Note: This link will take you away from the Medicare section of the Priority Health website.
Original Medicare and Medigap plans don't cover prescription drug costs. You may want to add PriorityMedicare RxSM, which would give you Medicare Part D prescription drug benefits.
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Medigap Outline of Coverage (440KB PDF)Medicare Supplement plans made easy
Choosing a Medigap Policy (555KB PDF)Read the federal government's brochure about choosing a Medigap plan.
Medigap application form (140KB PDF)You can also apply online or by phone at 888 389-6676, from 8 a.m. to 8 p.m., 7 days a week. TTY users should call 711.
Automatic Bill Payment sign-up form (72KB PDF)Use this form to sign up to have your premiums automatically deducted from your bank account by electronic funds transfer (EFT).Or you can sign up when you use the online plan application. (coming soon)
PriorityMedicare Rx Summary of Benefits (135KB PDF)Form number: S5857_1001_1012_17 FINAL CMS-approved 08262010Summary of covered services, including copays
PriorityMedicare Rx enrollment form, instructions and checklist (188KB PDF)Form number: S5857_2000_2001_20 CMS-approved 08052010, S5857_1009_1009_5 CMS(09/2009), S5857_2000_2004_48 CMS-approved 08182010You can also enroll online or by phone at 888 389-6676, from 8 a.m. to 8 p.m., 7 days a week. TTY users should call 711.
Appeals and Grievances flyer (97KB PDF)Form number: Y0056_1009_1009_52 File and Use 09272010
Notice of Privacy Practices (91KB PDF)
Centers for Medicare and Medicaid (CMS) Star Rating (141KB PDF)
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