2022 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, $0 primary care provider visits and more. Plus, Vital includes a $30 per month Part B premium credit – that's money back in your pocket – and a $10 per month produce allowance for eligible members with certain conditions. 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, routine vision and hearing coverage, a free gym membership and more. And if you’re headed south or get care in another state, The Priority Health Travel Pass covers you at in-network prices anywhere in the U.S. outside of Michigan.

We're sorry. This information is currently unavailable.

In-network benefits

Deductible

$0

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

$30
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

$4,700

This is the most you pay during a calendar year for in-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, Part D drug costs or services from out-of-network providers.

Inpatient hospital care

$435 copay per day
Days 1-4
$0 copay per day
Days 5 and beyond

There is no limit to the number of days covered by the plan each hospital stay. Plus, receive 28 home-delivered meals, provided through Mom's Meals, up to four times per year following an inpatient hospital, psychiatric hospital or Skilled Nursing Facility (SNF) discharge.

Authorization rules may apply.

Doctor office visits

$0 copay
Each primary care visit, in- and out-of-network
20% coinsurance

Each specialist visit
$0 copay
Each palliative care physician visit
Authorization rules may apply.

Emergency  & urgent care

20% coinsurance
Each emergency room visit (up to $90)
20% coinsurance
Each urgent care visit (up to $65)

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

Deductible does not apply.

Lab services

$0 copay
Medicare-covered lab services

Diagnostic tests and procedures

20% coinsurance
Medicare-covered diagnostic procedures and tests

Authorization rules may apply.

Outpatient X-rays

20% coinsurance
Medicare-covered outpatient X-rays

Diagnostic radiology services

20% coinsurance
Medicare-covered diagnostic radiology services

Diagnostic radiology includes services such as MRIs and CT scans.

Authorization rules may apply.

Radiation therapy

20% coinsurance
Medicare-covered radiation therapy services, such as cancer treatment 

Preventive services

$0 copay
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.

Dental services (by Delta Dental®)

$0 copay
Two exams, two cleanings, one set of bitewing X-rays & one brush biopsy each year
$0 copay

All other X-rays, including panoramic, once every two years

Routine vision (by EyeMed®)

$0 copay
One routine exam (includes dilation & refraction), one retinal imaging each year
$100 eyewear allowance

Each year

Out-of-network visits are reimbursable up to a set dollar amount.

Routine hearing (by TruHearing®)

$0 copay


Routine exam
$0 copay
Up to two TruHearing-branded "Advanced" hearing aids
One per ear, per year

Each hearing aid purchase includes a 60-day trial period, a year of follow-up visits and 80 batteries per hearing aid.

Over-the-counter (OTC) benefit and fresh produce allowance

$40
OTC allowance, per quarter
$10
Fresh produce allowance, per month

OTC benefit for use on drugs and health related products that do not need a prescription, such as allergy medication and eye drops. Fresh produce allowance for monthly in-store purchase of fresh produce. Eligibility requirements apply. Learn more.

Chiropractic services

20% coinsurance

Routine visit, up to 12 visits per year
20% coinsurance
Chiropractic X-ray services, performed once per year

Acupuncture services

$20 copay
Medicare-covered visit for chronic low back pain
$20 copay
Routine visit, up to six visits per year for other conditions

Priority Health Travel Pass


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

$0 copay
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

$0 copay

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

BrainHQ

$0 copay

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

$0
Tiers 1 and 2
$350
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)

$1 copay

Preferred retail (30-day)
$6 copay

Standard retail (30-day)
$0 copay
Preferred mail order through
Express Scripts (90-day)

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

Tier 2 (generic drugs)

$10 copay

Preferred retail (30-day)
$15 copay

Standard retail (30-day)
$0 copay
Preferred mail order through
Express Scripts (90-day)

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

Tier 3 (preferred brand drugs)

$42 copay

Preferred retail (30-day)
$47 copay

Standard retail (30-day)
$105 copay
Preferred mail order through
Express Scripts (90-day)

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

Tier 4 (non-preferred drugs)

45% coinsurance

Preferred retail (30-day)
50% coinsurance

Standard retail (30-day)
45% coinsurance
Preferred mail order through
Express Scripts (90-day)

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

Tier 5 (specialty drugs)

26% coinsurance
30 day supply

You pay copays or coinsurance 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

25% coinsurance
Covered generic drugs
25% coinsurance
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.


Optional benefits

Enhanced Dental and Vision package


Optional benefit: Add additional dental and vision coverage to your plan for an extra $29 monthly premium, including additional dental coverage for things like crowns, root canals, extractions, fillings and more with $2,500 to spend each calendar year and another $150 per year toward your eyewear allowance.

Get details and learn how to add this coverage to your plan.

*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

Enroll now