2019 Alliance Medicare Supplement Brochure€¦ · know that you are protected with a plan from Alliance Health and Life Insurance Company (Alliance). With Alliance Medicare Supplement,

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.

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:

• 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.

3

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.

7

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

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

32

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 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


• 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


• 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


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

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)



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)







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







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

First $183 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)







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



maximum

$0/80% to a lifetime maximum of $50,00



maximum

80% to a lifetime

maximum of $50,000



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.

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© 2018 Health Alliance Plan of Michigan. A Nonprofit Company. .5M 9/2018

Documents

2019 Alliance Medicare Supplement Brochure€¦ · know that you are protected with a plan from Alliance Health and Life Insurance Company (Alliance). With Alliance Medicare Supplement,