2018 PriorityMedicare KeySM (HMO-POS)
The "no hassle" plan
Your Key plan will give you the luxury of a $0 monthly premium. You'll pay a little more for your deductibles.
- See specialists in our network without a referral
- Preventive coverage, such as annual exams and mammograms, included at no cost
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In-network benefits
Deductible
The amount you pay for covered health care services before Priority Health begins to pay.
Out-of-pocket maximum
This is the most you pay during a calendar year for in-network services before Priority Health begins to pay 100% of the allowed amount. This includes copayments, deductibles and coinsurance payments. It does not include your monthly premium, Part D drug costs or services from out-of-network providers.
Inpatient hospital care
Days 1-6
Days 7 and beyond
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
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.
Deductible does not apply.
Lab services
Medicare-covered lab services
Diagnostic tests and procedures
Medicare-covered diagnostic procedures and tests
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.
Dental services
Limited to Medicare-covered dental services
This includes Medicare-covered dental services such as extraction of teeth to prepare the jaw for radiation treatments. It does not include preventive services such as treatment, filling, removal or replacement of teeth.
Virtual care
Per visit
Also referred to as "remote access technologies," which is visiting with a health care professional over the phone or using online video.
Wellness (fitness) programs
For a fitness membership at a participating Silver&Fit® facility or up to 2 home fitness kits.
Prescription drug benefits
Part D prescription drug deductible
Tier 1 and tier 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 $3,750.
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.
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 $3,750.
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.
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 $3,750.
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.
Tier 4 (non-preferred drugs)
Preferred retail (30-day)
Standard retail (30-day)
Mail order (90-day)
You pay coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $3,750.
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.
Tier 5 (specialty drugs)
You pay coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $3,750.
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, while in the coverage gap
Covered generic drugs
Covered brand drugs
When you reach your total yearly drug cost (includes what our plan has paid and what you've paid) of $3,750, you'll enter what is called a coverage gap. At this time, you'll pay 44% of the plan's cost for covered generic drugs and 35% of the plan's cost for covered brand drugs, plus dispensing fee, until your total costs reach $5,000.
Most Medicare plans have this coverage gap (also called the "donut hole"), but not everyone will enter the coverage gap.
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 $5,000, you pay the greater of either: 5% of the cost OR a copay of $3.35 for generic and $8.35 for all other drugs.
Optional benefits
Enhanced vision, dental & hearing
Optional benefit available to add vision, dental and hearing coverage to your MAPD plan for an extra $29 monthly premium.
Get details and learn how to add this coverage to your plan.
Plan features & services
- Doctors and hospitals
- Drug coverage
- Pharmacies
- Premium assistance
- Silver & Fit
- Enhanced vision, dental & hearing
Plan documents
- Summary of benefits
- Making Medicare Choices Easier brochure, which includes 2018 premiums
- Evidence of Coverage booklet, compete details of what this plan covers
- 2019 Medicare Star Ratings