2021 PriorityMedicare KeySM (HMO-POS)

PriorityMedicare Key is the plan so many in Michigan know and love with $0 in-network medical deductible, $0 prescription deductible for generic drugs, low PCP and specialist copays and more. Plus, a $50-$75 OTC allowance depending on your region.

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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Plan features & services

Deductible

$0

The amount you'll pay for most covered in-network medical services before you start paying only copayments or coinsurance and Priority Health pays the balance.

Out-of-pocket maximum

$5,500

This is the most you pay for in-network services during a calendar year before Priority Health begins to pay 100% of the allowed amount. This includes copayments and coinsurance payments. It does not include your monthly premium, Part D drug costs or services from out-of-network providers.

Inpatient hospital care

$325 copay per day
Days 1-6
$0 copay per day
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

$10 copay
Each primary care visit
$45 copay
Each specialist visit

Authorization rules may apply.

Emergency & urgent care

$90 copay
Each emergency room visit
$50 copay
Each urgent care visit

Get emergency or urgent care services wherever you are in the United States or all over the world.

Lab services

$10 copay
Medicare-covered lab services

 

Diagnostic tests and procedures

$10 copay
Medicare-covered diagnostic procedures and tests
Authorization rules may apply.
 

Outpatient X-rays

$35 copay
Medicare-covered outpatient X-rays

Diagnostic radiology services

$150 copay
Medicare-covered diagnostic radiology services

Diagnostic radiology includes services such as MRIs and CT scans. 

Authorization rules may apply.

Radiation therapy

$25 copay
Medicare-covered radiation therapy services, such as cancer treatment

Preventive services

$0 copay
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®)

$0 copay
Two oral exams and two cleanings (regular or periodontal maintenance) per year
$0 copay

One set of bitewing X-rays per year

Routine vision (by EyeMed®)

$0 copay
One routine exam (including refraction with dilation as necessary) & one retinal imaging per year
$100 eyewear allowance


Each year

Routine hearing (by TruHearing™)

$0 copay

Routine exam
$295-$1,495 copay
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

$20 copay
Routine visit, up to 12 visits per year
$35 copay
Chiropractic X-ray services, performed once per year
$20 copay

Medicare-covered visit

Acupuncture services

$20 copay
Medicare-covered visit for chronic low back pain
$20 copay
Routine visit, up to six visits per year for other conditions

Over-the-counter (OTC) benefit allowance

$75
Per quarter allowance
Regions 1, 2, 5
$50
Per quarter allowance
Regions 3, 4

For use on drugs and health related products that do not need a prescription, such as allergy medication and eye drops. Learn more.

Out-of-state travel benefit (with MultiPlan)

You'll pay in-network prices when seeking care anywhere in the U.S. outside of Michigan, when you see Medicare-participating providers. Learn more.

You may stay enrolled in the plan when outside of the service area for up to 12 months, as long as your residency remains in the service area.

Virtual care

$0 copay
Each primary care, specialist or behavioral health provider 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.

SilverSneakers health and fitness program

$0 copay

Membership at participating SilverSneakers® fitness centers, plus access to online educational programs and SilverSneakers On-Demand™ workout videos. Learn more.

BrainHQ

$0 copay

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

$0
Tiers 1 and 2
$100
Tier 3-5 drugs

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)

$4 copay
Preferred retail (30-day)
$10 copay
Standard retail (30-day)
$0 copay
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)

$15 copay
Preferred retail (30-day)
$20 copay
Standard retail (30-day)
$0 copay
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)

$42 copay
Preferred retail (30-day)  
$47 copay
Standard retail (30-day)  
$105 copay
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)

45% coinsurance
Preferred retail (30-day)  
50% coinsurance
Standard retail (30-day)  
45% coinsurance
Mail order (90-day)

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,130.

Tier 5 (specialty drugs)

31% coinsurance
(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

25% coinsurance
Covered generic drugs
25% coinsurance
Covered brand drugs
When you reach your total yearly drug cost (includes what our plan has paid and what you've paid) of $4,130, you'll enter what is called a coverage gap. At this time, you'll pay 25% of the plan's cost for covered generic drugs and 25% of the plan's cost for covered brand drugs, plus dispensing fee, until your total costs reach $6,550.

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 $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

Optional benefit: Add additional dental and vision coverage to your plan for an extra $37 monthly premium, including additional dental coverage for things like crowns, root canals, extractions, fillings, implants and more with $1,500 to spend each calendar year and another $150 per year toward year eyewear allowance.

Get details and learn how to add this coverage to your plan.

PriorityMedicare KeySM

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