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TRANSCRIPT
2019 Alliance Medicare Supplement Brochure
MED SUPP 2019 PRODUCT 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.
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.
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 expenses: Coverage for Medicare
Part B coinsurance (20 percent of Medicare-
approved costs) or copays for doctors’
services, hospital outpatient services and
other medical services
• Blood: First three pints of blood each year
• Hospice: 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.
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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:
• Medicare Part A has an upfront deductible
of $1,340 for hospitalization – a deductible you
pay each benefit period before your Medicare
coverage begins.
• If you stay in the hospital more than 60 days,
you begin paying a copay of $335 per day.
• After 90 days in the hospital, your copay
increases to $670 per day.
• You pay 20 percent coinsurance for most
doctors’ services after you pay your Part B
deductible each year.
• You 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 anyplace 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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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.
Reliable, easy-to-use coverage.
Freedom and choice.
With an Alliance Medicare Supplement plan, you are covered wherever you go.
• You 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.
• Your 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.
• Your 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.
4
*If you 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.
** Plan C, Plan F, Plan G and Plan N.
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.
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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.
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Enroll today.To enroll in our Medicare plan, you can use one of the following four options:
1. Enroll online at the HAP website at hap.org/medicare
2. Call a licensed HAP Medicare sales representative at:
(800) 868-3153 (TTY: 711) 8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 – March 31)
8 a.m. to 6 p.m. ET, Monday through Friday (April 1 – Sept. 30)
3. Come to a HAP Medicare seminar, where you can talk with other Medicare beneficiaries. Call or go online to find out about seminar 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) 8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 – March 31)
8 a.m. to 6 p.m. ET, Monday through Friday (April 1 – Sept. 30)
4. Mail a completed enrollment form to: HAP Medicare Division 2850 W. Grand Blvd. Detroit, MI 48202
MED SUPP [2018] PROD BRO
Outline of Coverage for Plans A, C, F, G and N
Medicare Supplement 2019
MED SUPP Outline of Coverage Revised September, 2018
Understanding 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.
1
Important premium and plan information. . . . . . . . . . . . . . . p. 2
Premium information . . . . . . . . . . . p. 4
Medicare Supplement plans . . . . . . p. 6
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Alliance Medicare Supplement premiums.The 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 Nonsmoker or Smoker
2. Choose your plan: A, C, F, G or N
3. Scan for your age (as of January 1, 2019)
4. Select Male or Female
This amount will be included on the billing statement you receive in December for January 2019.
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)8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 – March 31)8 a.m. to 6 p.m. ET, Monday through Friday (April 1 – Sept. 30)
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.
54
Premium information.1
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
64 and under
$383.23 $355.35 $545.10 $505.43
65 $127.74 $118.45 $181.70 $168.48 $172.54 $159.98 $119.45 $110.75 $105.23 $97.57
66 $132.02 $122.42 $187.79 $174.12 $178.32 $165.34 $123.45 $114.46 $108.76 $100.84
67 $136.44 $126.52 $194.08 $179.95 $184.29 $170.88 $127.59 $118.29 $112.40 $104.22
68 $141.01 $130.76 $200.58 $185.98 $190.46 $176.60 $131.86 $122.25 $116.17 $107.71
69 $145.73 $135.14 $207.30 $192.21 $196.84 $182.52 $136.28 $126.35 $120.06 $111.32
70 $150.61 $139.67 $214.24 $198.65 $203.43 $188.63 $140.85 $130.58 $124.08 $115.05
71 $155.66 $144.35 $221.42 $205.30 $210.24 $194.95 $145.57 $134.95 $128.24 $118.90
72 $160.87 $149.19 $228.84 $212.18 $217.28 $201.48 $150.45 $139.47 $132.54 $122.88
73 $166.26 $154.19 $236.51 $219.29 $224.56 $208.23 $155.49 $144.14 $136.98 $127.00
74 $171.83 $159.36 $244.43 $226.64 $232.08 $215.21 $160.70 $148.97 $141.57 $131.25
75 $177.59 $164.70 $252.62 $234.23 $239.85 $222.42 $166.08 $153.96 $146.31 $135.65
76 $183.54 $170.22 $261.08 $242.08 $247.88 $229.87 $171.64 $159.12 $151.21 $140.19
77 $189.69 $175.92 $269.83 $250.19 $256.18 $237.57 $177.39 $164.45 $156.28 $144.89
78 $196.04 $181.81 $278.87 $258.57 $264.76 $245.53 $183.33 $169.96 $161.52 $149.74
79 $202.61 $187.90 $288.21 $267.23 $273.63 $253.76 $189.47 $175.65 $166.93 $154.76
80 $209.40 $194.19 $297.87 $276.18 $282.80 $262.26 $195.82 $181.53 $172.52 $159.94
81 $216.41 $200.70 $307.85 $285.43 $292.27 $271.05 $202.38 $187.61 $178.30 $165.30
82 $223.66 $207.42 $318.16 $294.99 $302.06 $280.13 $209.16 $193.89 $184.27 $170.84
83 $231.15 $214.37 $328.82 $304.87 $312.18 $289.51 $216.17 $200.39 $190.44 $176.56
84 $238.89 $221.55 $339.84 $315.08 $322.64 $299.21 $223.41 $207.10 $196.82 $182.47
85 Plus $298.61 $276.94 $424.80 $393.85 $403.30 $374.01 $279.26 $258.88 $246.03 $228.09
Medicare beneficiaries younger than age 65 are only eligible to apply for Plan A or Plan C.1 Premiums include the tax required under Michigan’s Health Insurance Claims Assessment (HICA) Act (Public Act 142 of 2011).
Medicare beneficiaries younger than age 65 are only eligible to apply for Plan A or Plan C.1 Premiums include the tax required under Michigan’s Health Insurance Claims Assessment (HICA) Act (Public Act 142 of 2011).
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
64 and under
$396.64 $367.79 $564.18 $523.12
65 $132.21 $122.60 $188.06 $174.37 $178.58 $165.58 $123.63 $114.63 $108.91 $100.98
66 $136.64 $126.70 $194.36 $180.21 $184.56 $171.13 $127.77 $118.47 $112.57 $104.37
67 $141.22 $130.95 $200.87 $186.25 $190.74 $176.86 $132.06 $122.43 $116.33 $107.87
68 $145.95 $135.34 $207.60 $192.49 $197.13 $182.78 $136.48 $126.53 $120.24 $111.48
69 $150.83 $139.87 $214.56 $198.94 $203.73 $188.91 $141.05 $130.77 $124.26 $115.22
70 $155.88 $144.56 $221.74 $205.60 $210.55 $195.23 $145.78 $135.15 $128.42 $119.08
71 $161.11 $149.40 $229.17 $212.49 $217.60 $201.77 $150.66 $139.67 $132.73 $123.06
72 $166.50 $154.41 $236.85 $219.61 $224.88 $208.53 $155.72 $144.35 $137.18 $127.18
73 $172.08 $159.59 $244.79 $226.97 $232.42 $215.52 $160.93 $149.18 $141.77 $131.45
74 $177.84 $164.94 $252.99 $234.57 $240.20 $222.74 $166.32 $154.18 $146.52 $135.84
75 $183.81 $170.46 $261.46 $242.43 $248.24 $230.20 $171.89 $159.35 $151.43 $140.40
76 $189.96 $176.18 $270.22 $250.55 $256.56 $237.92 $177.65 $164.69 $156.50 $145.10
77 $196.33 $182.08 $279.27 $258.95 $265.15 $245.88 $183.60 $170.21 $161.75 $149.96
78 $202.90 $188.17 $288.63 $267.62 $274.03 $254.12 $189.75 $175.91 $167.17 $154.98
79 $209.70 $194.48 $298.30 $276.58 $283.21 $262.64 $196.10 $181.80 $172.77 $160.18
80 $216.73 $200.99 $308.30 $285.85 $292.70 $271.44 $202.67 $187.88 $178.56 $165.54
81 $223.98 $207.72 $318.62 $295.42 $302.50 $280.54 $209.46 $194.18 $184.54 $171.09
82 $231.49 $214.68 $329.30 $305.31 $312.63 $289.93 $216.48 $200.68 $190.72 $176.82
83 $239.24 $221.87 $340.33 $315.54 $323.11 $299.64 $223.74 $207.40 $197.11 $182.74
84 $247.25 $229.30 $351.73 $326.11 $333.93 $309.68 $231.23 $214.35 $203.71 $188.86
85 Plus $309.06 $286.63 $439.67 $407.63 $417.42 $387.10 $289.03 $267.94 $254.64 $236.07
2018 Medicare values are listed. They may change for 2019.
All 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.
*** Plan 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.
Plan A Plan C Plan F Plan G Plan N
Plan A is the most
basic Medigap
plan. It helps fill
some of the gaps
in Medicare’s
coverage.
Plan C provides
more extensive
coverage than
Plan A. It may be
the right plan for
you if most of your
doctors accept
Medicare.
Plan F may be
a good choice
if some of your
doctors do not
accept Medicare’s
approved amount
as payment
in full.
Plan G* may also
be a good choice
if some of your
doctors do not
accept Medicare’s
approved amount
as payment
in full.
Plan N** has a low
monthly premium
and copays for visits
to the doctor’s
office and the
emergency room.
Plan A covers:
• Basic benefits
(see the list
at the left)
Plan C covers:
• Basic benefits,
plus:
• Skilled nursing
facility copay
• Part A deductible
• Part B deductible
• Worldwide
emergency
coverage***
Plan F covers:
• Basic benefits,
plus:
• Skilled nursing
facility copay
• Part A deductible
• Part B deductible
• Worldwide
emergency
coverage***
• Part B excess
charges (the
amount a doctor
charges in excess
of the Medicare-
approved
amount)
Plan G covers:
• Basic benefits,
plus:
• Skilled nursing
facility copay
• Part A deductible
• Worldwide
emergency
coverage***
• Part B excess
charges (the
amount a doctor
charges in excess
of the Medicare-
approved
amount)
Plan N covers:
• Basic benefits,
plus:
• Skilled nursing
facility copay
• Part A deductible
• Worldwide
emergency
coverage***
Alliance Medicare Supplement
76
* 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.
BenefitsPlans
A B C D F* G 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.
Medicare Alliance Medicare Supplement A
Alliance Medicare Supplement C
Alliance Medicare Supplement F
Alliance Medicare Supplement G
Alliance 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
First 60 days Nothing Nothing$1,340 (Part A
deductible)$1,340 (Part A
deductible)Nothing
$1,340 (Part A deductible)
Nothing$1,340 (Part A
deductible)Nothing
$1,340 (Part A deductible)
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 365 days
Nothing Nothing 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
$167.50 a dayNothing
Up to $167.50 a day
NothingUp to
$167.50 a dayNothing
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
copayment/coinsurance
NothingMedicare
copayment/coinsurance
NothingMedicare
copayment/coinsurance
Nothing
continued u
98
Alliance Medicare Supplement Plan Comparison
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)
$183 (Part B deductible)
Nothing$183 (Part B deductible)
Nothing Nothing$183 (Part B deductible)
Nothing$183 (Part B deductible)
Remainder of Medicare approved amounts
80% 20% Nothing 20% Nothing 20% Nothing 20% Nothing 20% Nothing
Clinical Laboratory Services
Tests for diagnostic lab services
100% Nothing Nothing 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 equipment (First $183 of Medicare approved amounts)
Nothing Nothing$183 (Part B deductible)
$183 (Part B deductible)
Nothing$183 (Part B deductible)
Nothing Nothing$183 (Part B deductible)
Nothing$183 (Part B deductible)
Remainder of Medicare approved amounts
80% 20% Nothing 20% Nothing 20% Nothing 20% Nothing 20%† Nothing
Medicare Alliance Medicare Supplement A
Alliance Medicare Supplement C
Alliance Medicare Supplement F
Alliance Medicare Supplement G
Alliance 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
Medicare (Part B) – Medical Services, per calendar year5
First $183 of Medicare approved amounts
Nothing Nothing$183 (Part B deductible)
$183 (Part B deductible)
Nothing$183 (Part B deductible)
Nothing Nothing$183 (Part B deductible)
Nothing$183 (Part B deductible)
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
continued u
1110
Alliance Medicare Supplement Plan Comparison (continued)
Medicare Alliance Medicare Supplement A
Alliance Medicare Supplement C
Alliance Medicare Supplement F
Alliance Medicare Supplement G
Alliance 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
Other Benefits – Not covered by Medicare
Foreign Travel – Not covered by Medicare, medically necessary emergency care services beginning during the first 60 days of each trip outside the USA.
First $250 each year/Remainder of charges
Nothing (except under
limited circumstances)
Nothing Nothing
$0/80% to a lifetime maximum of
$50,000
$250/20% and amounts
over the $50,000 lifetime
maximum
$0/80% to a lifetime maximum of $50,000
$250/20% and amounts
over the $50,000 lifetime
maximum
$0/80% to a lifetime maximum of $50,00
$250/20% and amounts
over the $50,000 lifetime
maximum
80% to a lifetime
maximum of $50,000
$250/20% and amounts
over the $50,000 lifetime
maximum
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)
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)8 a.m. to 8 p.m. ET, seven days a week (Oct. 1 – March 31) 8 a.m. to 6 p.m. ET, Monday through Friday (April 1 – Sept. 30)
Current Members:
If you have questions, contact Customer Service at (800) 873-7526 (TTY: 711).
For your convenience, our Customer Service office hours are: Monday through Friday, 8 a.m. to 8 p.m. ET
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 Service
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.
Ask. Learn. Understand your Medicare. With a little help from HAP.
hap.org/medicare
© 2018 Health Alliance Plan of Michigan. A Nonprofit Company. .5M 9/2018