HAP Senior Plus - Henry Ford (HMO)

Medicare Advantage Plan (Part C)

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PARTC

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C)
Insurance Provider
Health Alliance Plan
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This is a health coverage only plan with no drug coverage
  • This plan is available for 2015. see plan

Why We Like This Plan

  • Primary care physician office visit copay of $20

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
No
Out-Of-Pocket Spending Limit
$3,400 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
Not Applicable
Monthly Health Plan Premium
$50.00

Benefits

Service
In Network
Out of Network
Inpatient Hospital Care
$400 copay
Not Applicable
Inpatient Mental Health Care
$400 copay
Not Applicable
Skilled Nursing Facility (SNF)
Coming Soon
Coming Soon
Home Health Care
$0
Not Applicable
Doctor Office Visits
$20 maximum per visit
Not Applicable
Outpatient Services
$75 maximum per visit
Not Applicable
Ambulance Services
$75 maximum
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Kidney Disease and Conditions
$25 maximum per visit
Not Applicable
Specialist Office Visit
$35 maximum per visit
Not Applicable

Prescription Drug Coverage

Drugs Covered under Medicare Part B

General

Most drugs not covered.

0% to 20% of the cost for Medicare Part B chemotherapy drugs and other Part B drugs.


Drugs Covered under Medicare Part D

General

This plan does not offer prescription drug coverage.


Optional Supplemental Benefits

Optional Supplemental Package #1 Premium and Other Important Information Dental Services

Premium and Other Important Information

General

Package: 1 - Delta Dental Option 1:

$23.40 monthly premium, in addition to your $50 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
  • Preventive Dental
  • Comprehensive Dental


$800 plan coverage limit every year for these benefits.


Dental Services

General

Plan offers additional supplemental comprehensive dental benefits.

In-Network

50% of the cost for up to 2 supplemental oral exam(s) every three years

50% of the cost for up to 2 supplemental cleaning(s) every year

50% of the cost for up to 2 supplemental fluoride treatment(s) every year

50% of the cost for supplemental dental x-rays



General

Package: 1 - Delta Dental Option 1:

$23.40 monthly premium, in addition to your $50 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
  • Preventive Dental
  • Comprehensive Dental


$800 plan coverage limit every year for these benefits.



General

Plan offers additional supplemental comprehensive dental benefits.

In-Network

50% of the cost for up to 2 supplemental oral exam(s) every three years

50% of the cost for up to 2 supplemental cleaning(s) every year

50% of the cost for up to 2 supplemental fluoride treatment(s) every year

50% of the cost for supplemental dental x-rays


Premium and Other Important Information

General

Package: 1 - Delta Dental Option 1:

$23.40 monthly premium, in addition to your $50 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
  • Preventive Dental
  • Comprehensive Dental


$800 plan coverage limit every year for these benefits.


Dental Services

General

Plan offers additional supplemental comprehensive dental benefits.

In-Network

50% of the cost for up to 2 supplemental oral exam(s) every three years

50% of the cost for up to 2 supplemental cleaning(s) every year

50% of the cost for up to 2 supplemental fluoride treatment(s) every year

50% of the cost for supplemental dental x-rays


Optional Supplemental Package #2 Premium and Other Important Information Dental Services

Premium and Other Important Information

General

Package: 2 - Delta Dental Option 2:

$44.90 monthly premium, in addition to your $50 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
  • Preventive Dental
  • Comprehensive Dental


$1,500 plan coverage limit every year for these benefits.


Dental Services

General

Plan offers additional supplemental comprehensive dental benefits.

In-Network

0% of the cost for supplemental oral exams

0% of the cost for up to 2 supplemental cleaning(s) every year

0% of the cost for up to 2 supplemental fluoride treatment(s) every year

30% of the cost for supplemental dental x-rays



General

Package: 2 - Delta Dental Option 2:

$44.90 monthly premium, in addition to your $50 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
  • Preventive Dental
  • Comprehensive Dental


$1,500 plan coverage limit every year for these benefits.



General

Plan offers additional supplemental comprehensive dental benefits.

In-Network

0% of the cost for supplemental oral exams

0% of the cost for up to 2 supplemental cleaning(s) every year

0% of the cost for up to 2 supplemental fluoride treatment(s) every year

30% of the cost for supplemental dental x-rays


Premium and Other Important Information

General

Package: 2 - Delta Dental Option 2:

$44.90 monthly premium, in addition to your $50 monthly plan premium and the monthly Medicare Part B premium, for the following optional benefits:
  • Preventive Dental
  • Comprehensive Dental


$1,500 plan coverage limit every year for these benefits.


Dental Services

General

Plan offers additional supplemental comprehensive dental benefits.

In-Network

0% of the cost for supplemental oral exams

0% of the cost for up to 2 supplemental cleaning(s) every year

0% of the cost for up to 2 supplemental fluoride treatment(s) every year

30% of the cost for supplemental dental x-rays


Other Services

Inpatient Care

Doctor and Hospital Choice



In-Network

You must go to network doctors, specialists, and hospitals.

Referral required for network hospitals.


,

Inpatient Hospital Care



In-Network

No limit to the number of days covered by the plan each hospital stay.

$400 copay for each Medicare-covered hospital stay

$0 copay for additional non-Medicare-covered hospital days

Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.


Outpatient Care

Inpatient Mental Health Care



In-Network

You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

$400 copay for each Medicare-covered hospital stay.

Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.


,

Skilled Nursing Facility (SNF)



General

Authorization rules may apply.

In-Network

Plan covers up to 100 days each benefit period

No prior hospital stay is required.

You will not be charged additional cost sharing for professional services


,

Home Health Care



In-Network

$0 copay for Medicare-covered home health visits


,

Hospice



General

You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.


,

Doctor Office Visits



General

Authorization rules may apply.

In-Network

$0 to $20 copay for each Medicare-covered primary care doctor visit.

$0 to $35 copay for each Medicare-covered specialist visit.


Outpatient Medical Services and Supplies

Chiropractic Services



General

Authorization rules may apply.

In-Network

$20 copay for each Medicare-covered chiropractic visit

Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).


,

Podiatry Services



General

Authorization rules may apply.

In-Network

$35 copay for each Medicare-covered podiatry visit

Medicare-covered podiatry visits are for medically necessary foot care.


,

Outpatient Mental Health Care



General

Authorization rules may apply.

In-Network

$35 copay for each Medicare-covered individual therapy visit

$35 copay for each Medicare-covered group therapy visit

$35 copay for each Medicare-covered individual therapy visit with a psychiatrist

$35 copay for each Medicare-covered group therapy visit with a psychiatrist

$0 copay for Medicare-covered partial hospitalization program services


,

Outpatient Substance Abuse Care



In-Network

$35 copay for Medicare-covered individual substance abuse outpatient treatment visits

$35 copay for Medicare-covered group substance abuse outpatient treatment visits


,

Outpatient Services



General

Authorization rules may apply.

In-Network

$0 to $75 copay for each Medicare-covered ambulatory surgical center visit

$0 to $75 copay for each Medicare-covered outpatient hospital facility visit


,

Ambulance Services



General

Authorization rules may apply.

In-Network

$75 copay for Medicare-covered ambulance benefits.


,

Emergency Care



General

$65 copay for Medicare-covered emergency room visits

Worldwide coverage.

If you are immediately admitted to the hospital, you pay $0 for the emergency room visit.


,

Urgently Needed Care



General

$35 copay for Medicare-covered urgently-needed-care visits

If you are immediately admitted to the hospital, you pay $0 for the urgently-needed-care visit.


,

Outpatient Rehabilitation Services



General

Authorization rules may apply.

Medically necessary physical therapy, occupational therapy, and speech and language pathology services are covered.

In-Network

$15 copay for Medicare-covered Occupational Therapy visits

$15 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits


,

Durable Medical Equipment



General

Authorization rules may apply.

In-Network

20% of the cost for Medicare-covered durable medical equipment


Preventive Services

Prosthetic Devices



General

Authorization rules may apply.

In-Network

20% of the cost for Medicare-covered prosthetic devices

20% of the cost for Medicare-covered medical supplies related to prosthetics, splints, and other devices


,

Diabetes Programs and Supplies



General

Authorization rules may apply.

In-Network

$0 copay for Medicare-covered Diabetes self-management training

$0 copay for Medicare-covered:

  • Diabetes monitoring supplies


  • Therapeutic shoes or inserts


If the doctor provides you services in addition to Diabetes self-management training, separate cost sharing of $20 to $35 may apply


,

Diagnostic Tests, X-Rays, Lab Services, and Radiology Services



General

Authorization rules may apply.

In-Network

$0 copay for Medicare-covered:

  • lab services


$0 to $75 copay for Medicare-covered diagnostic procedures and tests

$0 to $75 copay for Medicare-covered X-rays

$0 to $75 copay for Medicare-covered diagnostic radiology services (not including X-rays)

$25 copay for Medicare-covered therapeutic radiology services

If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services, separate cost sharing of $20 to $35 may apply


,

Cardiac and Pulmonary Rehabilitation Services



In-Network

$15 copay for Medicare-covered Cardiac Rehabilitation Services

$15 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$15 copay for Medicare-covered Pulmonary Rehabilitation Services


Additional Benefits

Preventive Services



General

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

Authorization rules may apply.


,

Kidney Disease and Conditions



General

Authorization rules may apply.

In-Network

$0 to $25 copay for Medicare-covered renal dialysis

$0 copay for Medicare-covered kidney disease education services


,

Dental Services



In-Network

In general, preventive dental benefits (such as cleaning) not covered.

$20 to $35 copay for Medicare-covered dental benefits


,

Hearing Services



In-Network

Hearing aids not covered.

$0 copay for: Medicare-covered diagnostic hearing exams

  • supplemental routine hearing exams



,

Vision Services



In-Network

$0 copay for: Medicare-covered diagnosis and treatment for diseases and conditions of the eye, including an annual glaucoma screening for people at risk

supplemental routine eye exams

$0 copay for
  • one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery


  • up to 1 pair(s) of contact lenses every two years


  • up to 1 pair(s) of eyeglass lenses every two years


  • up to 1 eyeglass frame(s) every two years


If the doctor provides you services in addition to eye exams, separate cost sharing of $20 to $35 may apply

$80 plan coverage limit for contact lenses every two years.

$80 plan coverage limit for eyeglass frames every two years.


CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept HAP Senior Plus - Henry Ford (HMO) for Michigan

/
EUBANKS, PRINCE
20526 PLYMOUTH RD
DETROIT, MI 48228
AMOUZEGAR, SYED
16810 W WARREN AVE
DETROIT, MI 48228
GUAT SY JR MD PC
17000 HUBBARD DR
DEARBORN, MI 48126
KHATIB, BASEL
5728 SCHAEFER RD STE 101
DEARBORN, MI 48126
SIGNORI, ENRIQUE
4900 MERCURY DR
DEARBORN, MI 48126
GODOY, CARLOS
4700 SCHAEFER RD
DEARBORN, MI 48126
GRAHOVAC, JURE
5050 SCHAEFER RD
DEARBORN, MI 48126
LUNA, PAUL
5050 SCHAEFER RD
DEARBORN, MI 48126
ELMENINI, MOHAMMAD
10645 W WARREN AVE
DEARBORN, MI 48126
SELITSKY, BENSON
5050 SCHAEFER RD
DEARBORN, MI 48126
ROBERT C SCHWYN MD PC
17000 HUBBARD DR
DEARBORN, MI 48126
RAAD AL-SARAF MD PC
6650 GREENFIELD RD
DEARBORN, MI 48126
MICHIGAN MEDICAL SERVICES PLLC
13530 MICHIGAN AVE
DEARBORN, MI 48126
OBEID, MOHAMMED
14716 W WARREN AVE
DEARBORN, MI 48126
ANGELES, BERNADETTE
5111 AUTO CLUB DR
DEARBORN, MI 48126
VENKATARAMAN, PREETI
5111 AUTO CLUB DR
DEARBORN, MI 48126
HAMMOUD, HASSAN
4945 SCHAEFER RD
DEARBORN, MI 48126
DEARBORN URGENT CARE PC
5728 SCHAEFER RD
DEARBORN, MI 48126
ELHASAN-FAKIH, LOBNA
6620 SCHAEFER RD
DEARBORN, MI 48126
DERANI, MOHAMAD
15401 W WARREN AVE
DEARBORN, MI 48126
QADIR, GHULAM
6 PARKLANE BLVD
DEARBORN, MI 48126
BURGESS, SUSAN
4634 GREENFIELD RD
DEARBORN, MI 48126
AL-DAIS, ADNAN
14650 W WARREN AVE STE 300
DEARBORN, MI 48126
ONIANGO, TETE
4241 MAPLE ST
DEARBORN, MI 48126
ZAMAN, SARDAR
6434 MEAD ST
DEARBORN, MI 48126
Details
PRINCE EUBANKS, MD
Phone Number
(313) 273-2330
Office Locations
20526 PLYMOUTH RD
DETROIT, MI 48228
20526 PLYMOUTH RD DETROIT MI, 48228

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