Your 2020 PriorityMedicare Ideal plan information

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.

There is no limit to the number of days covered by the plan each hospital stay.

Authorization rules may apply.

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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 and 48 batteries per hearing aid.

You'll pay in-network prices when seeking care anywhere in the U.S. outside of Michigan, 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.

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

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.

For membership at participating SilverSneakers® fitness centers, plus access to online educational programs and SilverSneakers On-Demand™ workout videos. Learn more at www.silversneakers.com

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.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,020.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,020.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,020.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,020.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $4,020.

When you reach your total yearly drug cost (includes what our plan has paid and what you've paid) of $4,020, 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 $6,350.

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 $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 benefit: Add additional dental and vision coverage to your plan for an extra $33 monthly premium, including additional dental coverage for things like crowns, root canals, extractions, fillings and more with $1,500 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

We've partnered with Papa, a company that connects college students ("Papa Pals") to Medicare members with specific chronic conditions who need assistance with transportation, house chores, technology lessons, companionship, and other senior services. Learn more.