MyPriority Silver 5500
MyPriority® Silver 5500 plans are a smart option for individuals or families who are healthy and savings-minded. Many common health care services like primary care visits, specialist visits, urgent care, most prescriptions and labs are available with a low copay before deductible. This plan can be purchased on the federal Marketplace or directly from Priority Health.
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®
Your out-of-pocket costs may vary based on your subsidy level from the Federally-Facilitated Marketplace (FFM).
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 Find a Doctor tool to see if your doctor is in-network.
The metal level determines how you and your plan share the costs of care. Silver means your health plan pays 70% (on average) and you pay about 30%. Silver level plans offer a good balance of premium and out-of-pocket costs.
The deductible is the amount you pay for covered health care services before Priority Health begins to 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.
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.
Primary doctor, office visits (evaluation only), before deductible
Specialist, office visits (evaluation only), before deductible
Mental health, office visits only, before deductible
Limited virtual care
24/7 access to a provider with a Spectrum Health On-Demand virtual urgent care.
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.
Retail health, urgent care and emergency services
Retail health clinic, office visits (evaluation only), before deductible
Urgent care, office visits (evaluation only), before deductible
Emergency room (waived if admitted); 30% coinsurance, after deductible
When you seek treatment for an illness, injury, symptom or condition that needs immediate care.
Diagnostic tests, lab services, X-rays and radiology services
Diagnostic tests & lab services
X-rays & radiology services
Tier 1a and Tier 1b drugs
Tier 1 includes low-cost generic drugs, proven to be as safe as brand-name drugs.
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.
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