2021 PriorityMedicare VitalSM (PPO)
With PriorityMedicare Vital, you get everything you like about Original Medicare, plus everything you wish it had. Think a hassle-free open network with a drug plan, rich supplemental benefits, a $30 per month Part B premium credit and more. Available in regions 1, 2 and 5.*
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.
Part B premium credit
Per month
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.
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 1-4
Days 5 and beyond
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
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
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 (regular or periodontal maintenance) per year
One set of bitewing X-rays per year
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
Hearing aid cost includes 3 fitting and follow-up evaluations within the first year. 48 batteries per hearing aid.
Chiropractic services
Routine visit, up to 12 visits per year
Chiropractic X-ray services, performed once per year
Acupuncture services
Medicare-covered visit for chronic low back pain
Routine visit, up to six visits per year for other conditions
Over-the-counter (OTC) benefit allowance
Per quarter allowance
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 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.
Virtual care
Each primary care, specialist or behavioral health 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
Membership at participating SilverSneakers® fitness centers, plus access to online educational programs and SilverSneakers On-Demand™ 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
Tiers 1 and 2
Tiers 3-5
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 $4,130.
Tier 2 (generic drugs)
Preferred retail (30-day)
Standard retail (30-day)
Mail order (90-day)
You pay copays or coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $4,130.
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 $4,130.
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 $4,130.
Tier 5 (specialty drugs)
(30-day supplies only)
You pay copays or coinsurance 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
Covered generic drugs
Covered brand drugs
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
*Allegan, Arenac, Barry, Bay, Berrien, Branch, Calhoun, Cass, Clinton, Genesee, Huron, Ingham, Ionia, Isabella, Kalamazoo, Kent, Lenawee, Livingston, Macomb, Mason, Midland, Missaukee, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Ostego, Ottawa, Saginaw, St. Clair, Tuscola, Van Buren, Washtenaw, Wayne and Wexford
PriorityMedicare VitalSM
Plan features & services
- PriorityMedicare Vital 2021 plan details
- Doctors and hospitals
- Drug coverage
- Embedded Dental, Vision and Hearing
- Out-of-state travel benefit
- Over-the-counter (OTC) allowance
- 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