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HAP Medicare Connect (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare Connect (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare Connect (HMO) in 2025, please refer to our full plan details page.
HAP Medicare Connect (HMO) is a HMO 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 Connect (HMO) 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 Connect (HMO).
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 Connect (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $150.00 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 Maximum Out-Of-Pocket cost of $5000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Connect (HMO) plan has an enhanced alternative drug benefit. The plan has a $150 deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $9 copay at preferred pharmacies. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The HAP Medicare Connect (HMO) plan provides coverage for a wide range of services. Inpatient hospital stays have a $325 copay for days 1-5, and no copay for days 6-90, and outpatient services have copays that vary from $0 to $290. This plan also includes coverage for ambulance, emergency, primary care, preventive, hearing, vision, dental, and home health services. Many services have copays between $0 and $45, while others have coinsurance. Additionally, the plan includes benefits for home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will also pay a $325 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $290, observation services with a $290 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $15 copay for individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the HAP Medicare Connect (HMO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HAP Medicare Connect (HMO). Both Ground and Air Ambulance Services have a $300 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by HAP Medicare Connect (HMO). Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a copay of $0 - $45 and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The HAP Medicare Connect (HMO) plan covers primary care physician services, chiropractic services with a $20 copay for routine care and $35 copay for other services, occupational therapy services with a $20 copay, and physician specialist services with a $45 copay. The plan also covers mental health specialty services, psychiatric services with a $15 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, and additional telehealth benefits with a copay ranging from $0 to $45. Other health care professional services have a copay from $0 to $45 and opioid treatment program services have a $15 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Additional services such as health education, in-home safety assessments, and several others are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $0 and $1575, but inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The HAP Medicare Connect (HMO) plan covers vision services, including routine eye exams with a copay of $0-$45, and eyewear with a combined maximum benefit of $150 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, but upgrades are not covered.
Dental Services See details
The HAP Medicare Connect (HMO) plan covers dental services, including oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment. Other diagnostic dental services, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are also covered, but are offered as supplemental benefits which may require additional payment. Restorative services and endodontics have a 50% coinsurance, and oral and maxillofacial surgery has a 0-50% coinsurance. Adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 Medicare Connect (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Supplies have no coinsurance, and other Diabetic Equipment has coinsurance information listed in the details.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Lab Services are not covered. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $150, while Diagnostic Radiological Services have a maximum copay of $200, Therapeutic Radiological Services have a $25 copay, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the HAP Medicare Connect (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but in practice, Cardiac Rehabilitation Services, 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 by HAP Medicare Connect (HMO), but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The HAP Medicare Connect (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $70 every three months, and includes Nicotine Replacement Therapy (NRT) as a Part C OTC benefit. Acupuncture, meal benefits, 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 are not covered. The plan also covers the Assist America Emergency Travel Benefit.
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