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PriorityMedicare Merit insurance plan benefits

See your account

You'll have 24/7 access to your claims and prescription history once you register your member account on this website. Register your account now.

Your 2014 plan documents

If you have questions about your 2014 PriorityMedicare MeritSM (PPO) plan or these documents, call Customer Service. We'll be happy to help you.

Staying healthy

Preventive care is the best way to keep yourself healthy and your costs down. Check your Evidence of Coverage brochure, above, to see what preventive care is covered by your plan.

Finding doctors, hospitals, pharmacies & more

Save money when you use the Priority Health Medicare network of doctors, labs, equipment rental businesses and other health care providers. Search it online by name, ZIP code, city, or other options. Or page through the print version.

Your plan's drug coverage

Our MAPD (Medicare Advantage + Prescription Drug) plans cover both Medicare Part B and Medicare Part D prescription drugs.

Summary of what 2014 PriorityMedicare Merit covers

This chart shows what our 2014 PriorityMedicare Merit plan offers plan members. You can also download, view and print your coverage documents above.

In-network benefits

Deductible

$0

Out-of-pocket limit

$4,500

Inpatient hospital care

For each Medicare-covered hospital stay:

Days 1-5: $250 copay per day  

Days 6-90: $0 copay per day

$0 copay for additional non-Medicare covered hospital days

No limit to the number of days covered by the plan each hospital stay. Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.

Doctor office visits*

$20 copay for each primary care doctor visit

$40 copay for each specialist visit  

*Authorization rules may apply.

Diagnostic tests, x-rays, lab services, and radiology*

$30 copay for Medicare-covered lab services  

$30 copay for Medicare-covered diagnostic procedures and tests

$30 copay for Medicare-covered x-rays

$150 copay for Medicare-covered diagnostic radiology services (not including x-rays)

$30 copay for Medicare-covered therapeutic radiology services

If the doctor provides you services in addition to outpatient diagnostic procedures, tests and lab services, separate cost sharing of $20 to $40 may apply. If the doctor provides you services in addition to outpatient diagnostic and therapeutic radiology services, separate cost sharing of $20 to $40 may apply.

*Authorization rules may apply.

Preventive services*

$0 copay for a supplemental annual physical exam

$0 copay for all preventive services covered under Original Medicare at zero cost sharing

Abdominal aortic aneurysm screening

Alcohol misuse screening and behavioral counseling interventions in the primary care setting

Breast cancer screening (mammogram)

Bone mass measurement

Cardiovascular disease: Intensive behavioral therapy, bi-annual

Cardiovascular screening

Cervical and vaginal cancer screening

Colorectal cancer screening

Depression screening for adults

Diabetes screening

Influenza vaccine

Hepatitis B vaccine for people at risk  

HIV screening

Medical nutrition therapy services

Obesity, intensive behavioral therapy for

Personalized prevention plan services (annual wellness visits)

Pneumococcal vaccine

Prostate cancer screening

Prostate specific antigen (PSA) test only

Sexually transmitted infections (STIs), screening for, and high-intensity behavioral counseling to prevent

Smoking and tobacco use cessation

Welcome to Medicare preventive visit (initial preventive physical exam)

*Authorization rules may apply.

Part D prescription drugs

$0 deductible

You pay the following at a retail pharmacy until your total yearly drug costs reach $2,850:

Generic drugs (tier 1): $10 copay for a one-month (31-day) supply, $30 copay for a three-month (90-day) supply

Preferred brand drugs (tier 2): $45 copay for a one-month (31-day) supply, $135 copay for a three-month (90-day) supply  

Non-preferred brand drugs (tier 3): $90 copay for a one-month (31-day) supply, $270 copay for a three-month (90-day) supply

Specialty drugs (tier 4): 33% coinsurance for a one-month (31-day) supply

This plan uses a list of approved drugs, or a "formulary." The plan will send you the formulary or you can see it on this website.

Dental services (included with this plan)

$0 copay for 1 oral exam every year and 1 cleaning every year

50% of the cost for 1 set of bitewing x-rays every year

$40 copay for Medicare-covered dental benefits

Dental services (optional addition with this plan)

$15.50 monthly premium, in addition to your monthly plan premium and the monthly Medicare Part B premium.   

$1,000 plan coverage limit every year on all services

Covers:

100% coverage for two oral exams every year and two cleanings every year 

100% coverage for 1 set of bitewing x-rays every year

50% coverage for endodontic services (root canals) 

50% coverage for minor restorative fillings (fillings and crown repair)

Fitness membership (free with this plan through Silver&Fit®)

$0 copay for a health & fitness club membership at a participating Silver&Fit facility or Silver&Fit home fitness kits

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Medicare Advantage plans are offered by Priority Health.

Last modified: 1/3/2014
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