Priority Health Medicare Advantage plans
Priority Health has contracted with the Centers for Medicare and Medicaid Services (CMS) to offer Medicare Advantage plans with drug coverage (MAPD) and Medicare prescription drug coverage only (PDP) plans to Medicare beneficiaries living in select Michigan counties.
Medicare Advantage plan benefits
Medicare Advantage plans are offered by private insurance companies. In addition to Original Medicare benefits, these plans can include other coverage. Our plans cover:
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Initial preventive physical examination (IPPE), also known as the "Welcome to Medicare" visit, is a preventive E&M service that includes 7 components; note that clinical lab tests and preventive services that are currently covered and paid for by Medicare Part B must be billed separately from the IPPE.
See the "Expanded Benefits" brochure on cms.gov.
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Annual wellness visit, including personalized prevention plan services
See the Annual Wellness Visit brochure on cms.gov.
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Abdominal aortic aneurysm ultrasound screening (one-time) for eligible beneficiaries
See the "Expanded Benefits" brochure on cms.gov.
- New in 2011: Alcohol misuse screening and behavioral counseling interventions in a primary care setting for individuals who screen positive.
See the alcohol screening and counseling MLNMatters article on cms.gov.
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Bone mass measurement once every 2 years
See the Bone Mass Measurement brochure on cms.gov.
- Cancer screenings:
- Mammography and clinical breast exam
- Cervical and vaginal cancer (Pap test and pelvic exam, includes the clinical breast exam)
- Colorectal cancer (fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema)
- PSA blood test and digital rectal exam
- The Cancer Screenings brochure on cms.gov gives more details on these tests
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Cardiovascular screening blood tests
See the "Expanded Benefits" brochure on cms.gov.
- New in 2011: Cardiovascular disease intensive behavioral therapy in a primary care setting, annual face-to-face visit.
See the cardiovascular therapy MLNMatters article on cms.gov.
- New in 2011: Depression screening, annual
See the depression screening MLNMatters article on cms.gov.
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Diabetes screening and self-management training; medical nutrition therapy
See the Diabetes-Related Services Fact Sheet on cms.gov.
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Glaucoma screening
See the Glaucoma Screening brochure on cms.gov.
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HIV screening
See the HIV Screening brochure on cms.gov.
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Immunizations for seasonal influenza, pneumococcal polysaccharide vaccine, and hepatitus B virus
Influenza vaccinations are covered in-network at $0 copayment
Pneumococcal vaccinations are covered in-network at a $0 copayment
See the Preventive Immunizations brochure on cms.gov.
- New in 2011: Obesity screening and counseling for members with BMIs of 30 or higher (see Medicare preventive care guidelines for frequency)
- New in 2011: Sexually transmitted infections screening for members at high risk, including 2 face-to-face counseling sessions
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Tobacco use cessation counseling services
See the Tobacco Services brochure on cms.gov.
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Wellness programs, including membership in Silver&Fit® (free gym membership or free fitness videos)
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Basic dental services (one exam, one cleaning, 50% of one set of bite-wing x-rays) (enhanced dental coverage is also available)
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Prescription drug coverage
Member information
Health risk appraisals and high-risk members
Within 90 days of enrollment, Priority Health Medicare Advantage plan members are mailed a health risk appraisal survey to complete. Members who are identified as high-risk according to the health risk appraisal information are assigned to a Priority Health nurse case manager. The case manager coordinates services for the member and develops a care plan for him/her in consultation with the member's primary care physician's office.
Coverage documents/member materials
Check Priority Health's Medicare Advantage plan member pages for all coverage documents:
- Summaries of benefits
- Evidence of Coverage booklets (the complete benefits listing)
- Formulary
- Provider directory
- Member handbooks
Go to the Member pages now.
Federal requirements of Medicare plan providers
Advance beneficiary notification of noncoverage (ABN)
CMS requires that, when providers expect Medicare coverage to be denied, they inform beneficiaries of noncoverage using either on their own form or the standard ABN language on the CMS form. Get details and forms at cms.gov.
More provider requirements
Learn more about what the federal government requires of Priority Health and all Medicare Advantage Plan providers. Go to the Priority Health obligations under Medicare page.
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