HAP Medicare Prime (PPO)

HAP Medicare Prime (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 Prime (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 Prime (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.

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:

Drug Coverage

The HAP Medicare Prime (PPO) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generics, you will pay no copay when using preferred pharmacies or preferred mail order services, while standard pharmacies charge a $9 copay for a one-month supply. Tier 2 generic drugs require an $11 copay for a one-month supply at preferred pharmacies, though you can save with no copay for a three-month supply filled through preferred mail order. Brand-name and specialty medications on this plan are covered through coinsurance. Tier 3 preferred brands require a 15% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 37% coinsurance. Specialty drugs in Tier 5 require a 30% coinsurance for a one-month supply across all preferred and standard pharmacy options.

Additional Benefits

The HAP Medicare Prime (PPO) plan provides comprehensive healthcare coverage with no copay and no coinsurance for primary care physician visits, preventive services, home health care, and cardiac rehabilitation. For inpatient hospital stays, members pay no coinsurance and a $350 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Outpatient services and emergency care are also highly accessible, featuring no coinsurance and copays ranging from no copay for ambulatory surgical centers up to a $130 copay for emergency room visits. This plan also offers robust supplemental benefits, including an annual dental maximum of $2,000 with no copay for preventive care and up to 50% coinsurance for restorative services. Vision and hearing needs are covered with no copay for routine exams, alongside a $150 annual eyewear allowance and prescription hearing aid copays. Additionally, members benefit from unlimited one-way transportation to approved medical sites with no copay, no copays on over-the-counter items, and a 20% coinsurance for durable medical equipment and dialysis services.