Cover retirees at no cost to you

Priority Health's group Medicare coverage offers you innovative and cost-saving retiree health plan solutions. These plans lower your overall health care costs because they provide low rates and don't require you to make premium contributions.

Four standard plans available: Prime, Essential, Basic (includes free gym membership) or Enhanced (includes free gym membership)

Our plans:

  • Provide complete coverage through the gap
  • Cover members wherever they are, even if they travel out of state
  • Allow non-Medicare spouses to remain covered by your regular group plan
  • Can be implemented off-cycle (which lowers your average age at renewal)
  • Give members access to our excellent Priority Health Medicare physician and pharmacy networks
  • Offer discounts on fitness center memberships, equipment and clothing and more
  • Provide prescription drug coverage with no deductible and in the Medicare Part D "donut hole"

Compare benefit options for standard Medicare plans

A list of the benefits available in the four group PriorityMedicare standard plans. Contact your group Medicare representative or your independent agent for more information. Amounts shown are in-network only.

Benefit PriorityMedicare
Prime
PriorityMedicare
Essential
PriorityMedicare
Basic
PriorityMedicare Enhanced
Out-of-pocket maximum $6,700 $6,700 $6,700 $6,700
Deductible $500 $375 $250 $0
Inpatient hospital care $150 copayment per day (days 1-5) $100 copayment per day (days 1-5) $50 copayment per day (days 1-5) $0 copayment
Office visit: primary care $25 copayment* $20 copayment* $15 copayment* $10 copayment
Office visit: specialists $35 copayment* $30 copayment* $25 copayment* $20 copayment
Diagnostic tests,
x-rays, lab services and radiology services
  • $35 copayment for x-rays
  • $25 copayment for diagnostic test, therapeutic radiology and lab services
  • $225 for imaging services
  • $30 copayment for x-rays
  • $20 copayment for diagnostic test, therapeutic radiology and lab services
  • $175 for imaging services
  • $25 copayment for x-rays
  • $15copayment for diagnostic test, therapeutic radiology and lab services
  • $150 for imaging services
  • $10 copayment for x-rays
  • $10 copayment for diagnostic test, therapeutic radiology and lab services
  • $100 for imaging services
Ambulance services $125 copayment* $125 copayment* $100 copayment* $100 copayment*
Urgently needed care1 $55 copayment* $50 copayment* $45 copayment* $40 copayment*
Worldwide emergency care1 $65 copayment* $65 copayment* $65 copayment* $65 copayment*
Preventive services2 $0 copayment* $0 copayment* $0 copayment* $0 copayment
Annual wellness and preventive physical exam $0 copayment* $0 copayment* $0 copayment* $0 copayment
Durable medical equipment 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance
Vision
services3
$35 copayment* $30 copayment*
  • $25 copayment* (includes one non-Medicare covered routine eye exam every year)
  • $60 eyewear allowance every year*
  • $20 copayment (includes one non-Medicare covered routine eye exam every year)
  • $200 eyewear allowance every year*
Hearing
services4
$30 copayment* $20 copayment*
  • $0 copayment* (includes routine hearing exams)
  • $200 for supplemental hearing aids every three years*
  • $0 copayment (includes routine hearing exams)
  • $500 for supplemental hearing aids every three years*
Fitness membership (free with this plan through Silver&FitĀ®) n/a n/a $0 copayment* $0 copayment*
Part D prescription drugs
(retail: 31-day supply)
-initial coverage period (until your total drug costs reach $2,850)
  • $0 deductible
  • Generic: 50% coinsurance ($5 min/$100 max)
  • Preferred brand: 50% coinsurance ($5 min/$100 max)copayment
  • Non-preferred brand: 50% coinsurance ($5 min/$100 max)copayment
  • Specialty: 50% coinsurance ($5 min/$100 max)
  • Infertility: 50% coinsurance
  • $0 deductible
  • Generic: $15 copayment
  • Preferred brand: $50 copayment
  • Non-preferred brand: $80 copayment
  • Specialty: 20% coinsurance (up to $150 max)
  • Infertility: 50% coinsurance
  • $0 deductible
  • Generic: $15 copayment
  • Preferred brand: $50 copayment
  • Non-preferred brand: $80 copayment
  • Specialty: 20% coinsurance (up to $150 max)
  • Infertility: 50% coinsurance
  • $0 deductible
  • Generic: $10 copayment
  • Preferred brand: $40 copayment
  • Non-preferred brand: $70 copayment
  • Specialty: 20% coinsurance (up to $100 max)
  • Infertility: 50% coinsurance
* Deductible does not apply.
1 $0 copayment if admitted to the hospital within 24 hours(s) for the same condition.
2 Preventive services include: Welcome to Medicare exam, abdominal aortic aneurysm screening, bone mass measurement. breast cancer screening (Mammogram), cardiovascular screening, cervical and vaginal cancer screening, colorectal cancer screening, depression screening, diabetes screening. glaucoma screening, HIV screening, Immunizations (pneumonia, Influenza, Hepatitis B), medical nutrition therapy, obesity screening, prostrate cancer screening, screening to reduce alcohol misuse, sexually transmitted infections screening, smoking and tobacco cessation.
For each Medicare covered exam to diagnose and treat diseases and condition of the eye. $0 copayment for annual glaucoma screening for people at risk. $0 copayment for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.
For each Medicare covered diagnostic hearing exam.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.

See the Priority Health Medicare website for more information about provider networks and approved drug lists.