A non-government entity
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 2025, 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 2025.
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:
Sign up for HAP Senior Plus Henry Ford Tiered Access (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HAP Senior Plus Henry Ford Tiered Access (HMO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. 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 a preferred pharmacy, while preferred brand drugs have a 48% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HAP Senior Plus Henry Ford Tiered Access (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have copays from $0 to $205. Emergency services have a copay, and primary care visits range from no copay to a $35 copay. This plan also includes coverage for hearing, vision, and dental services, with specific copays and coinsurance for each. Additional benefits include home health services with no copay, medical equipment with coinsurance, and over-the-counter items with a quarterly benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $275 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $205, observation services with a copay between $115 and $205, ambulatory surgical center (ASC) services with no copay, and outpatient substance abuse services with a copay between $0 and $35 for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You may have a copay between $0 and $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $275 copay. Transportation Services to plan-approved health-related locations are covered for up to 12 one-way trips per year, with no copay or coinsurance; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HAP Senior Plus Henry Ford Tiered Access (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The HAP Senior Plus Henry Ford Tiered Access (HMO) plan covers primary care physician services with a copay between $0 and $35, chiropractic services with a $20 copay, occupational therapy services with a copay between $10 and $30, physician specialist services with a copay between $30 and $50, and mental health specialty services with a copay between $0 and $35. The plan also covers other health care professionals with a copay between $0 and $50, psychiatric services with a copay between $0 and $35, physical therapy and speech-language pathology services with a copay between $10 and $30, additional telehealth benefits with a copay between $0 and $50, and opioid treatment program services with a copay between $0 and $35. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, and additional preventive services; however, health education, in-home safety assessments, personal emergency response systems, 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, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Additional services such as remote access technologies have a $45 copay, while nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing services include hearing exams with no copay, and prescription hearing aids with a copay between $0 and $1575, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. Routine hearing exams and fitting/evaluation for hearing aids are also covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $50, as well as coverage for eyewear, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $150 per year, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a copay of $0-$50, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services with 50% coinsurance, Endodontics with 50% coinsurance, Periodontics, and Oral and Maxillofacial Surgery with 0%-50% coinsurance. Other Diagnostic Dental Services, Prosthodontics (removable and fixed), Implant Services, and Orthodontic Services are offered as optional supplemental benefits. Adjunctive General Services, Maxillofacial Prosthetics, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but 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 Senior Plus Henry Ford Tiered Access (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 10% to 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 10% to 20% coinsurance with no copay, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 0% to 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $200, Diagnostic Radiological Services with a copay up to $200, Therapeutic Radiological Services with a copay between $25 and $40, and Outpatient X-Ray Services with no copay. Lab Services are not covered.
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 technically covered, but in practice, none of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HAP Senior Plus Henry Ford Tiered Access (HMO) plan, with a prior authorization required. There is 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
Other Services include over-the-counter items with a $75 benefit every three months, a meal benefit for chronic illness, and Assist America Emergency Travel Benefit, while acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved