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HAP Senior Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Senior Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Senior Plus (PPO) in 2025, please refer to our full plan details page.
HAP Senior Plus (PPO) is a PPO plan offered by Henry Ford Health System available for enrollment in 2025 to people living in Central, Southwest and Southeast Michigan Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that HAP Senior Plus (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HAP Senior Plus (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HAP Senior Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $165.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $4000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HAP Senior Plus (PPO) plan has an "Enhanced Alternative" drug benefit type. The plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $11 copay at a preferred pharmacy, and preferred brand drugs have 48% coinsurance at a preferred pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The HAP Senior Plus (PPO) plan offers a wide range of benefits with varying costs. Hospital stays come with a copay, but many outpatient services have no copay. The plan also includes coverage for ambulance, emergency, and primary care services, along with preventive, hearing, vision, and dental services, each with its own copay or coinsurance structure. Additional benefits include home health services with no copay, and coverage for home infusion, dialysis, medical equipment, and diagnostic services. There is also an allowance for over-the-counter items and a meal benefit. However, it is important to note that some services like mental health, psychiatric, podiatry, and certain alternative therapies are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $250 copay for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are not covered, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the HAP Senior Plus (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ambulance services, with a $250 copay for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered, with 12 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HAP Senior Plus (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay of $0 to $45, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
HAP Senior Plus (PPO) covers primary care, including chiropractic, occupational therapy, and physical therapy services. Chiropractic services have a $20 copay for routine care, and a $35 copay for other services, each limited to one visit per year. Occupational therapy and physical therapy services have a $15 copay, while physician specialist services have a $25 copay. Additional telehealth benefits are covered with a copay ranging from $0 to $45. Mental health and psychiatric services, as well as podiatry services, are not covered.
Preventive Services See details
The HAP Senior Plus (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services include nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered, but the plan does not cover inner ear, outer ear, or over-the-ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $25, and eyewear with a combined maximum benefit of $150 every year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, while upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a copay between $0 and $25, and other services including Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery, with varying cost-sharing and limitations. Other Diagnostic Dental Services, Prosthodontics, removable, Implant Services, and Prosthodontics, fixed are optional supplemental benefits, and Adjunctive General Services and Orthodontics are not covered. There is a $2,000 annual maximum benefit for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HAP Senior Plus (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the HAP Senior Plus (PPO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under the HAP Senior Plus (PPO) plan include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with coinsurance for Medicare-covered items, and Diabetic Supplies with 0-20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HAP Senior Plus (PPO) plan. Diagnostic Procedures/Tests have a maximum copay of $150, while Therapeutic Radiological Services have a $40 copay, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the HAP Senior Plus (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is no copay or coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HAP Senior Plus (PPO), but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional days beyond what Medicare covers and non-Medicare-covered stays are not covered.
Other Services See details
Other Services with the HAP Senior Plus (PPO) plan include a $125 allowance every three months for over-the-counter items and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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