2018 PriorityMedicare SelectSM (PPO)
Want a little more?
This plan gives you the most coverage, with the lowest out-of-pocket costs. You'll be free to go to doctors and hospitals that are outside our network. You won't need to get prior authorizations for services you need, as long as they're covered by your plan.
- No deductible when you see doctors in our network
- Includes drug coverage with no deductible
- See specialists in our network without a referral
- Coverage in the United States and around the world
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In-network benefits
Deductible
Out-of-pocket maximum
This is the most you pay during a policy period (usually a year) before Priority Health begins to pay 100% of the allowed amount. This includes your copayments, deductibles and coinsurance payments. This limit does not include your monthly premium, Part D drug costs or services from out-of-network providers.
Inpatient hospital care
Days 1-5
Days 6 and beyond
Copay is the same whether you go to in-network or out-of-network providers.
No limit to the number of days covered by the plan each hospital stay.
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.
Deductible does not apply.
Lab services
Medicare-covered lab services
Copay is the same whether you go to in-network or out-of-network providers.
If you receive additional services, cost-sharing for those services may apply.
Authorization rules may apply.
Diagnostic tests and procedures
Medicare-covered diagnostic procedures and tests
Copay is the same whether you go to in-network or out-of-network providers.
If you receive additional services, cost-sharing for those services may apply.
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.
If you receive additional services, cost-sharing for those services may apply.
Authorization rules may apply.
Radiation therapy
Medicare-covered radiation therapy services, such as cancer treatment
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
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 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.
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.
Tier 3 (preferred 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.
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.
Tier 5 (specialty drugs)
You pay coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $3,750.
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 coverage
Optional benefit available to add vision, dental and hearing coverage to your MAPD plan for an extra $20.50 monthly premium.
Get details and learn how to add this coverage to your plan.
Plan documents
- Summary of benefits
- Making the right Medicare choices for you brochure, which includes 2018 premiums
- Evidence of Coverage booklet, complete details of what this plan covers
- 2019 Medicare Star Ratings
Plan features & services
- Doctors and hospitals
- Drug coverage
- Pharmacies
- Premium assistance
- Silver & Fit
- Enhanced vision, dental & hearing