A non-government entity
HAP Medicare MedicalAccess (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare MedicalAccess (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare MedicalAccess (HMO) in 2025, please refer to our full plan details page.
HAP Medicare MedicalAccess (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 MedicalAccess (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HAP Medicare MedicalAccess (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 MedicalAccess (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. Additionally, this plan comes with a Part B Premium reduction of $50.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 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
Prescription drugs are not covered by HAP Medicare MedicalAccess (HMO).
Additional Benefits
The HAP Medicare MedicalAccess (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes inpatient hospital stays with a copay, outpatient services, and emergency services with varying copays. The plan also covers primary care, hearing, vision, and dental services, with specific copays and maximum benefits for each. Additionally, it provides coverage for home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5 of an inpatient hospital stay, there is a $325 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as 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, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $300 copay, Ambulatory Surgical Center Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered by the HAP Medicare MedicalAccess (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $300 copay. The plan also covers 12 one-way trips per year to a plan-approved health-related location, using taxi, rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HAP Medicare MedicalAccess (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, $45 for Worldwide Urgent Coverage, and $300 for Worldwide Emergency Transportation.
Primary Care See details
The HAP Medicare MedicalAccess (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy with a $20 copay, physician specialist services with a $35 copay, and physical therapy with a $20 copay. Mental health services have a $15 copay for individual and group sessions, and psychiatric services also have a $15 copay for individual and group sessions. Additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
Preventive Services are covered, including annual physical exams, additional preventive services, kidney disease education services, and other preventive services. However, the plan does not cover 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. Other services covered by the plan include unlimited nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing services include hearing exams with no copay, and coverage for fitting/evaluation for hearing aids, with one visit per year. Prescription hearing aids (all types) are covered, with a copay between $0 and $1575, and two visits per year, while inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, as well as coverage for eyewear. Eyewear has a combined maximum benefit of $150 per year, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $2,000 per year. Medicare Dental Services require prior authorization and a doctor referral, with a copay ranging from $0 to $35. Other dental services include oral exams (2 visits per year), dental x-rays (bitewing x-rays once per year and full mouth/panoramic x-rays once every 5 years), prophylaxis (cleaning, 2 visits per year), fluoride treatment (2 visits per year), restorative services (1 visit every 5 years), endodontics (1 visit per lifetime), periodontics (2 visits per year), prosthodontics (fixed, unlimited visits), and oral and maxillofacial surgery (unlimited visits); however, adjunctive general services, prosthodontics (removable), maxillofacial prosthetics, implant services, 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 with a coinsurance between 0% and 20%, and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HAP Medicare MedicalAccess (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a 20% coinsurance and no copay; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a coinsurance between 0-20%, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a maximum copay of $150, while Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $200, Therapeutic Radiological Services have a $40 copay, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the HAP Medicare MedicalAccess (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 not covered by the HAP Medicare MedicalAccess (HMO) plan. Specific services including 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 the HAP Medicare MedicalAccess (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
The HAP Medicare MedicalAccess (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $60 every three months, as well as a meal benefit for chronic illnesses. However, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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