PriorityMediare® Dual Premier is a Highly Integrated Dual Eligible Special Needs Plan. You can enroll in the Dual Premier plan if you qualify for full Medicaid (QMB+, SLMB+ FBDE) based on standards established by the State of Michigan and federal requirements. Medicaid will provide assistance with Medicare cost-sharing and will also provide full Medicaid benefits. Your cost share is $0 when the service is covered by both Medicare and Medicaid. There may be cases where you have to pay cost sharing when a service or benefit is not covered by Medicaid.
PriorityMedicare Dual Premier eligibility requirements:
- You are enrolled in Medicare Parts A and B
- You are eligible for full Medicaid benefits, including:
- Qualified Medicare Beneficiary (QMB+)
- Specified Low-Income Medicare Beneficiary (SLMB+)
- Other Full Benefit Dual Eligible (FBDE)
- You reside within the plan’s service area. The counties include Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren and Wayne.
- You are a United States citizen or lawfully present in the United States; and
- You are 21 years of age or older.
- You are not currently enrolled in MI Choice, PACE or already on hospice.
- You are not residing in a State sanctioned Veterans home, State Psychiatric hospital or currently incarcerated.
- You do not have other comprehensive health coverage, including commercial HMO coverage.
If your category of Medicaid eligibility changes, your eligibility for these plans will change. You will have a 3-month deeming period to regain full Medicaid eligibility and will continue to be covered under this plan. If you lose your Michigan Medicaid eligibility but can be expected to regain it within three months, we’ll continue to provide all Medicare benefits covered by Priority Health. When your Michigan Medicaid coverage ends, we won’t pay for your Michigan Medicaid benefits. For more information, refer to Chapter 4 of your Member Handbook or call Customer Care at the number at the bottom of the page for help.