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HAP Senior Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Senior Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Senior Plus (HMO-POS) in 2026, please refer to our full plan details page.
HAP Senior Plus (HMO-POS) is a HMO-POS plan offered by Henry Ford Health System available for enrollment in 2025 to people living in Mid and Southeast Michigan Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HAP Senior Plus (HMO-POS) 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 (HMO-POS).
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 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $105.00. 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 combined Maximum Out-Of-Pocket cost of $4550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $4550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (HMO-POS) Medicare plan offers prescription drug coverage with no drug deductible. 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 are also highly affordable, starting with a $9 copay for a one-month supply at preferred locations. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brand drugs requiring 15% coinsurance at preferred pharmacies and 17% at standard pharmacies. Tier 4 non-preferred drugs carry a 40% to 42% coinsurance, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. Utilizing preferred pharmacies and preferred mail-order options provides the lowest out-of-pocket costs under this plan.
Additional Benefits
The HAP Senior Plus (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $30 copay for specialist visits. For hospital care, inpatient stays require a $300 daily copay for the first five days with no copay thereafter, while outpatient hospital services range from no copay up to a $225 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, while ambulance services require a $250 copay. This plan also includes valuable supplemental benefits, such as preventive dental care with no copay and comprehensive dental covered up to a $2,000 annual maximum. Routine hearing and vision exams are available starting with no copay, alongside a $150 annual eyewear allowance and coverage for up to two hearing aids. Additionally, members benefit from home health services with no copay and skilled nursing facility care featuring no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital care is covered by HAP Senior Plus (HMO-POS) with no coinsurance, requiring a $300 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. Prior authorization is required, and while acute stays include unlimited additional days at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under HAP Senior Plus (HMO-POS) feature no coinsurance, with outpatient hospital services requiring a $0 to $225 copay and observation services requiring a $225 copay per stay. Ambulatory surgical center and blood services are fully covered with no copay and no coinsurance, while some outpatient substance abuse services are covered with no copay or coinsurance, though individual and group sessions are not covered.
Partial Hospitalization See details
HAP Senior Plus (HMO-POS) covers partial hospitalization with a $55.00 copay and no coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HAP Senior Plus (HMO-POS), featuring a $250 copay and no coinsurance for ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
HAP Senior Plus (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted, and no coinsurance. Urgently needed services range from no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $130 for emergency care, $45 for urgent care, and $250 for emergency transportation.
Primary Care See details
HAP Senior Plus (HMO-POS) primary care benefits feature no copay and no coinsurance for primary care doctor visits, a $30 copay and no coinsurance for specialists, and a $10 copay and no coinsurance for physical, occupational, and speech therapy. While podiatry is not covered, some mental health and psychiatric services are covered under the plan, though individual and group sessions are not.
Preventive Services See details
Preventive services are covered under HAP Senior Plus (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive services are partially covered with no copay and no coinsurance; however, health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by HAP Senior Plus (HMO-POS), featuring one annual routine hearing exam and fitting evaluation with no copay or coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from no copay to $1,575, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered under HAP Senior Plus (HMO-POS), offering one annual routine eye exam with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $150 annual limit, though upgrades are excluded from coverage.
Dental Services See details
HAP Senior Plus (HMO-POS) covers dental services up to a $2,000 annual maximum, offering no copay and no coinsurance for preventive care such as cleanings, exams, and X-rays. Comprehensive dental benefits are partially covered with no copay and coinsurance ranging from 0% to 50%, though orthodontics, maxillofacial prosthetics, adjunctive general, and other preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HAP Senior Plus (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs incur a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HAP Senior Plus (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
HAP Senior Plus (HMO-POS) provides partial coverage for medical equipment with no copays and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, which require prior authorization. Diabetic supplies are covered with no copay and no coinsurance to 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under HAP Senior Plus (HMO-POS) with no coinsurance, though prior authorization is required and lab services are not covered. Diagnostic procedures range from no copay to $150, diagnostic radiology starts at no copay, and therapeutic radiology and outpatient X-rays require copays starting at $35.
Home Health Services See details
Home Health Services are covered by HAP Senior Plus (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HAP Senior Plus (HMO-POS) plan because none of the individual sub-services, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HAP Senior Plus (HMO-POS) with no coinsurance and do not require a prior three-day inpatient hospital stay, 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 Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HAP Senior Plus (HMO-POS), which offers chronic illness meal benefits and over-the-counter (OTC) items with no copay and no coinsurance for both services. Acupuncture is not covered under this plan.
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