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HAP Member Assist (PPO)

H2322 - 017 - 0
4 out of 5 stars (4 / 5)

HAP Member Assist (PPO) is a Medicare Advantage Plan by HAP Senior Plus (PPO).

This page features plan details for 2025 HAP Member Assist (PPO) H2322 – 017 – 0 available in Central, Southwest and Southeast Michigan Counties.

Locations

HAP Member Assist (PPO) is offered in the following locations.

Allegan County, Michigan
Arenac County, Michigan
Barry County, Michigan

Click to see more locations

Plan Overview

HAP Member Assist (PPO) offers the following coverage and cost-sharing.

Insurer:HAP Senior Plus (PPO)
Health Plan Deductible:$0
MOOP:$4,750 In and Out-of-network
$4,750 In-network
Drugs Covered:Yes

Ready to sign up for HAP Member Assist (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

HAP Member Assist (PPO) has a monthly premium of $26.60. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $26.60 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

HAP Member Assist (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $590.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Actuarially Equivalent Standard

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$26.60$0.00

Initial Coverage Phase

After you pay your $590.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

HAP Member Assist (PPO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Endodontics
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
    • Out-of-Network: No Coins – No Copay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay
    • Out-of-Network: No Coins – No Copay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $35 copay (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-200 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0-65 copay (Authorization Required)
  • Outpatient x-rays
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
    • Out-of-Network: 20% coinsurance per visit
  • Specialist
    • Out-of-Network: 20% coinsurance per visit
    • In-Network: $30 copay per visit

Emergency care/Urgent care

  • Urgent care
    • $0-45 copay per visit (always covered)
  • Emergency
    • $125 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $0-30 copay
  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • Out-of-Network: 20% coinsurance

Ground ambulance

    • Out-of-Network: $300 copay
    • In-Network: $300 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids
    • In-Network: $0-1,575 copay (Limits Apply)
    • Out-of-Network: $0-1,575 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • In-Network: $0-30 copay
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 20% coinsurance
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • In-Network: $250 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 20% per stay (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $4,750 In and Out-of-network
      $4,750 In-network

Medical equipment/supplies

  • Diabetes supplies
    • Out-of-Network: 20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: 0-20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
  • Chemotherapy
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Other Part B drugs
    • Out-of-Network: 20% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • Out-of-Network: 20% coinsurance
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 20% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $15 copay
  • Outpatient group therapy visit
    • In-Network: $15 copay
  • Outpatient individual therapy visit
    • In-Network: $15 copay
  • Inpatient hospital – psychiatric
    • In-Network: $250 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 20% per stay (Authorization Required)
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $15 copay
  • Outpatient individual therapy visit
    • Out-of-Network: 20% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 20% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: 20% coinsurance per visit (Authorization Required)
    • In-Network: $0-200 copay per visit (Authorization Required)

Preventive care

    • In-Network: $0 copay
    • Out-of-Network: 20% coinsurance

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • In-Network: $20 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Occupational therapy visit
    • In-Network: $20 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 20% per stay (Authorization Required)

Transportation

    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: $0 copay (Limits Apply)

Vision

  • Contact lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglasses (frames and lenses)
    • Out-of-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for HAP Member Assist (PPO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Need more information on HAP Member Assist (PPO)? See 2025 HAP Member Assist (PPO) at MedicareAdvantageRX.com.

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