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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 2026, 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 Southeast, West, Central and Northern Michigan. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $4150.00 (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 $4150.00 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) Medicare plan features a $0 prescription drug deductible, meaning your coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs start at a $9 copay for a 1-month supply at preferred pharmacies, and you can get a 3-month supply with no copay through preferred mail order. Higher-tier medications under this plan are covered via coinsurance. Tier 3 preferred brand drugs carry a 15% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs require 37% coinsurance and Tier 5 specialty drugs require 33% coinsurance. Utilizing standard pharmacies or standard mail order will result in slightly higher copays or coinsurance rates.
Additional Benefits
The HAP Senior Plus (PPO) plan offers comprehensive medical coverage with no copays for primary care visits, preventive services, and home health care. Specialist visits require a $25 copay, while inpatient hospital stays cost a $250 daily copay for the first five days followed by no copay. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care ranges from no copay to $45. For additional wellness benefits, the plan provides routine hearing and preventive dental care with no copays, alongside a $121 quarterly over-the-counter allowance. Routine eye exams feature a $0 to $25 copay, with up to $150 covered annually for eligible eyewear. Most durable medical equipment and dialysis services require a 20% coinsurance with no copay, making it easy to plan your healthcare budget.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HAP Senior Plus (PPO) with no coinsurance and a $250 copay for days 1 through 5, followed by no copay for days 6 through 90. While unlimited additional acute care days are fully covered at no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HAP Senior Plus (PPO) covers outpatient hospital services with no coinsurance and a copay of $0 to $200, while ambulatory surgical center and blood services have no copay and no coinsurance. For outpatient substance abuse, some services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
HAP Senior Plus (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
HAP Senior Plus (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance per trip, subject to prior authorization. Transportation services to plan-approved locations are partially covered with no copay or coinsurance for up to 12 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
HAP Senior Plus (PPO) covers emergency services with a $150 copay, which is waived if you are admitted, and urgently needed services with a copay ranging from no copay to $45, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $150, $45, and $250, respectively.
Primary Care See details
HAP Senior Plus (PPO) offers primary care physician visits with no copay and no coinsurance, specialist visits for a $25 copay with no coinsurance, and physical therapy for a $15 copay with no coinsurance. Podiatry is not covered, and while some mental health and psychiatric services are covered with no copay and no coinsurance, individual and group sessions for both of these services are not covered.
Preventive Services See details
HAP Senior Plus (PPO) preventive services are partially covered with no copay and no coinsurance for covered care, which includes annual physical exams, kidney disease education, and certain nutritional or fitness benefits. However, many supplemental services are not covered, such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
HAP Senior Plus (PPO) partially covers hearing services, offering one routine hearing exam and one fitting evaluation annually with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $0 to $1,575, but OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services under HAP Senior Plus (PPO) are partially covered, as other eye exam services and eyewear upgrades are not covered. Routine eye exams are covered once per year with a $0 to $25 copay and no coinsurance, while eligible eyewear is covered with no copay or coinsurance up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by HAP Senior Plus (PPO) up to a $2,000 annual limit, offering no copay and no coinsurance for preventive care like exams and cleanings, while Medicare dental services have a $0 to $25 copay and no coinsurance. Restorative and endodontic services require a 50% coinsurance and no copay, but other preventive services, adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HAP Senior Plus (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under HAP Senior Plus (PPO) with no copay and a 20% coinsurance. This coverage ensures you have access to necessary dialysis treatments with clearly defined out-of-pocket costs.
Medical Equipment See details
HAP Senior Plus (PPO) partially covers medical equipment with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies are covered with no copay and coinsurance ranging from no coinsurance to 20%, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
HAP Senior Plus (PPO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required and lab services are not covered. Diagnostic tests and procedures carry a copay ranging from no copay to $150, while radiological services require a $35 copay for X-rays, a minimum $40 copay for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the HAP Senior Plus (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HAP Senior Plus (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HAP Senior Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a daily copay of $218 for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HAP Senior Plus (PPO), featuring chronic illness meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered, but the plan provides a $121 OTC allowance every three months that carries forward if unused.
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