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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 2025, 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 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 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 $26.60. 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 $590.00 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 $4750.00 (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 $4750.00 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) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while standard generic drugs have 21% coinsurance at a preferred pharmacy. In the initial coverage phase, you pay these costs until your total drug costs reach $2000. After that, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The HAP Member Assist (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $250 copay for the first five days, then no copay for the rest of the stay. Outpatient services have copays from $0-$200. Emergency services will cost you a $125 copay, but this is waived if you are admitted to the hospital. The plan also covers many services with copays, including primary care, vision, and dental. You'll find coverage for hearing exams, prescription hearing aids, and eyewear. Additionally, the plan provides coverage for home health services, with no copay, and dialysis services with 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you also pay a $250 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered; Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $200, Observation Services with a $200 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 under the HAP Member Assist (PPO) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $300 copay. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year, using taxi, rideshare services, bus/subway, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the HAP Member Assist (PPO) plan, with a $125 copay for emergency services and no coinsurance; the copay is waived if admitted to the hospital. Urgently Needed Services have a copay between $0 and $45 and no coinsurance. Worldwide Emergency Services are covered, with a $125 copay for Worldwide Emergency Coverage, a $45 copay for Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation.
Primary Care See details
HAP Member Assist (PPO) covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $30 copay, mental health specialty services with a $15 copay, physical therapy and speech-language pathology services with a $20 copay, and psychiatric services with a $15 copay. This plan also offers additional telehealth benefits with a copay between $0 and $45, other health care professional services with a copay between $0 and $30, and opioid treatment program services with a $15 copay. Podiatry services are not covered.
Preventive Services See details
The HAP Member Assist (PPO) plan covers a variety of preventive services, including Medicare-covered services, annual physical exams, additional preventive services, kidney disease education, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, or counseling services. The plan covers nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies.
Hearing Services See details
Hearing Services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aids are covered for one visit per year. Prescription Hearing Aids (all types) are covered with a copay between $0 and $1575, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $30, and eyewear with a copay between $0 and $30. Eyewear has a combined maximum plan benefit coverage of $150 per year, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a copay ranging from $0 to $30, and other dental services with a $2,000 maximum per year. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery are covered, while adjunctive general services, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HAP Member Assist (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HAP Member Assist (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by HAP Member Assist (PPO), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with a coinsurance for some services, but Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Supplies have 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests with a maximum copay of $65, diagnostic radiological services with a copay of up to $200, 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 Member Assist (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 not covered by the HAP Member Assist (PPO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HAP Member Assist (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HAP Member Assist (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. The plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage of $125.00 every three months, and the plan also covers Meal Benefits for chronic illnesses, and Assist America Emergency Travel Benefit.
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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.
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