A non-government entity
HAP Medicare Explore (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare Explore (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare Explore (PPO) in 2025, please refer to our full plan details page.
HAP Medicare Explore (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 Medicare Explore (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 Medicare Explore (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 Medicare Explore (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5200.00 (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 $5200.00 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:
Sign up for HAP Medicare Explore (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HAP Medicare Explore (PPO) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, preferred generic drugs have an $11 copay at a preferred pharmacy, while standard generic drugs have 15% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HAP Medicare Explore (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, often with no or low copays. The plan also includes coverage for home health services, home infusion, and dialysis, though some services like skilled nursing facilities, require prior authorization and have associated costs.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $350 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you'll pay a $350 copay for days 1-5, and no copay for days 6-90; additional days are not covered.
Outpatient Services See details
Outpatient Services with the HAP Medicare Explore (PPO) plan include coverage for Outpatient Hospital Services with a copay between $0 and $325, Observation Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $15 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HAP Medicare Explore (PPO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HAP Medicare Explore (PPO) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HAP Medicare Explore (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services have a copay depending on the service, with Worldwide Emergency Coverage at $125, Worldwide Urgent Coverage at $45, and Worldwide Emergency Transportation at $300.
Primary Care See details
The HAP Medicare Explore (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $20 copay, physician specialist services with a $45 copay, mental health specialty services with a $15 copay, other health care professional services with a $0-$45 copay, psychiatric services with a $15 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$45 copay, and opioid treatment program services with a $15 copay. Podiatry services are not covered.
Preventive Services See details
The HAP Medicare Explore (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional covered services include Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered, with a copay between $0 and $1575, with two visits per year covered for all types of hearing aids except inner ear, outer ear, and over the ear, which are not covered.
Vision Services See details
The HAP Medicare Explore (PPO) plan covers vision services, including routine eye exams with a copay between $0 and $45, and eyewear with a combined maximum plan benefit of $150 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered, but upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams with no copay, dental x-rays, prophylaxis (cleaning), and fluoride treatment, with a maximum plan benefit of $2,000 per year. Restorative services and endodontics have a 50% coinsurance, and oral and maxillofacial surgery has 0-50% coinsurance. Adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HAP Medicare Explore (PPO) plan and require prior authorization. Insulin has a $35 copay, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HAP Medicare Explore (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered, and there is no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $180, diagnostic radiological services with a copay of at most $270, therapeutic radiological services with a $25 copay, and outpatient X-ray services with a $35 copay; however, lab services are not covered.
Home Health Services See details
Home Health Services are covered by the HAP Medicare Explore (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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HAP Medicare Explore (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The HAP Medicare Explore (PPO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $80 every three months, and includes Nicotine Replacement Therapy. Other services like Acupuncture, Meal Benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved