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HAP Senior Plus Henry Ford Tiered Access (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Senior Plus Henry Ford Tiered Access (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Senior Plus Henry Ford Tiered Access (HMO) in 2026, please refer to our full plan details page.
HAP Senior Plus Henry Ford Tiered Access (HMO) is a HMO plan offered by Henry Ford Health System available for enrollment in 2025 to people living in Wayne, Oakland and Macomb counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HAP Senior Plus Henry Ford Tiered Access (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 Senior Plus Henry Ford Tiered Access (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 Senior Plus Henry Ford Tiered Access (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $95.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4750.00 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 Senior Plus Henry Ford Tiered Access (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you pay no copay when using a preferred pharmacy or preferred mail order service, while standard pharmacies charge a $7 copay for a one-month supply. Tier 2 generic medications cost a $9 copay for a one-month supply at preferred pharmacies, which drops to no copay for a three-month supply through preferred mail order. For higher-tier medications, costs shift to coinsurance, starting with Tier 3 preferred brands at 15% coinsurance at preferred pharmacies and 17% at standard pharmacies. Tier 4 non-preferred drugs require 39% coinsurance at preferred locations and 41% at standard locations. Tier 5 specialty drugs carry a flat 33% coinsurance across all pharmacy and mail-order options for a one-month supply.
Additional Benefits
The HAP Senior Plus Henry Ford Tiered Access (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no coinsurance for many core services. Inpatient hospital stays require a $275 daily copay for the first six days and no copay thereafter, while primary care, specialist visits, and outpatient services range from no copay up to a $50 or $205 copay. Emergency care is covered with a $130 copay, which is waived upon admission, and urgent care visits range from no copay to a $45 copay. This plan also includes valuable supplemental benefits like routine dental, vision, and hearing services with no copays for preventive care, alongside a $2,000 annual dental limit and a $150 yearly eyewear allowance. Additionally, members benefit from no copay for home health services, up to 12 free one-way transportation trips annually, and a $70 quarterly over-the-counter allowance. For prescription hearing aids, copays range from no copay up to $1,575 with no coinsurance required.
Inpatient Hospital See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute hospital days are covered with no copay.
Outpatient Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $205 for outpatient hospital services and $115 to $205 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copays or coinsurance, while outpatient substance abuse sessions require a $0 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HAP Senior Plus Henry Ford Tiered Access (HMO) with no coinsurance and copays ranging from no copay to $55.00. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under the HAP Senior Plus Henry Ford Tiered Access (HMO) are covered, with Medicare-covered ground and air ambulance services requiring a $275 copay and no coinsurance. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital. Urgently needed services range from no copay to a $45 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $45 to $275.
Primary Care See details
HAP Senior Plus Henry Ford Tiered Access (HMO) partially covers primary care benefits with no coinsurance, though podiatry services are not covered. Most covered services, including primary care visits, specialist consultations, and therapy sessions, range from no copay up to a $50 copay.
Preventive Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers preventive services like annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. Additional preventive services are partially covered with no coinsurance for memory fitness, nutritional benefits, and smoking cessation, though remote access technologies require a $45 copay. Sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 and bathroom safety devices, and counseling are not covered.
Hearing Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) partially covers hearing services, offering one routine exam and one fitting evaluation annually with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $0 and $1,575, though OTC hearing aids and inner, outer, or over the ear prescription models are not covered.
Vision Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers vision services, including one annual routine eye exam with a $0 to $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 yearly limit for contact lenses and eyeglasses, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by HAP Senior Plus Henry Ford Tiered Access (HMO) up to a $2,000 annual maximum, featuring no copay and no coinsurance for preventive care like exams, cleanings, and fluoride. Comprehensive treatments such as restorative care and endodontics require no copay and 50% coinsurance, while orthodontics, adjunctive general services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered by HAP Senior Plus Henry Ford Tiered Access (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
HAP Senior Plus Henry Ford Tiered Access (HMO) covers medical equipment, prosthetics, and diabetic supplies with no copay. Durable medical equipment and prosthetics carry a 10% to 20% coinsurance, while diabetic supplies and therapeutic shoes or inserts range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the HAP Senior Plus Henry Ford Tiered Access (HMO) plan, as lab services are not covered. Covered services require prior authorization and carry no coinsurance, featuring no copay for outpatient X-rays, a copay range of no copay to $200 for diagnostic procedures and tests, no minimum copay for diagnostic radiological services, and a minimum $25 copay for therapeutic radiological services.
Home Health Services See details
Home health services are covered by the HAP Senior Plus Henry Ford Tiered Access (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) features no copay and no coinsurance for Cardiac Rehabilitation Services, though prior authorization is required and only some services are covered. Specifically, 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 Senior Plus Henry Ford Tiered Access (HMO) with no coinsurance and do not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
HAP Senior Plus Henry Ford Tiered Access (HMO) provides partial coverage for other services, featuring over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. The OTC benefit includes a $70 allowance every three months that carries forward, though acupuncture is not covered.
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