HAP Medicare MedicalAccess
HMO
Price: $0.00, per month
Price: $0.00, per month
Plan Specifics
- Coverage Type
- Part A, Part B
- Monthly Plan Premium
- $0
- Contract ID
- H2354-019
- Annual Medical Deductible
- $0
- Max Enrollee Out-of-Pocket
- $4,500 Annual In-Network
- Part B Premium Reduction
- $50
Medicare-Covered Medical Benefits
| Category | In-Network |
|---|---|
| Preventive Care | Covered at 100%. |
| Doctor's Office Visits | Primary Care Provider Office Visit: $0 copay. Specialist Office Visit: $35 copay; $0 copay applies for diabetic condition specific podiatry services. |
| Annual Physical | Medicare-covered Benefits: Covered. The Routine Physical Exam is covered once per calendar year. |
| Inpatient Hospital Care | $325 per day for days 1 through 5. $0 per day for days 6 through 90. |
| Emergency Care | Emergency Room: $125 copay. |
| Urgently Needed Services | Urgent Care: $45 copay. |
| Ambulance | $300 copay. |
| Ambulatory Surgical Center | $225 copay. |
| Chiropractic Services | 1 Office visit per year: $20 copay 1 set of X-rays per year: $35 copay Manual Manipulation of Spine: $20 copay. |
| Outpatient Therapy (Physical, Occupational, Speech, Cardiac) | $20 copay. |
| Outpatient Hospital & Observation Services | $300 copay. |
| Medical Equipment/Supplies | Durable Medical Equipment: 20% coinsurance. Prosthetic Devices: 20% coinsurance. Diabetic Supplies and Services: $0 - 20% coinsurance. 20% coinsurance for continuous glucose monitors when obtained at a DME provider. $0 copay for continuous glucose monitors when obtained at a pharmacy. $0 copay applies for all other diabetic supplies and services. |
| Diagnostic Procedures/Lab Services/Imaging | Diagnostic Procedures/Tests: $0 - $150 copay. X-Ray Services: $35 copay. Therapeutic Radiological Services: $40 copay. |
| High-Tech Diagnostic Radiology Services | $0 peripheral vascular disease ultrasounds. $200 high tech diagnostic tests. (CT, MRI, PET scan). |
| Diagnostic Tests, Procedure & Lab Services (including genetic testing) | $150 copay. |
| Other Diagnostic Test/Procedures | Pacemaker testing, allergy testing, bone density testing, surgical supplies (splints and casts included): $0 copay. |
| Ultrasounds | $35 copay. |
| Outpatient X-rays | $35 copay. |
| Therapeutic radiology services, such as radiation treatment for cancer | $40 copay. |
| Mental Health Services | $15 copay. |
| Foot Care (Podiatry Services) | Podiatry Services and Routine Foot Care: $0 - $35 copay; $0 copay applies for diabetic condition specific podiatry services. |
| Skilled Nursing Facility | $0 copay for days 1 to 20. $214 copay for days 21 to 100. |
Not Covered By Medicare |
|
| Hearing Services | Medicare-covered Benefits: $0 - $35 copay. Routine Hearing Exams: $0. Fitting/Evaluation for Hearing Aid: $0. Must use NationsHearing®. |
| Allowance for Hearing Aids | Hearing Aids (All Types): Covered. All Types: $0 - $1575 copay. Must use NationsHearing®. |
| Vision Services | Medicare-covered Benefits: $0 - $35 copay. Routine Eye Exam: $0 through Eyemed Insight Network. |
| Allowance for Eyewear | Contact Lenses: Covered. Eyeglasses (Lenses and Frames): Covered. $150 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, onlays, crowns, 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. |
| Transportation | 12 one-way trips - Includes doctor, dentist, optical, hearing and pharmacy visits. Powered by Veyo®. |
| Flexcard | $60 per qtr; with rollover to next qtr for OTC & healthy food/produce; 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™. |
| OTC | 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. |
| 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. |
| Meal Benefit | Limited to 2 discharges per year of 28 meals /14 days; max of 56 meals per year. |
Prescription Drug Benefits
| Coverage Type: | Part D |
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Pre-initial coverage limit
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