HAP

FAQs

The information in this section is general in nature. For plan details, please refer to the Evidence of Coverage or Alliance Medicare Supplement policy (Medigap members).

Medicare Advantage plans

  • What are Medicare Advantage plans?
    Medicare Advantage plans are an alternative to Original Medicare. Also called “Part C,” these plans provide an equivalent or better level of coverage.

    Medicare Advantage plans can include a Medicare Part D prescription drug benefit.

    HAP has a contract with the federal Medicare program to provide your Medicare Part C and Part D benefits. In other words, Medicare pays us and we cover you.

  • Do I lose my Medicare benefits when I join HAP Senior Plus or Alliance Medicare PPO?
    No. You are still in the Medicare program. In fact, you must have and keep both Medicare Part A and Part B in order to enroll in a Medicare Advantage plan. As a member of HAP Senior Plus or Alliance Medicare PPO, your benefits include all the benefits you are entitled to under Medicare and may include prescription drug coverage. Plus, you get a full range of additional health care benefits, including worldwide emergency and urgent care coverage. See the Summary of Benefits for more information.



  • Can I enroll in both a Medicare Advantage plan and a stand-alone prescription drug plan?
    No. Medicare does not allow enrollment in multiple Medicare-approved plans. Medicare Advantage plans with prescription drug coverage include both medical and Part D prescription drug coverage, so there is no need to enroll in an additional drug plan.
  • Can you cancel my plan?
    Generally, your Medicare Advantage plan cannot be cancelled involuntarily unless you do one of the following:
    • Cancel your Medicare Part B coverage
    • Permanently move out of the plan’s service area
    • Leave the plan’s service area for an extended absence of more than six continuous months
    • Fail to make a scheduled payment

    You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

    Medicare Advantage plans and Medicare prescription drug plans have contracts with Medicare and agree to stay in the program for a full year at a time. Each year, that contract is renewed. If your plan decides not to continue, it must send you a letter at least 90 days before your coverage will end. Even if your plan leaves the program, you will not lose Medicare coverage. You would still have Original Medicare or you could enroll in a different Medicare-approved plan.
  • Can I just keep my Original Medicare plan?
    Yes. But you may find that there are gaps in the coverage Original Medicare provides. With Original Medicare, Medicare pays a share of the Medicare-approved amount, and you pay your share. Your share includes coinsurance, copays and up-front deductibles. In some cases, you may be charged more than the Medicare-approved amount. If you experience a serious illness or have multiple conditions, these out-of-pocket costs can become significant. With a Medicare Advantage plan or a Medicare Supplement, these costs may be less.
    Original Medicare does not include “Part D” (prescription drug) coverage.
  • Will I have to submit claims for the services I receive?
    As an HMO, HMO-POS or PPO member, you do not have to submit claim forms for services provided by network providers. For example, if you see your doctor for an annual checkup, your doctor will bill us and you pay your copay. But if you have an emergency or urgent care situation while out of our service area, you may be required to pay for services when you receive them and then submit a claim for reimbursement. If you get routine services out-of-network under your HMO-POS benefit or with PPO coverage, you may also need to submit a claim for reimbursement.
  • What is the difference between a deductible and coinsurance?
    A deductible is the amount you must pay for health care services or prescriptions, before your plan begins to pay. The deductible amount can change every year. Coinsurance is a percentage (generally 20 percent) of the Medicare-approved amount that you must pay after you pay any deductible.
  • What is a copay?
    A copay is a set amount you pay for medical services or prescription drugs. For example, for a doctor’s office visit, your copay may be $15 or $20.
  • What are Medicare Star Ratings, and where can I find them?
    Every year, the federal Medicare program rates health and prescription drug plans based on factors like member satisfaction, quality of care, customer service and patient safety. These Star Ratings can be very helpful for comparing different plans. You can view the Star Ratings for HAP’s Medicare plans here.

Medicare Advantage Plan Networks

  • Can I go to any doctor or hospital I want?
    HAP Senior Plus-Henry Ford brings together the doctors, hospitals and health facilities of the Henry Ford Health System (HFHS). You choose your Personal Care Physician (PCP) from physicians who practice in Wayne, Oakland and Macomb counties. Your PCP helps ensure that care you receive from different specialists is coordinated and works well together.
    If the PCP you select belongs to the Henry Ford Medical Group (HFMG), you will see specialists, when needed, within the HFMG. Or, you may select a PCP from those affiliated with Henry Ford Health System but not part of the HFMG. This PCP will still coordinate your care, but you may see specialists from the entire HAP Senior Plus-Henry Ford network.

    HAP Senior Plus-Expanded Network HMO and HMO-POS plans lets you choose any network Personal Care Physician (PCP) to coordinate your care and arrange any necessary specialty care services. You can receive needed services from any HAP Senior Plus-contracted specialist for in-network care.

    When your plan includes the Point-of-Service (POS) benefit, you can get some covered routine care services outside the network. You may use any Medicare-participating doctor or specialist and any hospital that participates in Medicare with the Point-of-Service (POS) benefit. Your costs may be higher than when receiving services in-network.

    Alliance Medicare PPO is offered by Alliance Health and Life Insurance Company (Alliance). Alliance is a wholly owned subsidiary of Health Alliance Plan (HAP), a non-profit Michigan-based company.

    As an Alliance Medicare PPO member, you choose:
    • Any Medicare-participating doctor or hospital in the U.S., or
    • Doctors and hospitals who participate in our approved network.
    Alliance Medicare PPO covers your care whether it is in- or out-of-network. Your costs may be higher when using out-of-network providers.

    In every plan, you must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third party.
  • Do I need a referral to see a specialist?
    Our primary focus is to keep you well. That means you will be able to see a specialist whenever there is a medical reason to do so. With HAP Senior Plus, your Personal Care Physician (PCP) will help coordinate your specialty care. As a member of Alliance Medicare PPO, you can see any Medicare-participating doctor.
  • Why shouldn’t I choose a specialist as my Personal Care Physician?
    Personal Care Physicians (PCPs), known as internal medicine (internists) or family practice doctors, have had special study and training in the prevention and treatment of conditions that affect adults. Internists are sometimes referred to as the "doctor's doctor," because they are often called upon to act as consultants to other doctors to help solve puzzling diagnostic problems.
    Your Personal Care Physician, who is a trained professional, will help coordinate your specialty care. A Personal Care Physician looks at all the care you are receiving from all specialists. PCPs also bring to patients an understanding of wellness, disease prevention and the promotion of health.
  • I see two doctors, and both are in your HAP Senior Plus plan. The specialist is in one network and the internal medicine doctor is in another. Can I use them both?
    The answer depends on which HAP Senior Plus plan you select.
    HAP Senior Plus-Henry Ford brings together the doctors, hospitals and health facilities of the Henry Ford Health System (HFHS). You choose your Personal Care Physician (PCP) from physicians who practice in Wayne, Oakland and Macomb counties. Your PCP helps ensure that care you receive from different specialists is coordinated and works well together.

    If the PCP you select belongs to the Henry Ford Medical Group (HFMG), you will see specialists, when needed, within the HFMG. Or, you may select a PCP from those affiliated with Henry Ford Health System but not part of the HFMG. This PCP will still coordinate your care, but you may see specialists from the entire HAP Senior Plus-Henry Ford network.

    HAP Senior Plus-Expanded Network HMO and HMO-POS plans lets you choose any network Personal Care Physician (PCP) to coordinate your care and arrange any necessary specialty care services. You can receive needed services from any HAP Senior Plus-contracted specialist for in-network care.

    When your plan includes the Point-of-Service (POS) benefit, you can get some covered routine care services outside the network. You may use any Medicare-participating doctor or specialist and any hospital that participates in Medicare with the Point-of-Service (POS) benefit. Your costs may be higher than when receiving services in-network.
  • What do I do if I would like to switch my doctor?
    You can either call our Client Services department to request help with selecting or changing your PCP or you can go online (You are leaving a Medicare-approved site) and make the change.
  • What role does my Personal Care Physician play in urgent and emergency care?
    Your personal physician has a very important role in every aspect of your health care including urgent and emergency care. BEFORE the need arises contact your personal physician’s office for instructions regarding urgent and emergency situations. This is especially important if you are a member of HAP Senior Plus. Your Personal Care Physician will help arrange in-network follow-up care.

Medicare Advantage Plan Coverage

  • What if I have a preexisting condition? Will I be able to join now or will I have to wait for medical treatments for that condition?
    All of your plan benefits start the first day your Medicare Advantage plan coverage takes effect. There are no exclusions or waiting periods for preexisting conditions. The only medical condition that would prevent you from joining is end-stage renal disease, unless you already are a member of a HAP plan. Once you are a Medicare Advantage member, your rates cannot be raised for any medical condition and your plan cannot be canceled for any medical condition.
  • Do you cover long-term care or nursing home care?
    Long-term (nursing home) care needs are not covered by Medicare Advantage plans nor Medicare Supplement policies. This benefit would be covered under a long-term care insurance policy that you purchase separately.
  • What happens if I go to the emergency room for something I thought required immediate medical attention and find out it was not an emergency?
    We encourage you to seek medical care when you feel it is necessary. If you believe you are having an emergency, go to the emergency room for medical treatment. Your plan will pay the claim based on why you went to the emergency room, not on the diagnosis or final outcome of your treatment.
    Notifying your Personal Care Physician is especially important after treatment in an emergency room if you are a member of HAP Senior Plus. Your Personal Care Physician will help arrange in-network follow-up care.
  • What is an urgent medical condition?
    Sprained ankles, most burns, minor wounds requiring stitches, back pain, chronic headaches, urinary tract infections and severe cold or flu are typical examples of urgent conditions. An urgent condition is not life threatening but may require prompt attention. Urgent care access standards require care on the same day or next day depending on the severity of the condition.
    Contact your Personal Care Physician's (PCP's) office for urgent care instructions. Often urgent care conditions can be treated in your physician’s office. When you call with an urgent need, request a same-day or next-day appointment. Your PCP has appointments available for patients with urgent conditions. In fact, it is better to visit your PCP in an urgent situation rather than going to an emergency room because your PCP is aware of your medical history and any care that you are currently receiving. If your PCP is not available and other arrangements cannot be made through his or her office, you may go to any HAP-affiliated urgent care facility.

    If you are outside of our service area, you may seek urgent care at any urgent care facility. Notifying your Personal Care Physician is especially important after urgent care treatment if you are a member of HAP Senior Plus. Your Personal Care Physician will help arrange in-network follow-up care.
  • What is an emergency medical condition?
    A “medical emergency” occurs when you reasonably believe that your health is in serious danger and every second counts. A medical emergency includes severe pain, a bad injury, a serious illness or a medical condition that is quickly getting much worse.
    Emergency care is available 24 hours a day, seven days a week at emergency facilities. If you experience a medical emergency, go to the nearest emergency facility or call 911 for assistance. After a visit to an emergency room, you should follow up with your PCP. This ensures that any additional care will be coordinated through your PCP, that your medical records and history are updated and that your treatment reflects any existing conditions or medications.

    Notifying your Personal Care Physician is especially important after treatment in an emergency room if you are a member of HAP Senior Plus.
  • What is the difference between urgent and emergency care?
    Emergency care is more serious than urgently needed care. Emergencies are most commonly treated at a hospital emergency room. Urgent needs can often be treated by your PCP. If an urgent need arises when you are traveling, it can usually be treated at an urgent care center.
    In both cases, the need is unexpected, could not have been scheduled and should not wait for treatment at some future date.
  • Why is it important to know the difference between urgent and emergency conditions?
    Knowing the difference between urgent and emergency medical conditions can help you determine how to obtain the most appropriate care, save you costly copays and help ensure you are treated as quickly as your condition requires.
  • What should I do when I’m traveling?
    Our Medicare Advantage plans offer worldwide health care coverage for medical emergencies, accidental injuries and urgent care. Remember that, in an emergency situation, you can always call 911 in the United States or go to the nearest emergency room.
    Generally, the site where you seek care will ask for your health insurance card (your HAP or Alliance ID card) and call the number on the back for billing or coverage questions. If the doctor or hospital does not recognize your ID card and requires immediate payment for services, you are responsible for paying the hospital or doctor. We will fully reimburse you for the covered services less any copays you are required to pay.

    If you are admitted to a hospital not affiliated with us, you or your designee should notify us within 48 hours at the number listed on the back of your ID card.

    For information about follow-up care, please see your plan’s Evidence of Coverage (member contract) for out-of-network routine coverage.

Miscellaneous

Medicare Part D Plans

  • Do I have to get Part D prescription drug coverage?
    No. Prescription drug coverage is not mandatory for people eligible for Medicare. However, if you decide at a future date to elect Part D prescription drug coverage, you may pay a financial penalty assessed by Medicare.
    HAP Senior Plus–Henry Ford has a Medicare Advantage HMO plan without prescription drug coverage.
  • I don’t use a lot of prescriptions. Why should I get prescription drug coverage?
    Even if you do not use a lot of prescription drugs now, you should still consider enrolling in a Part D plan. As people age, they often need prescription drugs to stay healthy. Joining now will secure the lowest possible plan premium. If you do not currently have creditable coverage (coverage as good as Part D), and you wait past the time you are initially eligible to enroll in a Part D plan, you may have to pay a penalty of 1 percent for every month you delayed enrollment. This penalty would continue through the rest of your years with Medicare Part D coverage.
  • What is creditable coverage?
    “Creditable coverage” is the term the government uses to describe prescription-drug coverage that is at least as good as or better than what Medicare Part D offers. If you are enrolled in Medicare and have a drug benefit through an employer’s or union’s health plan, that coverage is likely to qualify as “creditable coverage.” If you lose those drug benefits, you will receive a certificate of creditable coverage that guarantees your right to buy a Medicare Part D plan within specified timeframes without paying a penalty for late enrollment.
  • What if I already have prescription drug coverage from a former employer or my union?
    If you have prescription drug coverage now through your employer or union, you should review your plan and talk to your plan benefits administrator or insurer before making any changes.
  • Can I get a plan with prescription drugs through HAP?
    Yes. You can enroll in one of our Medicare plans that includes Medicare Part D prescription drug benefits.
  • How will I know if the drug I take is covered?
    Each Medicare Part D plan provides its own list of covered drugs, which is called a formulary. There are several ways you can find out if we cover a drug you are taking.
    Use our Drug Finder (You are leaving a Medicare-approved site)

    Download our formulary

    If you have questions about how to meet your prescription coverage needs, HAP’s Destination Rx tool can help you find out what plan works best with your prescriptions.
    Learn more about Destination Rx

    If you are interested in becoming a member and would like more information about our Part D formulary, call a licensed HAP Medicare Sales Representative:
      (800) 868-3153 or TTY: 711

    Office Hours:
    Monday through Friday, 8 a.m. to 6 p.m. ET

    If you are a current HAP or Alliance member, call Customer Service:
      HAP Senior Plus (800) 801-1770
      Alliance Medicare PPO (888) 658-2536
      Alliance Medicare Rx (800) 765-3436 or TTY: 711

    Office Hours:
    Monday through Friday, 8 a.m. to 8 p.m.
    Saturday, 8 a.m. to noon
    At all other times, you may access our Interactive Voice Recording system at the same number and leave your name and phone number. A HAP Customer Service Representative will return your phone call the next business day.

    Extended hours from Oct. 1 to Feb. 14: 7 days a week, 8 a.m. to 8 p.m.

    Or write to us at:
    HAP Customer Service
    Attn: Medicare
    2850 W. Grand Blvd.
    Detroit, MI 48202
  • What if my prescription drug is not on your formulary?
    If you are taking a drug that is not on our formulary, you can talk with your doctor about whether a different drug might be an effective alternative for you. If an effective alternative is not available, you or your doctor can request an exception to allow coverage of the drug you use.
  • How will I know if I have reached the initial coverage limit on prescription coverage?
    During the initial coverage limit (ICL) of a Part D plan, you pay only the copay or coinsurance amount. The plan pays the rest.
    Each month, you receive a statement of activity that shows:
      Your out-of-pocket cost to date
      The total amount paid by the plan
      The remaining benefit amount in your initial coverage stage


    This statement is called the Explanation of Benefits (EOB).The EOB can eliminate unpleasant surprises at the pharmacy. If you are concerned about the Coverage Gap (or “donut hole”), you may want to consider a Medicare Advantage plan that provides coverage for Generic drugs at the same copay through the coverage gap.

Medicare Supplement (Medigap) plans

  • What is a Medicare Supplement or Medigap policy?
    A Medicare Supplement insurance policy (also known as Medigap) is sold by private insurance companies to fill “gaps” in Original Medicare plan coverage. This policy helps pay your share of hospital and medical costs – your coinsurance, copays and deductibles. Medigap policies only work with the Original Medicare plan and do not include any benefits not covered by Medicare (such as dental, eyeglasses or the Flexible Health Options benefit available in some of HAP’s Medicare Advantage plans).
    Medicare Supplements sold after 2006 do not include prescription drug benefits.

    See your plan’s policy for coverage details.
  • How do I know if I am I eligible for Alliance Medicare Supplement?
    Generally, if you are a Michigan resident enrolled in both Medicare Parts A and B, you are eligible to apply 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 monthly 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 first become eligible for Medicare and enroll in Medicare Part B. Any preexisting condition may be excluded from coverage for the first six months you are enrolled in a Medicare Supplement.
  • Am I covered when I travel?
    Yes. Your coverage goes with you anywhere in the United States. With Plan C, Plan F or Plan N, you also have worldwide emergency coverage.
  • Do I need a referral to see a specialist?
    With Alliance Medicare Supplement, you can see any doctor or specialist who participates in Medicare. No referrals are required.
  • Can I keep my Alliance Medicare Supplement policy if I move out of state?
    Yes. You can keep your current Medicare Supplement policy regardless of where you live as long as you are still in the Original Medicare plan and maintain your Part B coverage.
  • How can I get prescription drug coverage?
    If you are interested in Medicare prescription drug benefits in addition to your Alliance Medicare Supplement plan, we invite you to consider Alliance Medicare Rx (PDP) . Alliance Medicare Rx is a Medicare-approved Part D stand-alone Prescription Drug Plan (PDP) that offers affordable prescription drug coverage.
    The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact HAP. Limitations, copayment and restrictions may apply. Benefits, copayments/coinsurance may change January 1 of each year.

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