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HAP Medicare Complete Assist (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare Complete Assist (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare Complete Assist (PPO D-SNP) in 2026, please refer to our full plan details page.
HAP Medicare Complete Assist (PPO D-SNP) is a PPO D-SNP 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 2026.
It's important to know that HAP Medicare Complete Assist (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HAP Medicare Complete Assist (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HAP Medicare Complete Assist (PPO D-SNP).
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 Complete Assist (PPO D-SNP), 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 $13900.00 (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 $13900.00 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 Complete Assist (PPO D-SNP) plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. While specific drug coverage tier details and copayments are not currently available for this plan, understanding this initial deductible is a crucial step in evaluating your yearly healthcare costs. Because tier-specific copays and coinsurance rates are not specified, you will want to verify how your specific prescriptions are covered under this plan's formulary. Comparing this $615 deductible against your current medication needs will help determine if this PPO D-SNP plan is the right fit for your Medicare drug coverage.
Additional Benefits
The HAP Medicare Complete Assist (PPO D-SNP) plan offers comprehensive coverage where many outpatient, diagnostic, and primary care services require no copay and a standard 20% coinsurance. Inpatient hospital stays require a $2,185 copay per acute stay and a $2,036 copay per psychiatric stay with no coinsurance, while emergency room visits carry a $115 copay that is waived upon admission. This plan also provides valuable supplemental benefits, including home health care and skilled nursing services with no copay and no coinsurance. Members benefit from dental, vision, and hearing coverage with no copays, featuring annual allowance limits of up to $2,000 for dental, $300 for eyewear, and $1,000 for hearing aids. Additionally, the plan includes up to 36 one-way transportation trips, over-the-counter items, and chronic illness meals at no cost to the member.
Inpatient Hospital See details
HAP Medicare Complete Assist (PPO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,185 copay per acute stay and a $2,036 copay per psychiatric stay. Prior authorization is required, and while unlimited additional acute days are covered with no copay, non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by HAP Medicare Complete Assist (PPO D-SNP) with no copays and a 20% coinsurance for outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital and ambulatory surgical center services.
Partial Hospitalization See details
Partial hospitalization is covered by HAP Medicare Complete Assist (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HAP Medicare Complete Assist (PPO D-SNP) covers ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services are partially covered with no copay or coinsurance for up to 36 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 Medicare Complete Assist (PPO D-SNP) with a $115 copay, which is waived if you are admitted to the hospital within three days, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Primary care benefits under HAP Medicare Complete Assist (PPO D-SNP) are generally covered with no copay and a 20% coinsurance, which applies to primary care, specialist, psychiatric, and physical therapy services. While most outpatient and professional services are covered under these terms, podiatry services are not covered, and additional telehealth benefits require a $40 copay along with 20% coinsurance.
Preventive Services See details
HAP Medicare Complete Assist (PPO D-SNP) covers preventive services with no copay for Medicare-covered zero-dollar preventive benefits, though a 20% coinsurance applies to specific services like kidney disease education, nutritional benefits, additional smoking cessation counseling, and EKGs. Certain sub-services are not covered under this plan, including annual physical exams, health education, and in-home safety assessments.
Hearing Services See details
HAP Medicare Complete Assist (PPO D-SNP) provides partially covered hearing services, including annual routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,000 annual limit, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HAP Medicare Complete Assist (PPO D-SNP) partially covers vision services, offering one routine eye exam per year with no copay, 20% coinsurance, and no deductible, though other eye exam services are not covered. Covered eyewear, including eyeglasses and contact lenses, has no copay, no coinsurance, and no deductible up to a $300 annual combined limit, but upgrades are excluded.
Dental Services See details
HAP Medicare Complete Assist (PPO D-SNP) offers partially covered dental services, excluding other diagnostic services, other preventive services, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics. Covered Medicare dental services require no copay and a 20% coinsurance, while other covered dental services have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
HAP Medicare Complete Assist (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the HAP Medicare Complete Assist (PPO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under HAP Medicare Complete Assist (PPO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment and prosthetics, and there are no manufacturer restrictions on diabetic supplies or equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HAP Medicare Complete Assist (PPO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. Covered benefits include diagnostic procedures, lab services, therapeutic and diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered by HAP Medicare Complete Assist (PPO D-SNP) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
HAP Medicare Complete Assist (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay and a 20% coinsurance, requiring prior authorization. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
HAP Medicare Complete Assist (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, but a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
HAP Medicare Complete Assist (PPO D-SNP) partially covers other services, providing over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. Acupuncture and dual eligible highly integrated services are not covered under this plan.
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