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 2025, 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 2025.
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 $26.60. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.60. 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.
This plan has a $590.00 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 $9350.00 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 a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your prescriptions based on the drug tier. Once your total drug costs reach $2,000, you will enter the next coverage phase. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify for LIS, you will pay $26.60 per month for Part D. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HAP Medicare Complete Duals (HMO D-SNP) plan offers a variety of benefits beyond standard Medicare coverage. Inpatient hospital stays have a copay, while outpatient services, partial hospitalization, and primary care have a 20% coinsurance. Emergency and urgent care services have varying copays and coinsurance depending on the location. This plan also includes coverage for ambulance and transportation, with no copay for transportation to plan-approved locations. Preventive services are covered, and there are additional benefits for hearing, vision, and dental care. Other covered services include home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $2,185 for a Medicare-covered Inpatient Hospital-Acute stay and $2,036 for a Medicare-covered Inpatient Hospital Psychiatric stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days/Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, as well as Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services, both with a 20% coinsurance. Outpatient Blood Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the HAP Medicare Complete Duals (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no copay, but you will pay 20% coinsurance for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered for up to 36 one-way trips per year, and there is no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HAP Medicare Complete Duals (HMO D-SNP) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a $45 copay; Worldwide Emergency Transportation has a 20% coinsurance, while Worldwide Emergency Coverage has a $110 copay, and Worldwide Urgent Coverage has a $45 copay.
Primary Care See details
Under the HAP Medicare Complete Duals (HMO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy, specialist services, mental health services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. These services have a 20% coinsurance, and chiropractic services and podiatry services include services not usually covered by Medicare plans.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, and additional services like Personal Emergency Response System (PERS), Nutritional/Dietary Benefits, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefits. Kidney Disease Education Services, Barium Enemas, EKG following Welcome Visit, and Digital Rectal Exams are covered with 20% coinsurance, while Glaucoma Screening and Diabetes Self-Management Training are covered.
Hearing Services See details
Hearing services include routine hearing exams with a 20% coinsurance and fitting/evaluation for hearing aids with one visit every year. Prescription hearing aids are covered up to $1,000 every year, however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HAP Medicare Complete Duals (HMO D-SNP) plan covers vision services including routine eye exams with 20% coinsurance, and eyewear with a combined maximum benefit of $300 every year. Eyeglass lenses, eyeglass frames, and contact lenses are also covered, but upgrades are not.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance, Oral Exams with 2 visits per year, Dental X-Rays with 1 bitewing xray per year and full mouth xrays once every 5 years, Prophylaxis (Cleaning) with 2 visits per year, Fluoride Treatment with 2 visits per year, Adjunctive General Services, and Oral and Maxillofacial Surgery. Other services such as Endodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the HAP Medicare Complete Duals (HMO D-SNP) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under this plan. Durable Medical Equipment has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance with no copay, and Medical Supplies have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, and require prior authorization. There is no copay for diagnostic services, and you pay at most 20% coinsurance for diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the HAP Medicare Complete Duals (HMO D-SNP) plan with no copay or coinsurance. 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 Complete Duals (HMO D-SNP) plan. Specifically, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization required, and the cost sharing is defined by Medicare. Additional days beyond Medicare-covered SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HAP Medicare Complete Duals (HMO D-SNP) plan covers Over-the-Counter (OTC) Items, including Nicotine Replacement Therapy (NRT), and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services 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