PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Health Alliance Plan
CMS Rating
Plan Type
HMO-POS
Annual Deductible
$50.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors Only (some exceptions)
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In and Out-of-network $3,400 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$50 In-network
Monthly Drug Plan Premium
$106.50
Monthly Health Plan Premium
$113.50

Benefits

Service
Cost
Ambulance
In-network: $100
Point of Service: 20%
Doctor's office visits
Primary Physician
In-network: $15 per visit
Point of Service: 20% per visit
Specialist
In-network: $30 per visit
Point of Service: 20% per visit
Durable medical equipment (wheelchairs, oxygen, etc.)
In-network: 20% per item
Point of Service: 20% per item
Emergency care
$75 per visit (always covered)
Home health care
In-network: You pay nothing
Point of Service: 20%
Mental health care
In-network: $85 for days 1 through 5
$0 for days 6 through 90
Point of Service: 20% per stay
Outpatient hospital
In-network: $0-75 per visit
Point of Service: 20% per visit
Renal dialysis
In-network: $0-25 per visit
Point of Service: 20% per visit
Inpatient hospital care
In-network: $85 for days 1 through 5
$0 for days 6 through 90
Point of Service: 20% per stay
Skilled Nursing Facility (SNF)
In-network: $15 for days 1 through 20
$160 for days 21 through 100
Point of Service: 20% per stay

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copay$4 copay
Tier 2: Non-Preferred Generic$10 copay$10 copay$10 copay
Tier 3: Preferred Brand Name$45 copay$45 copay$45 copay
Tier 4: Non-Preferred Brand Name31% coinsurance31% coinsurance31% coinsurance
Tier 5: Specialty Tier31% coinsurance31% coinsurance31% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$10 copay$10 copay$10 copay
Tier 2: Non-Preferred Generic$25 copay$25 copay$25 copay
Tier 3: Preferred Brand Name$112.5 copay$112.5 copay$112.5 copay
Tier 4: Non-Preferred Brand Name31% coinsurance31% coinsurance31% coinsurance
Tier 5: Specialty Tier31% coinsurance31% coinsurance31% coinsurance

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
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
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept HAP Senior Plus - Expanded Network (HMO-POS) for Michigan

/
EUBANKS, PRINCE
20526 PLYMOUTH RD
DETROIT, MI 48228
PRECHEL, WILLIAM
16551 W WARREN AVE
DETROIT, MI 48228
SAAD, GEORGE
20526 PLYMOUTH RD STE C
DETROIT, MI 48228
ZOUABI, FIRAS
18311 W WARREN AVE
DETROIT, MI 48228
AMOUZEGAR, SYED
16810 W WARREN AVE
DETROIT, MI 48228
PIKO, CYNTHIA
4900 MERCURY DR
DEARBORN, MI 48126
SELITSKY, BENSON
5050 SCHAEFER RD
DEARBORN, MI 48126
MOHAMED, TAHIR
6050 GREENFIELD RD
DEARBORN, MI 48126
ELMENINI, MOHAMMAD
10645 W WARREN AVE
DEARBORN, MI 48126
YASIN, FARES
4634 GREENFIELD RD
DEARBORN, MI 48126
VENKATARAMAN, PREETI
5111 AUTO CLUB DR
DEARBORN, MI 48126
GRAHOVAC, JURE
5050 SCHAEFER RD
DEARBORN, MI 48126
KHATIB, BASEL
5728 SCHAEFER RD STE 101
DEARBORN, MI 48126
DEARBORN URGENT CARE PC
5728 SCHAEFER RD
DEARBORN, MI 48126
DEARBORN FAMILY MEDICINE CENTER
5728 SCHAEFER RD
DEARBORN, MI 48126
SAMI ABU FARHA MD PC
5280 OAKMAN BLVD
DEARBORN, MI 48126
CHARARA, KASSEM
6211 CHASE RD
DEARBORN, MI 48126
HASHMI, AZRA
6401 MILLER RD
DEARBORN, MI 48126
SY, GUAT
17000 HUBBARD DR
DEARBORN, MI 48126
ABDALLAH, BELAL
15400 MICHIGAN AVE
DEARBORN, MI 48126
BANISTER, SUHAIL
4700 SCHAEFER RD
DEARBORN, MI 48126
SHAH, SARJU
15500 LUNDY PKWY
DEARBORN, MI 48126
PANDIT, RENU
4900 MERCURY DR
DEARBORN, MI 48126
VIVIANO, DAVID
5050 SCHAEFER RD
DEARBORN, MI 48126
SIGNORI, OSCAR
4900 MERCURY DR
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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