Plan FAQs

Questions about PriorityMedicare plans

Click on any question below to read the answer. You'll also find answers to questions about the prescription drug plan portion of your coverage under the Prescription Plan FAQs.

What should I do if I have other insurance in addition to Medicare?
What protection do I have if I enroll in a PriorityMedicare^SM plan?
How can I compare your plans to my other Medicare options?
Where are PriorityMedicare plans available?
Can I choose my doctor?
What happens if I go to a doctor who's not in the PriorityMedicare network?
Can I leave or quit a PriorityMedicare plan?


Q: What should I do if I have other insurance in addition to Medicare?

If you have Medicare supplemental insurance that fills gaps in the original Medicare plan, you may not need it if you join a PriorityMedicare plan.

Note: If you drop your supplemental policy, you may not be able to get the same one back. You should check into this carefully before you drop your supplemental policy to make sure you have all of the coverage you need. You or your spouse may have, or be able to get, employer group health coverage. If so, you should talk to the employer to find out how your benefits will be affected if you join a PriorityMedicare plan. Get this information before you decide.


Q: What protection do I have if I enroll in a PriorityMedicare plan?

1. One-Year Coverage Guarantee.

All medical plans in the Medicare program (including PriorityMedicare Value, PriorityMedicare and PriorityMedicare Plus) agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year.

Even if a Medicare health plan leaves the program, you won't lose Medicare prescription drug coverage. If a plan decides not to continue, it must send you a letter at least 90 days before your coverage ends. The letter will explain your options for Medicare coverage in your area.

2. Requests for Exceptions, Appealing Our Decisions and Filing Grievances (complaints).

As a member of a PriorityMedicare plan, you have the right to request a coverage determination, which includes the right to request an exception, file an appeal if we deny coverage for a prescription drug and file a grievance. You have the right to request a coverage determination if you want us to cover a Part D drug that you believe should be covered.

An exception is a type of coverage determination. You may ask us for an exception if you believe you need a drug that is not on our list of covered drugs or believe you should get a non-preferred drug at a lower out-of-pocket cost. You can also ask for an exception to cost utilization rules, such as a limit on the quantity of a drug. If you think you need an exception, contact us before you try to fill your prescription at a pharmacy. Your doctor must provide a statement to support your exception request. If we deny coverage for your prescription drug(s), you have the right to appeal and ask us to review our decision.

Finally, you have the right to file a grievance if you have any type of problem with us or one of our network pharmacies that doesn't involve coverage for a prescription drug. Read more about the exceptions, appeals and complaints process.

Q: How can I compare your plans to my other Medicare options?

PriorityMedicare members receive all of the benefits that the original Medicare plan offers. We also offer more benefits, which may change from year to year. Look in the Summary of Benefits brochure for any PriorityMedicare plan to see a chart comparing its benefits to the original Medicare plan.

[Go to the Summary of  Benefits for PriorityMedicare Value]
[Go to the Summary of  Benefits for PriorityMedicare]
[Go to the Summary of  Benefits for PriorityMedicare Plus]
[Go to the Summary of  Benefits for PriorityMedicare Rx]
[Go to the Combined Summary of  Benefits for PriorityMedicare plans (medical)]

Q: Where are PriorityMedicare plans available?

PriorityMedicare Value, PriorityMedicare and PriorityMedicare Plus (are available in the following 19 Michigan counties: Allegan, Antrim, Barry, Benzie, Crawford, Grand Traverse, Kalkaska, Kent, Leelanau, Manistee, Missaukee, Montcalm, Muskegon, Newago, Oceana, Osceola, Ottawa, Roscommon and Wexford. If you're covered by an employer that offers PriorityMedicare but you do not live in one of these counties, contact the employer group representative to see if you are eligible.

PriorityMedicare Rx, a Medicare prescription drug plan, is offered everywhere in the state of Michigan.

Q: Can I choose my doctor?

PriorityMedicare Value, PriorityMedicare and PriorityMedicare Plus medical plans have a network of doctors, specialists and hospitals. You can use any doctor or other health care provider who is part of this network. You may also go to doctors outside of our network, but your costs may be higher. Note: The health care providers in our network can change at any time. Check the Provider Directory for a list. (You can also search our online Find a Doctor directory for network doctors who participate in our plans. Clicking on this online directory will take you away from the PriorityMedicare section of this website.)

Q: What happens if I go to a doctor who's not in the PriorityMedicare network?

You can go to doctors, specialists, pharmacies or hospitals out of the network, but you may have to pay more for the services you receive. You may also have to follow special rules prior to getting services. Learn more about using out-of-network health care providers.

Q: Can I leave or quit a PriorityMedicare plan?

There are limits to when you can leave, how often you can make changes and what type of plan you can join after you leave. You may only enroll in or disenroll from a plan during specific times of the year, unless you're newly eligible for Medicare. For 2008 coverage, you must sign up between November 15 and December 31, 2007. Your next opportunity to change plans won't be until November 15, 2008 (for 2009 coverage).

There are also a few situations where you would be required to leave. For example, we will disenroll you from your PriorityMedicare plan if you move permanently out of our geographic service area. We're not allowed to ask you to leave the plan because of your health.

If you disenroll from your PriorityMedicare plan, it may take some time for your membership to end and your new Medicare plan to take effect. Until your membership ends, you must keep getting your Medicare services through PriorityMedicare or you will have to pay for them yourself.

For more information about your rights and responsibilities or the disenrollment process, see your plan's Evidence of Coverage document.