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 2026, 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 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 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 $105.00. 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 robust medical coverage featuring no copay for primary care physician visits and a $35 copay for specialists. Inpatient hospital stays require a $325 daily copay for days one through five followed by no copay, while outpatient hospital services range from no copay up to a $300 copay. Emergency care carries a $130 copay, which is waived if you are admitted, with no coinsurance required. Supplemental benefits include preventive dental and routine hearing exams with no copays, alongside a $2,000 annual dental limit and a $150 yearly eyewear allowance. While home health services have no copay, durable medical equipment and dialysis services require a 20% coinsurance. Members also receive extra perks like a $95 quarterly over-the-counter allowance and up to 12 one-way health-related transportation trips per year with no copay.
Inpatient Hospital See details
HAP Medicare MedicalAccess (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a $325 daily copay for days 1 through 5, followed by no copay for days 6 through 90. While unlimited additional acute days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HAP Medicare MedicalAccess (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $300, while outpatient substance abuse sessions have a $15 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HAP Medicare MedicalAccess (HMO) with a $55.00 copay and no coinsurance. Prior authorization may be required for some of these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under HAP Medicare MedicalAccess (HMO), with ground and air ambulance services requiring a $300 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 or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HAP Medicare MedicalAccess (HMO) covers emergency services with a $130 copay (waived if admitted) and no coinsurance, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $45, and $300, respectively.
Primary Care See details
Primary care benefits under HAP Medicare MedicalAccess (HMO) feature primary care physician visits with no copay and no coinsurance, alongside specialist visits for a $35 copay and no coinsurance. Additional services like physical therapy ($20 copay), chiropractic care ($15 to $35 copay), and mental health services ($15 copay) also carry no coinsurance, though podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by HAP Medicare MedicalAccess (HMO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and nutritional training. However, certain benefits like health education, in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
HAP Medicare MedicalAccess (HMO) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,575 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
HAP Medicare MedicalAccess (HMO) covers one routine eye exam per year with a $0 to $35 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible up to a $150 annual maximum, but upgrades are excluded.
Dental Services See details
HAP Medicare MedicalAccess (HMO) partially covers dental services up to a $2,000 annual limit, offering preventive care like cleanings and exams with no copay and no coinsurance. Medicare-covered dental services have a $0 to $35 copay and no coinsurance, while comprehensive services like endodontics and oral surgery have no copay and up to 50% coinsurance; however, 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 MedicalAccess (HMO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HAP Medicare MedicalAccess (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
HAP Medicare MedicalAccess (HMO) partially covers medical equipment with no copays for covered items, though a 20% coinsurance applies to durable medical equipment (DME), prosthetics, and medical supplies, and a 0% to 20% coinsurance applies to diabetic supplies. Prior authorization is required for DME and prosthetics, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HAP Medicare MedicalAccess (HMO) because lab services are not covered. Covered services require prior authorization and have no coinsurance, with copays ranging from no copay up to $150 for diagnostic tests, a $35 copay for X-rays, a minimum $40 copay for therapeutic radiology, and no copay for diagnostic radiology.
Home Health Services See details
HAP Medicare MedicalAccess (HMO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
HAP Medicare MedicalAccess (HMO) does not cover Cardiac Rehabilitation Services, as all associated sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are listed as not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HAP Medicare MedicalAccess (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the 100-day Medicare benefit period are not covered.
Other Services See details
HAP Medicare MedicalAccess (HMO) partially covers other services, offering chronic illness meals and a $95 quarterly over-the-counter (OTC) item allowance with no copay and no coinsurance, while acupuncture is not covered.
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