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HAP Member Assist (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Member Assist (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Member Assist (PPO) in 2026, please refer to our full plan details page.
HAP Member Assist (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 Member Assist (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 Member Assist (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 Member Assist (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 $615.00 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:
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Drug Coverage
The HAP Member Assist (PPO) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through preferred mail-order services. Tier 2 generic drugs cost as low as a $10 copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a $16 copay. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require an 18% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 40% coinsurance. Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail-order options.
Additional Benefits
The HAP Member Assist (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, preventive care, and home health services. Specialist office visits require a $30 copay, while inpatient hospital stays carry a $250 daily copay for the first five days and no copay for days six through 90. Emergency room visits have a $130 copay that is waived if admitted, and ground or air ambulance services require a $300 copay. Additional benefits include routine dental care up to a $2,000 annual limit and annual routine vision and hearing exams with no copay. You also receive up to $150 annually for eyewear and a $116 quarterly over-the-counter benefit for health products with no copay or coinsurance. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
HAP Member Assist (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 to 5 and no copay for days 6 to 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HAP Member Assist (PPO) covers outpatient hospital services with no coinsurance and a copay between $0 and $200, alongside a $200 copay per stay for observation services. Ambulatory surgical center and outpatient blood services feature no copay or coinsurance, while outpatient substance abuse sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HAP Member Assist (PPO) 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 Member Assist (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HAP Member Assist (PPO) with a $130 copay, which is waived if admitted to the hospital, and no coinsurance, while urgently needed services have a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $45, and $300, respectively.
Primary Care See details
HAP Member Assist (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Other covered primary care benefits like physical and occupational therapy ($20 copay), chiropractic care ($15 to $35 copay), and mental health services ($15 copay) also feature no coinsurance, though podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under HAP Member Assist (PPO) with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, and select nutritional benefits. Uncovered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
HAP Member Assist (PPO) covers annual routine hearing exams and fitting evaluations with no copay, no deductible, and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,575 for up to two devices per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HAP Member Assist (PPO), offering one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, such as glasses and contact lenses, has no copay and no coinsurance up to a $150 annual limit, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by HAP Member Assist (PPO) up to a $2,000 annual maximum, featuring no copay and no coinsurance for most covered services, and a $0 to $30 copay and no coinsurance for Medicare-covered dental. Non-covered sub-services include other diagnostic, other preventive, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
HAP Member Assist (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Medicare Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
HAP Member Assist (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
HAP Member Assist (PPO) partially covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and prosthetics, and between no coinsurance and 20% coinsurance for diabetic supplies. Prior authorization is required for most equipment, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
HAP Member Assist (PPO) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization for these services. Diagnostic procedures and tests carry a copay of $0 to $65, while lab services are not covered; radiological services feature no copay for diagnostic imaging (minimum), a minimum $25 copay for therapeutic radiation, and a $35 copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by HAP Member Assist (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HAP Member Assist (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
HAP Member Assist (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with additional days beyond the Medicare limit not covered.
Other Services See details
HAP Member Assist (PPO) partially covers other services, offering chronic illness meal benefits and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $116 every three months for eligible health products, and unused balances carry forward to the next period.
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