2019 PriorityMedicare SelectSM (PPO)
This plan gives you the most coverage and the lowest out-of-pocket costs. Ready to travel? This plan goes with you. You'll pay the same in- and out-of-network copays for many services, plus there is no in-network medical deductible.
All Priority Health Medicare Advantage plans include:
- Ways to save on prescription drugs, with Preferred Pharmacy pricing and $0 copay on 90-day mail order tier 1 and 2 drugs
- Preventive dental services, including exams and cleanings
- Free fitness center membership or at-home fitness kits
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In-network benefits
Deductible
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
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.
Doctor office visits
Each primary care doctor visit
Each specialist visit
Copay is the same whether you go to in-network or out-of-network providers.
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
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
2 oral exams and 2 cleanings per year
1 set of bitewing X-rays per year
Virtual care
Per visit
Also referred to as "evisits" or "remote access technologies," virtual care is a cost-effective and convenient way to visit with a health care professional via phone or video for non-emergencies.
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 $3,820.
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 $3,820.
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 $3,820.
Tier 4 (non-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 $3,820.
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 $3,820.
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 $3,820, you'll enter what is called a coverage gap. At this time, you'll pay 37% 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 $5,100.
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 $5,100, you pay the greater of either 5% of the cost OR a copay of $3.40 for generic and $8.50 for all other drugs.
Optional benefits
Enhanced Vision, Dental & Hearing Package
Optional benefit: Add vision, dental and hearing coverage to your MAPD plan for an extra $27.20 monthly premium.
Get details and learn how to add this coverage to your plan.
PriorityMedicare SelectSM
Plan features & services
- PriorityMedicare Select 2019 plan details
- Doctors & hospitals
- Drug coverage
- Pharmacies
- Premium assistance
- Silver&Fit® fitness program
- Enhanced vision, dental & hearing
Plan documents
- Summary of benefits
- Making Medicare Choices Easier brochure, which includes 2019 premiums
- Evidence of Coverage booklet, complete details of what this plan covers
- 2020 Medicare Star Ratings