2021 PriorityMedicare MeritSM (PPO)
Our tried and true PPO, PriorityMedicare Merit offers a low in-network medical deductible, a low out-of-network coinsurance and low out-of-pocket maximum.
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 1-5
Days 6 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
Each palliative care physician 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
Anticoagulant lab services (if on blood thinners)
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 per year (regular or periodontal maintenance)
One set of bitewing x-rays and one brush biopsy per year, all other x-rays one every two years
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
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)
Virtual care
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
The value
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
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 Drugs 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 $4,430.
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 $4,430.
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 $4,430.
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 $4,430.
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 $4,430, 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 $7,050.
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 $7,050, you pay the greater of either 5% of the cost OR a copay of $3.95 for generic and $9.85 for all other drugs.
Enhanced Dental and Vision package
PriorityMedicare MeritSM
Plan features & services
- PriorityMedicare Merit 2021 plan details
- Doctors and hospitals
- Drug coverage
- Embedded Dental, Vision and Hearing
- Out-of-state travel benefit
- Pharmacies
- Premium assistance
- 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