MyPriority Standard Gold 2000

MyPriority® Gold 2000 is a standardized plan, offered by qualified health plans (QHPs) on the federal Marketplace. Standard plans have uniform plan designs with the same cost-sharing parameters from issuer to issuer, making plan choice and comparison simpler for enrollees. These standard plans allow consumers to more easily find the right form of quality, affordable health coverage for their circumstances.

Your health is our top priority

Earning 4 out of 5 stars* on healthcare.gov, Priority Health gives you more for your money and does more to improve your health.

Highlights of what members get:

  • On-demand mental health support: myStrength, included at no added cost, is a mental health and wellness online tool that helps you live your best life.
  • Chronic condition management: Access to a variety of medications, supplies and services to help keep your chronic conditions under control—covered in full or with a low cost share, before deductible.
  • Diabetes management: Our plans provide coverage for diabetes management services, supplies and treatments for no cost, before deductible when furnished by a participating durable medical equipment (DME) provider. Diabetes prescriptions and testing procedures are covered before deductible, with cost share.
  • Global emergency assistance: If you or your dependents become ill or injured while traveling more than 100 miles from home, our partner Assist America® can help you get care and even arrange your safe travel home.
  • Hearing exams and hearing aids: Discounts for you and your extended family with TruHearing®

This plan comes with our HMO network of doctors; however, there are some facilities that are not included. Please check our Find A Doctor tool to make sure your doctor is in network.

Your out-of-pocket costs may vary based on your subsidy level from the Federally-Facilitated Marketplace (FFM).

Network

HMO

An HMO provides care through a designated network of doctors, specialists and facilities that members must use in order to be covered by the plan. A primary care provider coordinates your care and you need to see an in-network doctor unless it's an emergency or you get prior approval.

Use our online Find a Doctor directory to check if your doctor is in-network. Change the search parameters from All plans to MyPriority HMO.

Metal level

Gold

The metal level determines how you and your plan share the costs of care. Gold generally means higher monthly premiums but lower out-of-pocket costs when you receive care.

Deductible

$2,000
Individual
$4,000
Family

This is the amount you pay for in-network covered health care services before Priority Health begins to pay.

Coinsurance

75%
Plan pays
25%
You pay

Coinsurance is the percentage of the cost of medical services you have to pay after you've met your deductible. Some services–like preventive care and chronic condition management–are accessible with low or no coinsurance before you meet your deductible.

Out-of-pocket limit

$8,700
Individual 
$17,400
Family

This is the most you'll pay for covered health care expenses in one year. This amount includes deductibles, coinsurance and copayments for covered services.

Office visits

$30 copayment
Primary care
(evaluation only)
Before deductible
$60 copayment
Specialist
(evaluation only)
Before deductible
$30 copayment
Mental health
Before deductible
 

Tier 1a and Tier 1b drugs

$15 copayment
Tier 1a
Before deductible
$15 copayment
Tier 1b
Before deductible

Tier 1 includes low-cost generic drugs, proven to be as safe as brand-name drugs.

Retail health, urgent care and emergency services

$45 copayment
Retail health clinic, office visits (evaluation only), before deductible
$45 copayment
Urgent care, office visits (evaluation only), before deductible
25% coinsurance
Emergency room, after deductible

When you seek treatment for an illness, injury, symptom or condition that needs immediate care.

Limited virtual care

Covered in full
Before deductible

24/7 access to a provider with a Spectrum Health On-Demand virtual urgent care.

Preventive care

Covered in full
Before deductible

Preventive services help you avoid potential health problems or find them early when they are most treatable before you feel sick or have symptoms. See our Preventive Health Care Guidelines for a list of covered preventive services.

Maternity

Covered in full
Routine prenatal and postnatal care, before deductible

Diagnostic tests, X-rays, lab services and radiology services

25% coinsurance
After deductible

The features and benefits explained in this section are intended to give you an overview of your coverage and do not include or explain every detail of what is and is not covered. Please refer to the Summary of Benefits and coverage.