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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 2026, 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 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 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 $200.00 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 $5400.00 (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 $5400.00 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 Medicare Explore (PPO) plan features a $200 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order service. For Tier 2 generic medications, copays start at $11 for a one-month supply at preferred locations, with no copay required for a three-month supply filled through preferred mail order. Brand-name and specialty medications are subject to coinsurance, with Tier 3 preferred brands costing 15% coinsurance at preferred pharmacies and 17% at standard pharmacies. Tier 4 non-preferred drugs carry a coinsurance between 37% and 39%, while Tier 5 specialty drugs require a 30% coinsurance for a one-month fill. Selecting preferred pharmacies and mail-order options is the most cost-effective way to manage your prescription drug expenses under this plan.
Additional Benefits
The HAP Medicare Explore (PPO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs and no coinsurance for many benefits. You will pay no copay for primary care visits, while specialist visits cost up to $45, and inpatient hospital stays require a $350 daily copay for the first six days. Emergency care is available with a $130 copay, and outpatient hospital services range from no copay up to a $325 copay. Supplemental benefits include preventive dental, annual hearing exams, and home health services all with no copay and no coinsurance. Dental services are covered up to a $2,000 annual limit, eyewear is covered up to $150 yearly, and there is a quarterly $75 allowance for over-the-counter items with no copay. For durable medical equipment and dialysis services, you can expect no copay but a standard 20% coinsurance.
Inpatient Hospital See details
HAP Medicare Explore (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HAP Medicare Explore (PPO) covers outpatient services with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services, a $325 copay per stay for observation services, and a $15 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
HAP Medicare Explore (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
HAP Medicare Explore (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Routine transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
HAP Medicare Explore (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital) and urgently needed services with a $0 to $45 copay, both with no coinsurance. Worldwide emergency services are also covered with no coinsurance, featuring copays of $130 for emergency care, $45 for urgent care, and $300 for emergency transportation.
Primary Care See details
HAP Medicare Explore (PPO) primary care benefits are partially covered, as podiatry services are not covered. Covered services feature no coinsurance, with copays ranging from no copay for primary care visits up to $45 for specialists and telehealth services.
Preventive Services See details
HAP Medicare Explore (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, with services such as health education, weight management programs, and personal emergency response systems not covered under this plan.
Hearing Services See details
HAP Medicare Explore (PPO) covers hearing exams with no deductible, no copay, and no coinsurance, which includes one routine exam and one fitting evaluation annually. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,575 for up to two devices per year, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
HAP Medicare Explore (PPO) offers partially covered vision services, including one annual routine eye exam with a $0 to $45 copay and no coinsurance, and eyewear covered with no copay or coinsurance up to a $150 yearly limit. No deductibles apply, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by HAP Medicare Explore (PPO) up to a $2,000 combined annual limit, offering no copay and no coinsurance for most preventive care, $0 to $45 copays with no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for comprehensive services. Other preventive dental services, adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HAP Medicare Explore (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin is available for a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the HAP Medicare Explore (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
HAP Medicare Explore (PPO) partially covers medical equipment with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, and medical supplies. Diabetic supplies feature no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HAP Medicare Explore (PPO) with no coinsurance, though prior authorization is required and lab services are not covered. Covered services range from no copay for diagnostic radiology to a $35 copay for outpatient X-rays, a minimum $25 copay for therapeutic radiology, and a copay of up to $180 for diagnostic procedures and tests.
Home Health Services See details
Home health services are covered by the HAP Medicare Explore (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
HAP Medicare Explore (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HAP Medicare Explore (PPO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the HAP Medicare Explore (PPO) plan, which offers Over-the-Counter (OTC) items with no copay and no coinsurance up to $75 every three months. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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