PriorityMedicare® D-SNP

Page last updated on: 10/15/25

Thank you for being a Priority Health Medicare Advantage member.

You can find important plan information below. If you have questions or would like to request printed copies of your plan documents, our customer care team is happy to help.

If you need to make any changes to your coverage, connect with your agent of record, or our Medicare benefit advisors, who are happy to help with plan changes. Please call toll-free 844.801.4721.

Please complete your Health Risk Assessment (HRA) to help us understand your needs. Once completed, you will be assigned a care manager who will work with you to create a personalized care plan.

You can complete your HRA online or by calling the phone number on the back of your member ID card.

20262025

New for 2026, updates to your PriorityFlex card

In addition to using your card for over-the-counter purchases, if you qualify* your allowance can also be used toward healthy food and produce, home utilities, pest control services, meal delivery, personal care items and household supplies.

To qualify, you must meet Special Supplemental Benefit for Chronically Ill (SSBCI) requirements and complete the survey at priorityhealth.com/qualify

 

 

  • Chronic alcohol use disorder and other substance use disorders
  • Autoimmune disorders:
    • Polyarteritis nodosa
    • Polymyalgia rheumatica
    • Polymyositis
    • Dermatomyositis
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
    • Psoriatic arthritis
    • Scleroderma
  • Cancer
  • Cardiovascular disorders:
    • Cardiac arrhythmias
    • Coronary artery disease
    • Peripheral vascular disease
    • Valvular heart disease
    • Chronic heart failure
  • Dementia
  • Diabetes
  • Overweight, Obesity and Metabolic Syndrome
  • Chronic gastrointestinal disease:
    • Chronic liver disease
    • Non-alcoholic fatty liver disease (NAFLD)
    • Hepatitis B
    • Hepatitis C
    • Pancreatitis
    • Irritable bowel syndrome
    • Inflammatory bowel disease
  • Chronic Kidney Disease (CKD):
    • CKD requiring dialysis/End-stage renal disease (ESRD) (SDRD)
    • CKD not requiring dialysis
  • Severe Hematologic Disorders:
    • Aplastic anemia
    • Hemophilia
    • Immune thrombocytopenic purpura
    • Myelodysplastic syndrome
    • Sickle-cell disease (excluding sickle cell trait)
    • Chronic venous thromboembolic disorder
  • HIV/AIDS
  • Chronic Lung Disorders:
    • Asthma
    • Chronic bronchitis
    • Cystic Fibrosis
    • Emphysema
    • Pulmonary fibrosis
    • Pulmonary hypertension
    • Chronic Obstructive Pulmonary Disease (COPD
  • Chronic and disabling mental health conditions:
    • Bipolar disorders
    • Major depressive disorders
    • Paranoid disorder
    • Schizophrenia
    • Schizoaffective disorder
    • Post-traumatic stress disorder (PTSD)
    • Eating Disorders
    • Anxiety disorders
  • Neurologic Disorders:
    • Amyotrophic lateral sclerosis (ALS)
    • Cerebral palsy
    • Epilepsy
    • Extensive paralysis (that is, hemiplegia, quadriplegia, paraplegia, monoplegia)
    • Huntington's disease
    • Multiple sclerosis
    • Parkinson's disease
    • Polyneuropathy
    • Fibromyalgia
    • Chronic fatigue syndrome
    • Spinal cord injuries
    • Spinal stenosis
    • Stroke-related neurologic deficit
    • Traumatic brain injury
  • Stroke
  • Post-organ transplantation care
  • Conditions that may cause cognitive impairment: 
    • Alzheimer's disease
    • Intellectual and developmental disabilities
    • Traumatic brain injury
    • Disabling mental illness associated with cognitive impairment
    • Mild cognitive impairment
  • Conditions that may cause similar function challenges and require similar services:
  • Spinal cord injuries
  • Paralysis
  • Limb loss
  • Stroke
  • Arthritis
  • Chronic Conditions that impair vision, hearing (deafness), taste, touch and smell
  • Conditions that require continued therapy services in order for individuals to maintain or retain functioning

Chronic Hypertension

Osteoporosis

Chronic lower back pain

Provider and pharmacy directories

Use the Find a Doc tool or download directories below to see providers and pharmacies, including DME suppliers.

Region2026 directories coming soon2025 directories
North region: Alcona, Alpena, Antrim, Arenac, Benzie, Charlevoix, Cheboygan, Clare, Crawford, Emmet, Gladwin, Grand Traverse, Iosco, Kalkaska, Lake, Leelanau, Manistee, Mason, Missaukee, Montmorency, Ogemaw, Oscoda, Osceola, Otsego, Presque Isle, Roscommon, Wexford
East region: Bay, Clinton, Genesee, Gratiot, Huron, Isabella, Lapeer, Midland, Saginaw, Sanilac, Shiawassee, St Clair, Tuscola
South region: Berrien, Branch, Calhoun, Cass, Eaton, Hillsdale, Ingham, Jackson, Kalamazoo, Lenawee, Livingston, Monroe, St. Joseph, Van Buren, Washtenaw
West region: Allegan, Barry, Ionia, Kent, Mecosta, Montcalm, Muskegon, Newaygo, Oceana, Ottawa
Southeast region: Macomb, Oakland, Wayne

Coverage exceptions, decisions and appeals

For coverage decisions, appeals and payment decisions for medical care or Part D drugs, and the appeals forms visit this page.

Important update to home health services and diabetic supplies.

Starting October 6, 2025, “Home health services” will no longer require prior authorization.

Also starting October 6, 2025, OneTouch® diabetic supplies will no longer be covered when dispensed by a retail or mail-order pharmacy. If you wish to continue using OneTouch diabetic supplies, you’ll be responsible for the total cost. Contour® brands (Ascensia) and Accu-Chek® Guide (Roche) are covered alternative supplies to monitor your blood glucose.

H8379_NCMS400040062603D_C 09162025

*Benefit mentioned is part of a special supplemental benefit for chronically ill members with one of the following conditions: diabetes, chronic obstructive pulmonary disease (COPD), arrhythmia, depression, heart failure, prostate/breast/other cancers and bipolar disorder. This is not a complete list of qualifying conditions. Even if you have a qualifying condition, you will not necessarily qualify to receive the benefit because coverage of the item or service depends on if you are chronically ill as defined by CMS and meet all applicable eligibility requirements. To see if you qualify, contact our Customer Care team by calling the number on this page.