A non-government entity
HAP Medicare Complete Duals (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare Complete Duals (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare Complete Duals (HMO D-SNP) in 2026, please refer to our full plan details page.
HAP Medicare Complete Duals (HMO D-SNP) is a HMO D-SNP 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 2026.
It's important to know that HAP Medicare Complete Duals (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HAP Medicare Complete Duals (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HAP Medicare Complete Duals (HMO D-SNP).
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 Complete Duals (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 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 Medicare Complete Duals (HMO D-SNP)
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 Medicare Complete Duals (HMO D-SNP) plan has an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before your plan benefits begin to cover the costs. Understanding this deductible is essential for estimating your overall yearly prescription expenses. Detailed information regarding specific drug tiers, copayments, and coinsurance amounts is not available for this plan. To determine the exact costs for your specific medications, it is recommended to review the plan's comprehensive drug formulary.
Additional Benefits
The HAP Medicare Complete Duals (HMO D-SNP) plan provides comprehensive healthcare coverage with many services requiring no copay, though a standard 20% coinsurance applies to outpatient, specialist, and diagnostic services. While inpatient hospital stays require specific copays and no coinsurance, routine home health services are fully covered with no copay and no coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, while urgent care visits require a $40 copay. This plan also features valuable supplemental benefits, including routine dental, vision, and hearing care which feature no copays alongside annual coverage allowances. Additionally, members benefit from up to 36 one-way transportation trips per year and a $158 monthly over-the-counter allowance with no copay and no coinsurance. Durable medical equipment and diagnostic services are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HAP Medicare Complete Duals (HMO D-SNP) with no coinsurance, requiring a $2,185 copay per Original Medicare period for acute stays and a $2,036 copay per stay for psychiatric services. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HAP Medicare Complete Duals (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for ambulatory surgical center and outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization services are covered under HAP Medicare Complete Duals (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HAP Medicare Complete Duals (HMO D-SNP), requiring a 20% coinsurance and no copay for ground and air ambulance transports. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
HAP Medicare Complete Duals (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency transportation is covered with a 20% coinsurance and no copay.
Primary Care See details
Primary care and professional services are partially covered by HAP Medicare Complete Duals (HMO D-SNP), as podiatry services are not covered. Most covered benefits, such as primary care, specialist visits, and therapy, require no copay and a 20% coinsurance, while telehealth services have a $40 copay and 20% coinsurance.
Preventive Services See details
HAP Medicare Complete Duals (HMO D-SNP) offers partially covered preventive services with no copays, though a 20% coinsurance applies to specific benefits such as kidney disease education, nutritional training, smoking cessation, and post-visit EKGs. Several sub-services are not covered, including annual physical exams, health education, in-home safety assessments, and medical nutrition therapy.
Hearing Services See details
HAP Medicare Complete Duals (HMO D-SNP) covers hearing services, including one routine hearing exam per year with no copay and a 20% coinsurance, and one fitting evaluation with no copay. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 annual maximum, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HAP Medicare Complete Duals (HMO D-SNP) covers routine eye exams once per year with no copay, 20% coinsurance, and prior authorization, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered up to a $300 annual maximum with no copay and no coinsurance, but upgrades are not covered.
Dental Services See details
Dental services are partially covered under the HAP Medicare Complete Duals (HMO D-SNP) plan, featuring no copay and 20% coinsurance for Medicare-covered dental, alongside no copay and no coinsurance for other covered dental services up to a $2,000 annual maximum. While many preventive and restorative services are included, other diagnostic dental, other preventive dental, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HAP Medicare Complete Duals (HMO D-SNP) covers Home Infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HAP Medicare Complete Duals (HMO D-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by HAP Medicare Complete Duals (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for durable medical equipment and prosthetics.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HAP Medicare Complete Duals (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This benefit includes Medicare-covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered by HAP Medicare Complete Duals (HMO D-SNP) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HAP Medicare Complete Duals (HMO D-SNP) with no copay and require prior authorization, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HAP Medicare Complete Duals (HMO D-SNP) with no coinsurance and Medicare-defined copays, subject to prior authorization. This benefit is partially covered as it excludes additional days beyond the standard Medicare limit, but it does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
HAP Medicare Complete Duals (HMO D-SNP) partially covers other services, providing meal benefits for chronic illnesses and a $158 monthly over-the-counter allowance with no copay and no coinsurance. Acupuncture is not covered under this plan.
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