A non-government entity
HAP Medicare Superior (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare Superior (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare Superior (HMO) in 2026, please refer to our full plan details page.
HAP Medicare Superior (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 Superior (HMO) 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 Medicare Superior (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 Superior (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.
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 $150.00 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 $5100.00 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
The HAP Medicare Superior (HMO) plan has an annual drug deductible of $150. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs cost as little as a $9 copay for a one-month supply at preferred locations, or no copay for a three-month supply through preferred mail order. Higher-tier prescription drugs are covered through coinsurance, which varies based on your pharmacy choice. Tier 3 preferred brand drugs require a 15% coinsurance at preferred pharmacies, while Tier 4 non-preferred drugs carry a 38% coinsurance. Specialty drugs in Tier 5 require a 31% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HAP Medicare Superior (HMO) plan offers robust healthcare coverage with multiple options for no-copay services, including primary care visits, preventive care, home health services, and cardiac rehabilitation. For hospital stays, members pay no coinsurance, though inpatient acute stays require a $325 daily copay for the first five days, while outpatient hospital services range from no copay up to a $300 copay. Emergency care is available with a $130 copay, which is waived upon admission, and specialist visits require a $40 copay with no coinsurance. This plan also features valuable ancillary benefits, such as dental care with no copays for preventive services and a 50% coinsurance for comprehensive care up to a $2,000 annual limit. Vision and hearing services include routine exams with no coinsurance and no deductibles, alongside allowance-based coverage for eyewear and hearing aids. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance, while select over-the-counter items are fully covered with no copay or coinsurance.
Inpatient Hospital See details
HAP Medicare Superior (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as unlimited additional acute days are included at no cost, while additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under HAP Medicare Superior (HMO) are covered with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $300 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HAP Medicare Superior (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
HAP Medicare Superior (HMO) covers ambulance services with a $300 copay and no coinsurance for both ground and air transport. Transportation services are partially covered, offering unlimited one-way rides to plan-approved health-related locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
HAP Medicare Superior (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived upon immediate hospital admission. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $45 to $300.
Primary Care See details
Primary care services under HAP Medicare Superior (HMO) are partially covered, offering no copay and no coinsurance for primary care physician visits, while podiatry services are not covered. Other covered services require no coinsurance, with copays such as $40 for specialists, $20 for physical therapy, and $15 for mental health sessions.
Preventive Services See details
HAP Medicare Superior (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and routine screenings. The benefit is partially covered, as it includes nutritional counseling, smoking cessation, and memory fitness, but excludes sub-services like health education, weight management, counseling, and in-home support.
Hearing Services See details
HAP Medicare Superior (HMO) covers annual routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with up to two devices per year with no coinsurance and copayments ranging from no copay to $1,575, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HAP Medicare Superior (HMO) provides partially covered vision services, featuring one annual routine eye exam with a $0 to $40 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $150 annual limit for contacts and eyeglasses, but upgrades are not covered.
Dental Services See details
HAP Medicare Superior (HMO) provides partially covered dental services up to a $2,000 annual limit, featuring no copay and no coinsurance for preventive care like cleanings and exams. Comprehensive treatments such as restorative care and endodontics require no copay and a 50% coinsurance, but other preventive services, adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HAP Medicare Superior (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HAP Medicare Superior (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by HAP Medicare Superior (HMO) with no copays, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment, prosthetics, and medical supplies require prior authorization and 20% coinsurance, while diabetic supplies require no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HAP Medicare Superior (HMO) with no coinsurance, though prior authorization is required and lab services are not covered. Covered services feature a $35 copay for outpatient X-rays, a minimum $60 copay for therapeutic radiology, and copays ranging from no copay up to $200 for diagnostic procedures and tests.
Home Health Services See details
Home Health Services are covered under the HAP Medicare Superior (HMO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HAP Medicare Superior (HMO) with no copay and no coinsurance, meaning some services are covered, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HAP Medicare Superior (HMO) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed for admission, additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
HAP Medicare Superior (HMO) offers partial coverage for Other Services, providing over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture and meal benefits are not covered. Covered OTC benefits include nicotine replacement therapy and naloxone with no maximum limit on coverage.
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