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Overview of Priority Health Medicare 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 plans are a replacement product for Original Medicare. In addition to Original Medicare benefits, they include limited coverage for:
  • Preventive services
  • Wellness programs
  • Some out-of-network benefits not otherwise available to Medicare recipients
  • Prescription coverage
Medigap (Medicare Supplement insurance) plans don't replace Original Medicare, they supplement it, covering some of the copays an deductibles that Original Medicare doesn't.

Learn more about all Priority Health Medicare plans


Benefit notes

Priority Health Medicare Advantage plan members have direct access to these services:
  • Mammography screenings
  • Influenza vaccinations (covered in-network at $0 copay)
  • In-network women's health specialists for routine and preventive health services
In addition, pneumococcal vaccinations are also covered in-network at a $0 copay.

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 Health Plans page for all coverage documents:
  • Summaries of benefits
  • Evidence of Coverage booklets (the complete benefits listing)
  • Formulary
  • Provider directory
  • Member handbooks
Go to the Member materials page now.

Federal requirements of Medicare plan providers

Learn more about what the federal government requires of Priority Health and all Medicare Advantage Plan and Medicare Prescription Drug Plan providers.
Go to the Priority Health obligations under Medicare page

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Last modified 08/18/10