2021 PriorityMedicare Vital^SM (PPO)

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.

You must keep paying your Medicare Part B premium, but will receive a $360 Part B premium credit each year ($30 per month) if you enroll in this plan.

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.

No limit to the number of days covered by the plan each hospital stay.

Authorization rules may apply

Authorization rules may apply.

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

Deductible does not apply.

Authorization rules may apply.

Diagnostic radiology includes services such as MRIs and CT scans.

Authorization rules may apply.

See a list of preventive services covered at $0 copay. Any additional preventive services approved by Medicare during the contract year will be covered.

Hearing aid cost includes 3 fitting and follow-up evaluations within the first year. 48 batteries per hearing aid.

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

You'll pay 20% coinsurance when seeking care anywhere in the U.S., including Michigan and the Upper Peninsula, 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.

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.

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

A personal gym for the brain. You can access online exercises that improve memory, attention, brain speed and more. Learn more.

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.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,430.

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

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,430.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,430.

You pay copays or coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $4,430.

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.

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.