2021 PriorityMedicare IdealSM (PPO)
This plan is one of our best for helping you manage chronic conditions, you’ll get the care you need, at a price you can afford. Plus, PriorityMedicare Ideal includes free companion care, giving you help with chores and transportation.
Our Medicare Advantage plans include the benefits you need, plus the extras you want. Like preventive dental services and routine vision and hearing coverage, including hearing aids and a $100 eyewear allowance. Plus, a free gym membership or home workout options. And if you’re headed south or get care in another state, our plans cover you at in-network prices anywhere in the U.S. outside of Michigan.
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In-network benefits
Deductible
The amount you'll pay for most covered medical services, in-network and out-of-network combined, before you start paying only copayments or coinsurance and Priority Health pays the balance.
Out-of-pocket maximum
This is the most you pay during a calendar year for in-network and out-of-network services before Priority Health begins to pay 100% of the allowed amount. This limit includes copayments and coinsurance payments. It does not include your monthly premium or Part D drug costs.
Inpatient hospital care
Days 1-6
Days 7 and beyond
There is no limit to the number of days covered by the plan each hospital stay.
Authorization rules may apply.
Doctor office visits
Each primary care visit
Each specialist visit
Authorization rules may apply.
Emergency & urgent care
Each emergency room visit
Each urgent care visit
Get emergency or urgent care services wherever you are in the United States or all over the world.
Lab services
Medicare-covered lab services
Diagnostic tests and procedures
Medicare-covered diagnostic procedures and tests
Authorization rules may apply.
Outpatient X-rays
Medicare-covered outpatient X-rays
Diagnostic radiology services
Medicare-covered diagnostic radiology services
Diagnostic radiology includes services such as MRIs and CT scans.
Authorization rules may apply.
Radiation therapy
Medicare-covered radiation therapy services, such as cancer treatment
Preventive services
Annual wellness visit and preventive services covered under Original Medicare
See a list of preventive services covered at $0 copay. Any additional preventive services approved by Medicare during the contract year will be covered.
Preventive dental services (by Delta Dental®)
Two oral exams and two cleanings (regular or periodontal maintenance) per year
One set of bitewing X-rays per year
Routine vision (by EyeMed®)
One routine exam (including refraction with dilation as necessary) & one retinal imaging per year
Each year
Routine hearing (by TruHearing™)
Routine exam
Per year, per ear for hearing aids from top manufacturers
Hearing aid cost includes three fitting and follow-up evaluations within the first year and 48 batteries per hearing aid.
Chiropractic services
Routine visit, up to 12 visits per year
Chiropractic X-ray services, performed once per year
Medicare-covered visit
Acupuncture services
Medicare-covered visit for chronic low back pain
Routine visit, up to six visits per year for other conditions
Out-of-state travel benefit (with MultiPlan)
Over-the-counter (OTC) benefit allowance
Per quarter allowance
For use on drugs and health related products that do not need a prescription, such as allergy medication and eye drops. Learn more.
Virtual care
Each primary care, specialist or behavioral health virtual visit
Also referred to as "evisits" or "telehealth," virtual care is a cost-effective and convenient way to visit with a health care professional via phone or video for non-emergencies.
Companion care with Papa
Per month
Connects college students ("Papa Pals") with Medicare Advantage members for assistance with things like:
- Technology support
- Household chores
- Transportation
- Meal prep
- Companionship
SilverSneakers health and fitness program
Membership at participating SilverSneakers® fitness centers, plus access to online educational programs and SilverSneakers On-DemandTM workout videos. Learn more.
BrainHQ
A personal gym for the brain. You can access online exercises that improve memory, attention, brain speed and more. Learn more.
Prescription drug benefits
Have questions on drug tiers? Learn more.
You have lower copays when you use a preferred pharmacy. See if your pharmacy is on the "preferred" list.
Part D prescription drugs deductible
Tiers 1 and 2
Tiers 3-5
This deductible applies to the cost of all drugs on the plan's list of approved drugs, or "formulary." Download the formulary to see approved drugs or view the Approved Drug List on this website.
Tier 1 (preferred generic drugs)
Preferred retail (30-day)
Standard retail (30-day)
Mail order (90-day)
You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,130.
Tier 2 (generic drugs)
Preferred retail (30-day)
Standard retail (30-day)
Mail order (90-day)
You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,130.
Tier 3 (preferred brand drugs)
Preferred retail (30-day)
Standard retail (30-day)
Mail order (90-day)
You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,130.
Tier 4 (non-preferred drugs)
Preferred retail (30-day)
Standard retail (30-day)
Mail order (90-day)
Tier 5 (specialty drugs)
(30-day supplies only)
You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,130.
Part D prescription drugs, while in the coverage gap
Covered generic drugs
Covered brand drugs
Part D prescription drugs, catastrophic coverage
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,550, you pay the greater of either 5% of the cost OR a copay of $3.70 for generic and $9.20 for all other drugs.
Optional benefits
Enhanced Dental and Vision package
PriorityMedicare IdealSM
Plan features & services
- PriorityMedicare Ideal 2021 plan details
- Doctors and hospitals
- Drug coverage
- Embedded Dental, Vision and Hearing
- Out-of-state travel benefit
- Over-the-counter (OTC) allowance
- Pharmacies
- Premium assistance
- Companion care with Papa
- SilverSneakers health and fitness program
- BrainHQ
- Enhanced Dental and Vision package
Plan documents
- Summary of benefits
- Your guide to choosing the right Medicare Advantage plan brochure, which includes 2021 premiums
- Evidence of Coverage booklet, complete details of what this plan covers
- 2021 Medicare Star Ratings