Your 2019 PriorityMedicare Ideal plan information

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.

This is the most you pay for in-network services during a calendar year for in-network services before Priority Health begins to pay 100% of the allowed amount. This includes your copayments, deductibles and coinsurance payments. This limit does not include your monthly premium, Part D drug costs or services from out-of-network providers.

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

Authorization rules may apply.

New for 2019: Deductible does not apply to primary care visits, you'll pay your copay right away.

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.

If you receive additional services, cost-sharing for these services may apply.

Authorization rules may apply.

If you receive additional services, cost-sharing for these services may apply.

Authorization rules may apply.

If you receive additional services, cost-sharing for these services may apply.

Authorization rules may apply.

Diagnostic radiology includes services such as MRIs and CT scans.

If you receive additional services, cost-sharing for these services may apply.

Authorization rules may apply.

If you receive additional services, cost-sharing for these services may apply.

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. 

Services may require a referral from your doctor.

If you receive additional services, cost-sharing for those services may apply.

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 a fitness membership at a participating Silver&Fit® facility or up to 2 home fitness kits.

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 $3,820.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $3,820.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $3,820.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $3,820.

You pay copays for drugs on this plan's formulary until your total yearly drug costs reach $3,820.

When you reach your total yearly drug cost (includes what our plan has paid and what you've paid) of $3,820, you'll enter what is called a coverage gap. At this time, you'll pay 37% 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 $5,100.

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 vision, dental and hearing coverage to your MAPD plan for an extra $32 monthly premium.

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