HAP Medicare Complete Assist
PPO-DSNP
Price: $0.00, per month
Price: $0.00, per month
Plan Specifics
- Coverage Type
- Part A, Part B, Part D
- Monthly Plan Premium
- $0
- Contract ID
- H2322-020
- Annual Medical Deductible
- $0-$263 (Depending on level of Medicaid Eligibility)
- Annual Prescription Deductible
- $0 - $590 (Depending on LIS status)
- Max Enrollee Out-of-Pocket
- $9,350 Annual In-Network
- $14,000 Combined In and Out-of-Network
- Part B Premium Reduction
- $2.30
Medicare-Covered Medical Benefits
| Category | In-Network | Out-of-Network |
|---|---|---|
| Preventive Care | Covered at 100%. | $0 - 20% coinsurance. |
| Doctor's Office Visits | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Annual Physical | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Inpatient Hospital Care | $0 or $2185 per stay for inpatient acute. $0 or $2036 per stay for inpatient psyphiatric. | $0 or 20% coinsurance per stay for inpatient acute. |
| Emergency Care | $0 or $110 copay. | $0 or 20% coinsurance per stay for inpatient psyphiatric |
| Urgently Needed Services | $0 - $45 copay. | $0 or $110 copay. |
| Ambulance | $0 - 20% coinsurance. | $0 - $45 copay. |
| Ambulatory Surgical Center | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Chiropractic Services | 1 Office visit per year: $0 - 20% coinsurance. 1 set of X-rays per year: $0 - 20% coinsurance. Manual Manipulation of Spine: $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Outpatient Therapy (Physical, Occupational, Speech, Cardiac) | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Outpatient Hospital & Observation Services | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Medical Equipment/Supplies | Durable Medical Equipment and Prosthetic Devices: $0 - 20% coinsurance. Diabetic Supplies and Services: $0 - 20% coinsurance. | Durable Medical Equipment and Prosthetic Devices: $0 - 20% coinsurance. Diabetic Supplies and Services: $0 - 20% coinsurance. |
| Diagnostic Procedures/Lab Services/Imaging | Diagnostic Procedures/Tests: $0 - 20% coinsurance. X-Ray Services: $0 - 20% coinsurance. Therapeutic Radiological Services: $0 - 20% coinsurance. | Diagnostic Procedures/Tests: $0 - 20% coinsurance. X-Ray Services: $0 - 20% coinsurance. Therapeutic Radiological Services: $0 - 20% coinsurance. |
| High-Tech Diagnostic Radiology Services | $0 - 20% coinsurance for peripheral vascular disease ultrasounds. $0 - 20% coinsurance for high tech diagnostic tests. (CT, MRI, PET scan). | $0 - 20% coinsurance for peripheral vascular disease ultrasounds. $0 - 20% coinsurance for high tech diagnostic tests. (CT, MRI, PET scan). |
| Diagnostic Tests, Procedure & Lab Services (including genetic testing) | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Other Diagnostic Test/Procedures | Pacemaker testing, allergy testing, bone density testing, surgical supplies (splints and casts included): $0 - 20% coinsurance. | Pacemaker testing, allergy testing, bone density testing, surgical supplies (splints and casts included): $0 - 20% coinsurance. |
| Ultrasounds | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Outpatient X-rays | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Therapeutic radiology services, such as radiation treatment for cancer | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Mental Health Services | $0 - 20% coinsurance. | $0 - 20% coinsurance. |
| Foot Care (Podiatry Services) | Podiatry Services and Routine Foot Care: $0 - 20% coinsurance. Routine podiatry services are limited to 6 visits per year. | Podiatry Services: $0 - 20% coinsurance. Routine Foot Care: $0 - 20% coinsurance. |
| Skilled Nursing Facility | $0 copay for days 1 to 20. $0 or $214 copay for days 21 to 100. | $0 - 20% coinsurance for days 1 to 20. $0 - 20% coinsurance for days 21 to 100. |
Not Covered By Medicare |
||
| Hearing Services | Medicare-covered hearing Benefits: $0 or 20% coinsurance. Routine Hearing Exams:$0 . Fitting/Evaluation for Hearing Aid: $0. Must use NationsHearing®. | Medicare-covered hearing Benefits: $0 or 20% coinsurance. Routine Hearing Exams:$0 . Fitting/Evaluation for Hearing Aid: $0. Must use NationsHearing®. |
| Allowance for Hearing Aids | Hearing Aids (All Types): Covered. All Types: $1,000 allowance. Must use NationsHearing®. | Hearing Aids (All Types): Covered. All Types: $1,000 allowance. Must use NationsHearing®. |
| Vision Services | Medicare-covered Benefits: $0 copay. Routine Eye Exam: $0 through Eyemed Insight Network. | Medicare-covered Benefits: $0 copay. Routine Eye Exam: $0 through Eyemed Insight Network. |
| Allowance for Eyewear | Contact Lenses: Covered. Eyeglasses (Lenses and Frames): Covered. Eyeglass Lenses: Covered. Eyeglass Frames: Covered. Upgrades: Not Covered. $300 allowance. Must use Eyemed insight network. | Contact Lenses: Covered. Eyeglasses (Lenses and Frames): Covered. Eyeglass Lenses: Covered. Eyeglass Frames: Covered. Upgrades: Not Covered. $300 allowance. Must use Eyemed insight network. |
| Dental Services | Preventive & comprehensive dental through Delta Dental PPO Network- Includes $2,000 max for preventive and comprehensive services combined; 100% coverage for: 2 oral exams, 2 cleanings or 2 periodontal cleanings, 2 fluoride treatments, brush biopsy, 1 set of bitewings per year, root canals, fillings, bridges, bridge repairs, crown repairs, perio surgical/non surgical procedures, surigcal extractions/oral surgery, emergency palliative treatment, occlusal guards/adjustments, anesthesia and simple extractions. Doesn't apply to Ded or MOOP. No prior auth or referral required. | Preventive & comprehensive dental through Delta Dental PPO Network- Includes $2,000 max for preventive and comprehensive services combined; 100% coverage for: 2 oral exams, 2 cleanings or 2 periodontal cleanings, 2 fluoride treatments, brush biopsy, 1 set of bitewings per year, root canals, fillings, bridges, bridge repairs, crown repairs, perio surgical/non surgical procedures, surigcal extractions/oral surgery, emergency palliative treatment, occlusal guards/adjustments, anesthesia and simple extractions. Doesn't apply to Ded or MOOP. No prior auth or referral required. |
| Wellness Programs | Fitness Benefit, Memory Fitness provided by BrainHQ®, Nutritional/Dietary, Unlimited Sessions of Smoking & Tobacco Cessation Counseling. | Fitness Benefit, Memory Fitness provided by BrainHQ®, Nutritional/Dietary, Unlimited Sessions of Smoking & Tobacco Cessation Counseling. |
| Personal Emergency Response System (PERS) | 24/7 monitoring service that can respond to emergency services, family or caregiver For members with an identified fall risk. Powered by NationsResponse®. | 24/7 monitoring service that can respond to emergency services, family or caregiver For members with an identified fall risk. Powered by NationsResponse®. |
| Companion Care | Provides members with emotional support and socialization and help with a variety of tasks, such as running errands, household chores, social activities, transportation, meal prep, and setting up technology. 8 hours per month. For members with an identified social isolation or loneliness. Powered by PAPA®. | Provides members with emotional support and socialization and help with a variety of tasks, such as running errands, household chores, social activities, transportation, meal prep, and setting up technology. 8 hours per month. For members with an identified social isolation or loneliness. Powered by PAPA®. |
| Transportation | 36 one-way trips - Includes doctor, dentist, optical, hearing and pharmacy visits. Powered by Veyo®. | 36 one-way trips - Includes doctor, dentist, optical, hearing and pharmacy visits. Powered by Veyo®. |
| Flexcard | $138 per month with rollover for OTC, healthy food/produce, home modifications, pest control, utilities, fuel at pump, rideshare services & copay assist (excludes vendors); includes retail. | $138 per month with rollover for OTC, healthy food/produce, home modifications, pest control, utilities, fuel at pump, rideshare services & copay assist (excludes vendors); includes retail. |
| SilverSneakers® fitness benefits | As a member, you have a fitness benefit through SilverSneakers® at no additional cost. SilverSneakers® can help you live a healthier, more active life through fitness and social connection. You are covered for a fitness benefit through SilverSneakers® at participating locations. You have access to instructors who lead specially designed group exercise classes. At participating locations nationwide, you can take classes plus use exercise equipment and other amenities. Additionally, SilverSneakers FLEX® gives you options to get active outside of traditional gyms (like recreation centers, malls and parks). SilverSneakers also connects you to a support network and virtual resources through SilverSneakers LIVE™ classes, SilverSneakers On-Demand™ videos and our mobile app, SilverSneakers GO™. | As a member, you have a fitness benefit through SilverSneakers® at no additional cost. SilverSneakers® can help you live a healthier, more active life through fitness and social connection. You are covered for a fitness benefit through SilverSneakers® at participating locations. You have access to instructors who lead specially designed group exercise classes. At participating locations nationwide, you can take classes plus use exercise equipment and other amenities. Additionally, SilverSneakers FLEX® gives you options to get active outside of traditional gyms (like recreation centers, malls and parks). SilverSneakers also connects you to a support network and virtual resources through SilverSneakers LIVE™ classes, SilverSneakers On-Demand™ videos and our mobile app, SilverSneakers GO™. |
| OTC | Coverage available with Flex Card allowance. (See Flex Card details above). | Coverage available with Flex Card allowance. (See Flex Card details above). |
| Digital Diabetes Program | For members already enrolled in HAP's Digital Diabetes program who also have a diagnosis of hypertension additional tools are available to help dual-diagnosed members manage both of these conditions including assistance with weight management and their emotional wellbeing. | For members already enrolled in HAP's Digital Diabetes program who also have a diagnosis of hypertension additional tools are available to help dual-diagnosed members manage both of these conditions including assistance with weight management and their emotional wellbeing. |
| Diabetes Management | Robust care for diabetics at affordable cost. $0 cost share for critical diabetes prevention and care on items such as podiatry visits and virtual care check ups. $0 podiatry visits for diabetics. $0 Continuous Glucose monitor when filled at a pharmacy. Insulins covered under Medicare Part B are subject to a coinsurance cap of $35 for one month’s supply of insulin with no deductible. | Robust care for diabetics at affordable cost. $0 cost share for critical diabetes prevention and care on items such as podiatry visits and virtual care check ups. $0 podiatry visits for diabetics. $0 Continuous Glucose monitor when filled at a pharmacy. Insulins covered under Medicare Part B are subject to a coinsurance cap of $35 for one month’s supply of insulin with no deductible. |
| Meal Benefit | Limited to 2 discharges per year of 28 meals /14 days; max of 56 meals per year. | Limited to 2 discharges per year of 28 meals /14 days; max of 56 meals per year. |
Prescription Drug Benefits
| Coverage Type: | Part D | |||||
| Disclaimer |
HAP Medicare Complete Duals now offers a Value Based Insurance Design (VBID) that eliminates drug cost shares for LIS eligible enrollees through all 3 phases of your benefit (Deductible, Initial Phase, Catastrophic Phase).
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Pre-initial coverage limit
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Standard Retail Cost Sharing - One Month Supply
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Standard Retail Cost Sharing - Three Month Supply
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Standard Mail Order Cost Sharing - Three Month Supply
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Preferred Retail Cost Sharing - One Month Supply
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Preferred Retail Cost Sharing - Three Month Supply
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Preferred Mail Order Cost Sharing - Three Month Supply
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| Tier 1 - Preferred Generic | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 2 - Generic | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 3 - Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4 - Non-Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5 - Specialty Tier | 25% | N/A | N/A | 25% | N/A | N/A |