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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 2025, 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 2025.
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 $26.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.30. You must continue to pay paying your reduced 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 $14000.00 (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 $14000.00 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 has a $590 deductible for prescription drugs. This plan may have a reduced premium if you qualify for the low-income subsidy, costing $26.60. After your deductible is met, you will pay the cost-sharing amounts for your drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HAP Medicare Complete Assist (PPO D-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with 20% coinsurance, and emergency services with varying copays. The plan also covers primary care, preventive services, hearing, vision, dental, and home health services, with specific cost-sharing arrangements like coinsurance or copays. Additional benefits include ambulance and transportation services, home infusion, dialysis, medical equipment, and diagnostic services, all with associated cost-sharing. The plan provides coverage for various other services such as over-the-counter items and a meal benefit, while excluding services like cardiac rehabilitation and certain other specialized treatments.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a copay of $2185 for a Medicare-covered stay, and additional days are covered with no copay. Inpatient Hospital Psychiatric services have a copay of $2036 per admission or stay, while Additional Days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the HAP Medicare Complete Assist (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HAP Medicare Complete Assist (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 36 one-way trips per year, using taxi, rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the HAP Medicare Complete Assist (PPO D-SNP) plan. Emergency services have a $110 copay, and urgently needed services have a $45 copay. Worldwide emergency services have a $110 copay for Worldwide Emergency Coverage, a $45 copay for Worldwide Urgent Coverage, and a 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The HAP Medicare Complete Assist (PPO D-SNP) plan covers primary care services with a 20% coinsurance. Chiropractic services, including routine chiropractic care, are covered with a 20% coinsurance, and routine chiropractic care is limited to 1 visit every year. The plan also covers occupational therapy, physician specialist services, and mental health specialty services, all with a 20% coinsurance. Other covered services include podiatry, other health care professional, psychiatric services, physical therapy and speech-language pathology, additional telehealth benefits with a $45 copay and 20% coinsurance, and opioid treatment program services.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, 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, support for caregivers of enrollees, and telemonitoring services are not covered. Kidney Disease Education Services, and Other Preventive Services are covered with 20% coinsurance. Additional sessions of smoking and tobacco cessation counseling, fitness benefits, in-home support services, remote access technologies, and Nutritional/Dietary Benefits are covered.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20%, and fitting/evaluation for hearing aids with 1 visit per year. Prescription hearing aids are covered up to a maximum of $1000 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 20% coinsurance, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, with a combined maximum benefit of $300 per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance. Other dental services have a maximum benefit of $2,000 per year. Oral exams, prophylaxis (cleaning), fluoride treatments, and periodontics are covered, with limitations on the number of visits. Dental X-Rays are covered with limitations on the number of X-Rays and periodicity. The plan does not cover endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, or orthodontics. Oral and Maxillofacial Surgery is covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HAP Medicare Complete Assist (PPO D-SNP) plan, and require prior authorization. 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 by the HAP Medicare Complete Assist (PPO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the HAP Medicare Complete Assist (PPO D-SNP) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance, while durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the HAP Medicare Complete Assist (PPO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services all have a coinsurance of at most 20%, while all other diagnostic and radiological services have no copay.
Home Health Services See details
Home Health Services are covered 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 Medicare Complete Assist (PPO D-SNP) plan. Although the plan covers Cardiac Rehabilitation Services, the specific sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. You will have a copay for this benefit, but the specific amount is not listed in the provided information.
Other Services See details
The HAP Medicare Complete Assist (PPO D-SNP) plan covers over-the-counter items and a meal benefit for a chronic illness, but acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. This plan also includes the Assist America Emergency Travel Benefit.
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