Your 2024 PriorityMedicare Thrive plan information

PriorityMedicare + Kroger is now PriorityMedicare Thrive

Find out what our PriorityMedicare Thrive (PPO) plan offers you. Review your benefits in the chart below or by downloading any of your coverage documents.

Your 2024 plan documents

Your coverage documents provide detailed explanations about how your plan works.

Important Message About What You Pay for Vaccines - Our plan covers most Part D vaccines at no cost to you, even if you haven’t paid your deductible (if your plan has a deductible). Call Customer Service for more information.

Important Message About What You Pay for Insulin - You won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if you haven’t paid your deductible (if your plan has a deductible).

2024 PriorityMedicare Thrive coverage summary

This chart shows what our PriorityMedicare Thrive plan offers members.

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.

Out-of-pocket maximum

$5,200

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

$320 copay per day
Days 1-5
$0 copay per day
Days 6 and beyond

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

Authorization rules may apply

Doctor office visits

$0 copay
Each primary care visit

$40 copay
Each specialist visit

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

Emergency & urgent care

$120
Each emergency room visit
$40
Each urgent care visit

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

Lab services

$0 copay
Medicare-covered lab services

$0 copay
Anticoagulant lab services (if on blood thinners)

Diagnostic tests and procedures

$0 copay
Medicare-covered diagnostic procedures and tests
Authorization rules may apply.

Outpatient X-rays

$20 copay
Medicare-covered outpatient X-rays

Diagnostic radiology services

$275 copay
Medicare-covered diagnostic radiology services

Diagnostic radiology includes services such as MRIs and CT scans.

Authorization rules may apply.

Radiation therapy

$40 copay
Medicare-covered radiation therapy services, such as cancer treatment

Preventive care

$0 copay
Annual physical exam 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.

Routine Vision (by EyeMed®)

$0 copay
One routine exam (including refraction with dilation as necessary) & one retinal imaging per year
$200 eyewear allowance


Each year

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

$3,000 annual maximum that applies to the following services: $0 for fillings (includes composite resin and amalgam once per tooth per lifetime, $0 for simple extractions one per tooth per lifetime, $0 for crown repairs once per tooth every 12 months, $0 for anesthesia, no limit when used during any of the services above

Routine hearing (by TruHearing™)

$0 copay
Routine exam

$295-$1,495 copay
Per year, per ear for hearing aids from top manufacturers 

Hearing aid cost includes three fitting and follow-up evaluations within the first year and 48 batteries per hearing aid.

Chiropractic services

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

Medicare-covered visit

Acupuncture services

$20 copay
Medicare-covered visit

$20 copay
Routine visit, up to six visits per year for other conditions

OTC Plus allowance

$35
(no rollover) monthly

OTC Plus allowance can be on drugs and health related products that do not need a prescription, such as allergy medication and eye drops. Eligible members can also use their OTC Plus allowance towards healthy food and produce at Kroger stores. Learn more.

Priority Health Travel Pass

Travel Pass has you covered for out-of-area care at in-network prices, access to MultiPlan® Medicare Advantage providers, unlimited worldwide emergency and urgent care and Assist America® for global travel assistance. 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

For 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.

Plan D prescription drugs, deductible

$0

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.

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 $4,660.

Tier 4 (non-preferred drugs)

45% coinsurance
Preferred retail (30-day)
50% coinsurance
Standard retail (30-day)
45% coinsurance
Mail order (90-day)

You pay copays or coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $4,660.

Tier 5 (specialty drugs)

33% coinsurance
(30-day supplies only)

You pay copays or coinsurance for drugs on this plan's formulary until your total yearly drug costs reach $4,660.

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 $4,660, 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 $7,400.

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 7,400 you pay the greater of either 5% of the cost OR a copay of $4.15 for generic and $10.35 for all other drugs.

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, implants 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.