAP) offers many resources to help you make

sense of important Medicare decisions.

In this booklet, you’ll find important premium information, as well

as details on Alliance Medicare Supplement Plans and extras you

can expect when you decide on a HAP Medicare Solution.

Important premium and plan information. . . . . . . . . . . . . . . p. 2

Premium information . . . . . . . . . . . p. 4

Medicare Supplement plans . . . . . . p. 6

1

3

Alliance Medicare Supplement premiumsThe following charts can help you determine your Alliance Medicare Supplement plan premium.

For Alliance Medicare Supplement plans, certain factors may affect your monthly premium. Your

premium is based on the area you live in, your age, gender, and whether you use tobacco. The

deductibles, coinsurance and copay amounts listed in this booklet are based upon the 2018 CMS

approved values and are subject to change in 2019.

How to determine your monthly premium:

Refer to the charts inside and follow these steps:

1. Select the chart for Non-smoker or Smoker

2. Choose your plan: A, C, F, G or N

3. S can for your age (as of January 1, 2018)

4. Select Male or Female

This amount will be included on the billing statement you receive in December for January 2018.

The entire amount due will include your premium payment plus Michigan’s state tax.

We can only raise your premium if we raise the premium for all policies like yours in this state.

Need help choosing a plan? Call (800) 868-3153 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m.

2

Important things to know about Alliance Medicare Supplement.

Policy replacement

If you are replacing another health insurance policy,

do not cancel it until you have actually received your

new policy and are sure you want to keep it.

Disclosure

Use the charts in the booklet to compare

benefits and premiums among policies, certificates

and contracts.

Please read your policy very carefully

This booklet is only an outline describing your

policy’s most important features. The policy is your

insurance contract. You should read the policy itself

to understand all of the rights and duties of both

your insurance company and you.

Right to return policy

If you find that you are not satisfied with your policy,

you may return it to:

HAP Membership & Billing Government Programs

2850 W. Grand Blvd.

Detroit, MI 48202

If you send the policy back to us within 30 days after

you receive it, we will treat the policy as if it had

never been issued and return all of your payments.

Notice

This policy may not fully cover all of your medical

costs. Neither Alliance Medicare Supplement nor its

agents are connected with Medicare and are not

connected with or endorsed by the United States

government or the federal Medicare program. This

outline of coverage does not give all the details of

Medicare coverage. Contact your local Social Security

office or consult the booklet “Medicare & You” for

more details.

Fill out the application completely

When you fill out the application for your new policy,

be sure to answer, truthfully and completely, all

questions about your medical and health history.

Alliance reserves the right to cancel your policy

and refuse to pay any claims if you leave out or

falsify important medical information. Review the

application carefully before you sign it. Be certain

that all information has been properly recorded.

4 5

Plan A Smoker

Plan C Smoker

Plan F Smoker

Plan G Smoker

Plan N Smoker

Age Male Female Male Female Male Female Male Female Male Female

65 $125.92 $116.76 $163.53 $151.63 $170.07 $157.69 $137.37 $127.37 $121.01 $112.20

66 $130.14 $120.67 $169.01 $156.71 $175.76 $162.97 $141.97 $131.63 $125.07 $115.96

67 $134.50 $124.72 $174.67 $161.96 $181.65 $168.43 $146.73 $136.04 $129.26 $119.84

68 $139.00 $128.90 $180.51 $167.38 $187.74 $174.07 $151.65 $140.59 $133.59 $123.86

69 $143.66 $133.21 $186.56 $172.99 $194.03 $179.89 $156.73 $145.30 $138.06 $128.01

70 $148.47 $137.68 $192.81 $178.79 $200.53 $185.92 $161.98 $150.17 $142.69 $132.29

71 $153.45 $142.29 $199.27 $184.78 $207.25 $192.15 $167.40 $155.20 $147.47 $136.72

72 $158.59 $147.06 $205.94 $190.97 $214.19 $198.59 $173.01 $160.39 $152.40 $141.31

73 $163.90 $151.99 $212.85 $197.36 $221.37 $205.24 $178.81 $165.77 $157.51 $146.04

74 $169.40 $157.08 $219.98 $203.98 $228.78 $212.11 $184.80 $171.32 $162.78 $150.93

75 $175.07 $162.34 $227.35 $210.81 $236.44 $219.22 $190.99 $177.07 $168.24 $156.00

76 $180.94 $167.77 $234.97 $217.87 $244.35 $226.57 $197.38 $183.00 $173.88 $161.22

77 $187.00 $173.39 $242.84 $225.16 $252.54 $234.16 $204.00 $189.13 $179.71 $166.62

78 $193.27 $179.20 $250.98 $232.71 $261.00 $242.00 $210.83 $195.46 $185.73 $172.20

79 $199.74 $185.20 $259.38 $240.50 $269.74 $250.11 $217.89 $202.01 $191.95 $177.97

80 $206.44 $191.40 $268.08 $248.56 $278.78 $258.49 $225.18 $208.78 $198.38 $183.93

81 $213.35 $197.82 $277.06 $256.89 $288.11 $267.15 $232.73 $215.78 $205.02 $190.09

82 $220.51 $204.44 $286.34 $265.49 $297.77 $276.11 $240.52 $223.00 $211.90 $196.45

83 $227.90 $211.30 $295.94 $274.38 $307.75 $285.36 $248.59 $230.47 $219.00 $203.04

84 $235.53 $218.37 $305.85 $283.57 $318.06 $294.92 $256.92 $238.19 $226.33 $209.84

85 Plus $294.42 $272.97 $382.32 $354.47 $397.57 $368.66 $321.15 $297.75 $282.92 $262.30

Premium information.

Plan A Nonsmoker

Plan C Nonsmoker

Plan F Nonsmoker

Plan G Nonsmoker

Plan N Nonsmoker

Age Male Female Male Female Male Female Male Female Male Female

65 $121.66 $112.81 $158.00 $146.50 $164.32 $152.36 $132.72 $123.06 $116.92 $108.41

66 $125.74 $116.59 $163.29 $151.41 $169.82 $157.46 $137.17 $127.18 $120.84 $112.04

67 $129.95 $120.50 $168.76 $156.48 $175.51 $162.73 $141.77 $131.44 $124.89 $115.79

68 $134.30 $124.54 $174.41 $161.72 $181.39 $168.18 $146.52 $135.84 $129.07 $119.67

69 $138.80 $128.71 $180.25 $167.14 $187.47 $173.81 $151.43 $140.39 $133.39 $123.68

70 $143.45 $133.02 $186.29 $172.74 $193.75 $179.63 $156.50 $145.09 $137.86 $127.82

71 $148.26 $137.48 $192.53 $178.53 $200.24 $185.65 $161.74 $149.95 $142.48 $132.10

72 $153.23 $142.09 $198.98 $184.51 $206.95 $191.87 $167.16 $154.97 $147.25 $136.53

73 $158.36 $146.85 $205.65 $190.69 $213.88 $198.30 $172.76 $160.16 $152.18 $141.10

74 $163.67 $151.77 $212.54 $197.08 $221.04 $204.94 $178.55 $165.53 $157.28 $145.83

75 $169.15 $156.85 $219.66 $203.68 $228.44 $211.81 $184.53 $171.08 $162.55 $150.72

76 $174.82 $162.10 $227.02 $210.50 $236.09 $218.91 $190.71 $176.81 $168.00 $155.77

77 $180.68 $167.53 $234.63 $217.55 $244.00 $226.24 $197.10 $182.73 $173.63 $160.99

78 $186.73 $173.14 $242.49 $224.84 $252.17 $233.82 $203.70 $188.85 $179.45 $166.38

79 $192.99 $178.94 $250.61 $232.37 $260.62 $241.65 $210.52 $195.18 $185.46 $171.95

80 $199.46 $184.93 $259.01 $240.15 $269.35 $249.75 $217.57 $201.72 $191.67 $177.71

81 $206.14 $191.13 $267.69 $248.20 $278.37 $258.12 $224.86 $208.48 $198.09 $183.66

82 $213.05 $197.53 $276.66 $256.51 $287.70 $266.77 $232.39 $215.46 $204.73 $189.81

83 $220.19 $204.15 $285.93 $265.10 $297.34 $275.71 $240.18 $222.68 $211.59 $196.17

84 $227.57 $210.99 $295.51 $273.98 $307.30 $284.95 $248.23 $230.14 $218.68 $202.74

85 Plus $284.46 $263.74 $369.39 $342.48 $384.13 $356.19 $310.29 $287.68 $273.35 $253.43

A ll benefits listed are covered at 100% unless the chart indicates otherwise. The Medicare Supplement plan covers copayments/coinsurances only after the deductible is met unless the plan covers the deductible.

* This high deductible plan pays the same benefits as plan F after you have paid a calendar year ($2,240) deductible. Benefits from the high deductible plan F will not begin until out-of-pocket expenses are $2,240. Out-of-pocket expenses for this deductible are expenses that would ordinarily be paid by the policy. This includes Medicare deductibles for part A and part B, but does not include the plan’s separate foreign travel emergency deductible.

** For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible, the Medigap plan pays 100% of covered services for the rest of the calendar year.

*** Pl an N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

6

Plan A Plan C Plan F Plan G Plan N

Plan A is the most Plan C provides Plan F may be Plan G* may also Plan N** has a low

basic Medigap more extensive a good choice be a good choice monthly premium

plan. It helps fill coverage than if some of your if some of your and copays for visits

some of the gaps Plan A. It may be doctors do not doctors do not to the doctor’s

in Medicare’s the right plan for accept Medicare’s accept Medicare’s office and the

coverage. you if most of your approved amount approved amount emergency room.

doctors accept as payment as payment

Medicare. in full. in full.

Plan A covers: Plan C covers: Plan F covers: Plan G covers: Plan N covers:

• Basic benefits • Basic benefits, • Basic benefits, • Basic benefits, • Basic benefits,

(see the list plus: plus: plus: plus:

at the left)• Skilled nursing • Skilled nursing • Skilled nursing • Skilled nursing

facility copay facility copay facility copay facility copay

• Part A deductible • Part A deductible • Part A deductible • Part A deductible

• Part B deductible • Part B deductible • Worldwide • Worldwide

• Worldwide • Worldwide emergency emergency

coverage*** coverage***emergency emergency

coverage*** coverage*** • Part B excess

• Part B excess charges (the

amount a doctor charges (the

amount a doctor charges in excess

of the Medicare-charges in excess

of the Medicare-

approved

approved

amount)

amount)

Alliance Medicare Supplement

* Plan G pays 100 percent of Part B services except the Part B deductible.

** Plan N pays 100 percent of Part B services except the Part B deductible. Member pays up to $20 copay for doctor’s office visits and up to $50 for emergency room visits.

*** $ 250 deductible each year. Lifetime maximum of $50,000. Subscriber pays all amounts over $50,000.

7

BenefitsA B C D F* G

Plans

K** L** M N***

Inpatient hospital servicesMedicare Part A daily copayments plus an additional 365 days of coverage after Medicare benefits end

• • • • • • • • • •

Hospice careMedicare Part A coinsurance and copayments

• • • • • • 50% 75% • •

Medicare preventive careMedicare Part B coinsurance when applicable

• • • • • • • • • •

Medicare expensesMedicare Part B coinsurance

• • • • • • 50% 75% •

100% except up to a $20 office visit copayment and

up to a $50 emergency visit copayment

BloodFirst 3 pints under Medicare Parts A and B

• • • • • • 50% 75% • •

Skilled nursing facility careMedicare Part A daily copayments

• • • • 50% 75% • •

Medicare Part A deductible • • • • • 50% 75% 50% •

Medicare Part B deductible • •

Medicare Part B excess charges • •

Foreign travelEmergency services

80% 80% 80% 80% 80% 80%

Out-of-pocket annual limit $5,240 $2,620

Benefits included in all Medicare Supplement plans.

Alliance Medicare Supplement A

Alliance Medicare Supplement C

Alliance Medicare Supplement FMedicare Alliance Medicare

Supplement GAlliance Medicare

Supplement N

Medicare Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays Plan Pays Subscriber Pays

Hospital Services - per benefit period1 – Semi-private room and board, general nursing and miscellaneous services and supplies

$1,340 (Part A deductible)



First 60 days Nothing Nothing Nothing Nothing$1,340 (Part A

deductible)Nothing


Nothing

61st thru 90th dayAll but $335

a day$335 a day Nothing $335 a day Nothing $335 a day Nothing $335 a day Nothing $335 a day Nothing

91st day and after (while using 60 lifetime reserve days)

All but $670 a day

$670 a day Nothing $670 a day Nothing $670 a day Nothing $670 a day Nothing $670 a day Nothing

Once lifetime reserve days are used; additional 365 days

Nothing

100% of Medicare-

eligible expenses

Nothing2

100% of Medicare-

eligible expenses

Nothing2

100% of Medicare-

eligible expenses

Nothing2

100% of Medicare-

eligible expenses

Nothing2

100% of Medicare-

eligible expenses

Nothing2

Beyond the additional Nothing Nothing

365 days All costs Nothing All costs Nothing All costs Nothing All costs Nothing All costs

Skilled Nursing Facility Care - per benefit period1,3

First 20 days 100% Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing

21st thru 100th dayAll but

$167.50 a dayNothing

Up to $167.50 a day

Up to $167.50 a day

NothingUp to


Up to $167.50 a day

NothingUp to


101st day and after Nothing Nothing All costs Nothing All costs Nothing All costs Nothing All costs Nothing All costs

Part A Blood††

First three pints Nothing All costs Nothing All costs Nothing All costs Nothing All costs Nothing All costs Nothing

Additional Amounts 100% Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing

Hospice Care4

Hospice Care

All but very limited copayment/

coinsurance for outpatient drugs

and inpatient respite care

Medicare copayment/coinsurance

NothingMedicare

copayment/coinsurance

NothingMedicare


NothingMedicare


NothingMedicare


Nothing

continued u

98

Alliance Medicare Supplement Plan Comparison

Alliance Medicare Medicare Supplement AAlliance Medicare

Supplement CAlliance Medicare

Supplement FAlliance Medicare

Supplement GAlliance Medicare

Supplement N


Medicare (Part B) – Medical Services, per calendar year5

First $183 of Medicare $183 (Part B deductible)

Nothing Nothingapproved amounts

$183 (Part B Nothing

deductible) $183 (Part B

Nothingdeductible)

$183 (Part B deductible)

Nothing$183 (Part B

Nothingdeductible)

Remainder of Medicare approved amounts

80% 20% Nothing 20% Nothing 20% Nothing 20% Nothing 20%† $20 MD/$50 ER

Part B Excess Charges (above Medicare approved amounts)

Nothing Nothing All costs Nothing All costs 100% Nothing 100% Nothing Nothing All costs

Part B Blood††

First three pints Nothing All costs Nothing All costs Nothing All costs Nothing All costs Nothing All costs Nothing

Next $183 of Medicare approved amounts††

Nothing Nothing$183 (Part B deductible)


Nothing$183 (Part B deductible)



Remainder of Medicare 80% 20%

approved amountsNothing 20% Nothing 20% Nothing 20% Nothing 20% Nothing

Clinical Laboratory Services

Tests for diagnostic 100% Nothing

lab servicesNothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing

Parts A & B Home Health Care – Medicare approved services

Medically necessary skilled care services and medical supplies/ Durable medical Nothing Nothingequipment (First $183 of Medicare approved amounts)






Remainder of Medicare approved amounts

80% 20% Nothing 20% Nothing 20% Nothing 20% Nothing 20%† Nothing

Alliance Medicare Supplement Plan Comparison (continued)

continued u

10 11

Medicare Alliance Medicare Supplement A

Alliance Medicare Supplement C

Alliance Medicare Supplement F

Alliance Medicare Supplement G

Alliance Medicare Supplement N


Other Benefits – Not covered by Medicare

Foreign Travel—Not covered by Medicare, medically necessary

Nothing (except emergency care services under beginning during the

limited first 60 days of each trip circumstances)outside the USA.

Nothing Nothing

$250/20% $0/80%

and amounts to a lifetime

over the maximum of

$50,000 lifetime $50,000

maximum

$250/20% $0/80%


over the maximum

$50,000 lifetime of $50,000

maximum

$250/20% $0/80%


over the maximum

$50,000 lifetime of $50,00

maximum

$250/20% 80% to a

and amounts lifetime

over the maximum

$50,000 lifetime of $50,000

maximumFirst $250 each year/Remainder of charges

1 A benefit period begins on the first day you receive service as an inpatient in a hospital and ends after you have been out of the hospital and have not received skilled care in any other facilities for 60 days in a row.

2 NOTICE: When your Medicare Part A hospital benefits are exhausted, HAP stands in the place of Medicare and pays whatever amount Medicare would have paid for up to an additional 365 days. During this time the hospital can’t bill you for the balance based on any difference between its billed charges and the amount Medicare would have paid.

3 You must meet Medicare’s requirements, including having been in a hospital for at least three days, and enter a Medicare-approved facility within 30 days after leaving the hospital.

4 You must meet Medicare’s requirements including a doctor’s certification of terminal illness.

5 Medical expenses – In or out of the hospital and outpatient hospital treatment, such as physician’s services, inpatient and outpatient medical services and surgical services, physical and speech therapy, diagnostic tests, durable medical equipment.

† 20% except up to a $20 office visit and up to a $50 emergency visit copay.

†† Once you have been billed $183 of Medicare-approved amounts for covered services, your Part B deductible will have been met for the calendar year.

12

Alliance Medicare Supplement Plan Comparison (continued)

Ask. Learn. Understand your Medicare. With a little help from HAP.

hap.org/medicare

© 2017 Health Alliance Plan of Michigan. A Nonprofit Company. 5M 12/2017

2018 alliance medicare supplement brochure€¦ · with alliance medicare supplement (medigap)...

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