A non-government entity
HAP Medicare Diabetes and Heart (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HAP Medicare Diabetes and Heart (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HAP Medicare Diabetes and Heart (HMO C-SNP) in 2026, please refer to our full plan details page.
HAP Medicare Diabetes and Heart (HMO C-SNP) is a HMO C-SNP plan offered by Henry Ford Health System available for enrollment in 2026 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 Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-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 Diabetes and Heart (HMO C-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:
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Drug Coverage
The HAP Medicare Diabetes and Heart (HMO C-SNP) plan features an annual prescription drug deductible of $615. This means you must pay this deductible amount out-of-pocket for your covered prescriptions before the plan begins to cover its portion of your drug costs. Specific drug coverage tier details, including individual copays and coinsurance rates, are currently not available for this plan. For the most accurate and up-to-date pricing on your specific medications, you should review the plan's comprehensive formulary list.
Additional Benefits
The HAP Medicare Diabetes and Heart (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, while specialist visits require a $30 copay. Inpatient hospital stays require a $395 daily copay for the first five days and no copay for days six through 90, with no coinsurance. Emergency services are available with a $115 copay, which is waived if you are admitted, and skilled nursing facility stays have no copay for the first 20 days. For routine care, the plan provides robust dental benefits with no copay and no coinsurance up to a $2,000 annual limit, alongside no copay for eyewear up to a $300 yearly limit. Hearing services include a routine annual exam at no copay and up to $1,000 for prescription hearing aids. Additionally, members benefit from up to 36 one-way transportation trips per year and a $250 quarterly over-the-counter allowance with no copay and no coinsurance.
Inpatient Hospital See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $395 daily copay for days 1 to 5 and no copay for days 6 to 90. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $395 copay per stay for observation services. Outpatient substance abuse sessions require a $15 copay and no coinsurance, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers ground and air ambulance services with a $275 copay and no coinsurance, and provides partially covered transportation benefits with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations. Transportation to any health-related location is not covered.
Emergency Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers emergency services with a $115 copay, which is waived if admitted, and no coinsurance, while urgently needed services feature no copay to a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $115, $40, and $275 respectively.
Primary Care See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Other primary care services, including physical, occupational, speech therapy, and mental health services, are covered with copays ranging from $5 to $15 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by the HAP Medicare Diabetes and Heart (HMO C-SNP) plan with no copay and no coinsurance for all covered care, including annual physical exams and kidney disease education. While benefits like nutritional therapy and personal emergency response systems are covered, several services are not covered, including health education, in-home safety assessments, weight management programs, alternative therapies, and home safety modifications.
Hearing Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) offers partially covered hearing services with no copay and no coinsurance, including one routine hearing exam and one fitting evaluation per year. Prescription hearing aids are covered up to a $1,000 annual maximum for both ears combined, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) partially covers vision services with no deductible, offering one annual routine eye exam with a $0 to $30 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $300 yearly limit for contacts and eyeglasses, but upgrades are not covered.
Dental Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) offers partially covered dental services with no coinsurance and no copay for most preventive and comprehensive care up to a $2,000 annual limit, while Medicare-covered dental has a $0 to $30 copay and no coinsurance. Excluded services that are not covered include other diagnostic, other preventive, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HAP Medicare Diabetes and Heart (HMO C-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HAP Medicare Diabetes and Heart (HMO C-SNP) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits under the HAP Medicare Diabetes and Heart (HMO C-SNP) plan are partially covered with no copays for all services, though prior authorization is required for some items. Durable medical equipment and prosthetics carry a 20% coinsurance, while diabetic supplies have a 0% to 20% coinsurance 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 Diabetes and Heart (HMO C-SNP), as lab services are not covered and prior authorization is required. Diagnostic procedures and tests have no coinsurance and a $0 to $50 copay, while diagnostic radiological services have no copay, therapeutic radiological services require 20% coinsurance, and outpatient X-rays have a $35 copay.
Home Health Services See details
Home Health Services are covered by HAP Medicare Diabetes and Heart (HMO C-SNP) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the HAP Medicare Diabetes and Heart (HMO C-SNP) plan, but in practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HAP Medicare Diabetes and Heart (HMO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
HAP Medicare Diabetes and Heart (HMO C-SNP) partially covers Other Services, providing a chronic illness meal benefit and up to $250 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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