Plan Basics
Contract Year 2020
Medicare Type Medicare Advantage Plan (Part C)
CMS Plan ID H9487-001-000
Plan Organization Michigan Complete Health
Plan Type Medicare-Medicaid Plan HMO
Plan Name Michigan Complete Health (Medicare-Medicaid Plan)
Plan Organization Type Demo
Drugs Covered Yes
Doctors Choice Plan Doctors for Most Services
Benefit Type Enhanced Alternative
Special Needs Plan No
Overall Star Rating Not enough data available
Plan Cost Sharing
Premium $0.00
Monthly Part D Basic Premium $0.00
Monthly Part D Supplemental Premium $0.00
Monthly Part D Total Premium $0.00
Monthly Part D Premium Full Assistance $0.00
Monthly Part D Premium 75% Assistance $0.00
Monthly Part D Premium 50% Assistance $0.00
Monthly Part D Premium 25% Assistance $0.00
Part D Drug Deductible $0.00
Part D Catastrophic Coverage Threshold $6350
Gap Coverage Yes
Formulary Website Formulary Link

Medicare Advantage Plan Health Benefits


Comprehensive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Endodontics No - - - Not covered
Extractions Yes - Yes No $0 copay
Periodontics Yes - Yes No $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Yes - Yes No $0 copay
Diagnostic services No - Yes No $0 copay
Non-routine services No - - - Not covered
Restorative services No - Yes No $0 copay
Health Plan Deductible
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $0
Hearing
Service Cap Network Auth. Req. Ref. Req. Cost Share
Fitting/evaluation Yes - Yes Yes $0 copay
Hearing aids Yes - Yes Yes $0 copay
Hearing exam - - Yes Yes $0 copay
Maximum Out-of-pocket Enrollee Responsibility (does Not Include Prescription Drugs)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Not Applicable
Mental Health Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Outpatient group therapy visit - - Yes No $0 copay
Outpatient individual therapy visit - - Yes No $0 copay
Inpatient hospital - psychiatric - - Yes No $0 copay
Outpatient individual therapy visit with a psychiatrist - - Yes No $0 copay
Outpatient group therapy visit with a psychiatrist - - Yes No $0 copay
Preventive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Cleaning Yes - No No $0 copay
Fluoride treatment Yes - No No $0 copay
Dental x-ray(s) Yes - No No $0 copay
Oral exam Yes - No No $0 copay
Skilled Nursing Facility
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes Yes $0 copay
Diagnostic Procedures/lab Services/imaging
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic tests and procedures - - Yes Yes $0 copay
Diagnostic radiology services (e.g., MRI) - - Yes Yes $0 copay
Lab services - - Yes Yes $0 copay
Outpatient x-rays - - Yes Yes $0 copay
Emergency Care/Urgent Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
Emergency - - - - $0 copay
Urgent care - - - - $0 copay
Foot Care (podiatry Services)
Service Cap Network Auth. Req. Ref. Req. Cost Share
Foot exams and treatment - - Yes Yes $0 copay
Routine foot care - - - - Not covered
Medical Equipment/supplies
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diabetes supplies - - Yes - $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) - - Yes - $0 copay
Prosthetics (e.g., braces, artificial limbs) - - Yes - $0 copay
Outpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes Yes $0 copay
Rehabilitation Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Physical therapy and speech and language therapy visit - - Yes Yes $0 copay
Occupational therapy visit - - Yes Yes $0 copay
Additional Benefits And/or Reduced Cost-sharing For Enrollees With Certain Health Conditions?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Doctor Visits
Service Cap Network Auth. Req. Ref. Req. Cost Share
Specialist - - Yes Yes $0 copay
Primary - - - - $0 copay
Ground Ambulance
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $0 copay
Inpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes Yes $0 copay
Optional Supplemental Benefits
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - No
Other Health Plan Deductibles?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Preventive Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - Yes No $0 copay
Vision
Service Cap Network Auth. Req. Ref. Req. Cost Share
Eyeglass frames Yes - Yes No $0 copay
Eyeglass lenses Yes - Yes No $0 copay
Routine eye exam Yes - No No $0 copay
Upgrades - - - - Not covered
Contact lenses Yes - Yes No $0 copay
Eyeglasses (frames and lenses) Yes - Yes No $0 copay
Other No - - - Not covered
Medicare Part B Drugs
Service Cap Network Auth. Req. Ref. Req. Cost Share
Chemotherapy - - Yes - $0 copay
Other Part B drugs - - Yes - $0 copay
Transportation
Service Cap Network Auth. Req. Ref. Req. Cost Share
No - Yes No $0 copay
Wellness Programs (e.g., Fitness, Nursing Hotline)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - No No Covered
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Macomb County, Michigan, Wayne County, Michigan

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