A non-government entity
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 2026, 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 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 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) prescription drug plan features an annual drug deductible of $150. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs cost a $9 copay for a one-month supply at preferred pharmacies, though you can get a three-month supply with no copay through preferred mail order. Higher-tier medications under this plan require coinsurance rather than flat copays. Tier 3 preferred brands have a 15% coinsurance at preferred pharmacies and 17% at standard pharmacies, while Tier 4 non-preferred drugs require 40% or 42% coinsurance respectively. Specialty drugs in Tier 5 carry a 31% coinsurance for a one-month supply at all pharmacy and mail order locations.
Additional Benefits
The HAP Medicare Connect (HMO) plan offers comprehensive coverage with many essential services requiring no copayments or coinsurance, including primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a $325 copay per day for the first six days and no copay for days seven through 90, with no coinsurance. Specialist visits require a $45 copay, while emergency care has a $130 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits such as dental coverage up to a $2,000 yearly limit, featuring no copay for preventive care and up to 50% coinsurance for restorative services. Vision and hearing exams are available with no copay, and prescription hearing aids have a copay ranging from no copay up to $1,575. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance, while skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital care is partially covered by HAP Medicare Connect (HMO) with no coinsurance, requiring a $325 copay for days 1 through 6 and no copay for days 7 through 90. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services are covered by HAP Medicare Connect (HMO) with no coinsurance, featuring no copays for ambulatory surgical center services and outpatient blood services. Outpatient hospital services require a copay of $0 to $300 with prior authorization, observation services have a $300 copay per stay, and outpatient substance abuse sessions carry a $15 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the HAP Medicare Connect (HMO) plan with a $55 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
HAP Medicare Connect (HMO) covers ground and air ambulance services with a $300 copay per service and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HAP Medicare Connect (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $130, $45, and $300 respectively.
Primary Care See details
HAP Medicare Connect (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Other covered benefits, including therapy, chiropractic, and mental health services, feature copays ranging from $15 to $45 with no coinsurance, though podiatry services are not covered.
Preventive Services See details
HAP Medicare Connect (HMO) offers partially covered preventive services with no copay and no coinsurance for covered care like annual physicals and screenings. Non-covered services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by HAP Medicare Connect (HMO), offering routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered with no coinsurance and a copay between $0 and $1,575, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HAP Medicare Connect (HMO) partially covers vision services with no deductibles, excluding upgrades and other eye exam services. Routine eye exams are covered once yearly with a $0 to $45 copay and no coinsurance, and eyewear is covered with no copay or coinsurance up to a $150 annual limit.
Dental Services See details
Dental services are partially covered by HAP Medicare Connect (HMO) up to a $2,000 yearly maximum, offering no copay and no coinsurance for preventive care like exams and cleanings, and a $0 to $45 copay with no coinsurance for Medicare-covered dental. Restorative, endodontic, and oral surgery services have no copay but require up to 50% coinsurance, while other preventive services, adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HAP Medicare Connect (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay with no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
HAP Medicare Connect (HMO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
HAP Medicare Connect (HMO) partially covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies, and up to 20% coinsurance for diabetic supplies. Diabetic therapeutic shoes and inserts are not covered, and prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
HAP Medicare Connect (HMO) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization for all services while excluding laboratory services from coverage. Covered diagnostic tests carry a copay of $0 to $150, while radiological benefits feature a $35 copay for X-rays, a minimum $25 copay for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
Home health services are covered under HAP Medicare Connect (HMO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
HAP Medicare Connect (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. While some services are covered, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
HAP Medicare Connect (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
HAP Medicare Connect (HMO) partially covers other services, offering an over-the-counter (OTC) benefit of $70 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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