Your 2025 plan documents
Find out what our PriorityMedicare Thrive Plus (PPO) plan offers you. Review your benefits in the chart below or by downloading any of your coverage documents.
Your coverage documents provide detailed explanations about how your plan works.
- 2025 Evidence of Coverage
The Evidence of Coverage is the legal, detailed description of your benefits and costs. It also explains your rights and rules you need to follow when using your coverage for medical care and prescription drugs. - 2025 Annual Notice of Change
For existing members who have a 2022 Priority Health Medicare Advantage plan, the Annual Notice of Change outlines the year-over-year changes to the plan, including basic benefits and embedded extras. - 2025 Priority Health Medicare Advantage Formulary
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).
2025 PriorityMedicare Thrive Plus coverage summary
This chart shows what our PriorityMedicare Thrive Plus plan offers members.
Deductible | |
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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. | $0 |
Out-of-pocket maximum | |
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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. | $5,600 |
Inpatient hospital care | |
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Days 1-7 | $300 copay per day |
Days 8 and beyond | $0 copay per day |
No limit to the number of days covered by the plan each hospital stay.
Authorization rules may apply.
Doctor office visits | |
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Each primary care visit | $0 copay |
$0 for one routine skin check each plan year with a dermatologist. $40 for all other specialty provider visits. | $0-$40 copay |
Each palliative care physician visit | $0 copay |
Authorization rules may apply.
Emergency and urgent care | |
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Each emergency room visit | $120 copay |
Each urgent care visit | $50 copay |
Get emergency or urgent care services wherever you are in the United States or all over the world.
Lab services | |
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Medicare-covered lab services | $15 copay |
Anticoagulant lab services | $0 copay |
Diagnostic tests and procedures | |
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Medicare-covered diagnostic procedures and tests | $15 copay |
Authorization rules may apply.
Outpatient X-rays | |
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One diagnostic mammogram, following a routine mammogram | $0 copay |
Medicare-covered outpatient X-rays | $40 copay |
Diagnostic radiology services | |
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Medicare-covered diagnostic radiology services | $140 copay |
Diagnostic radiology includes services such as MRIs and CT scans.
Authorization rules may apply.
Radiation therapy | |
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Medicare-covered radiation therapy services, such as cancer treatment | $30 copay |
Preventive care | |
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Annual physical exam and preventive services covered under Original Medicare | $0 copay |
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®) | |
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One routine exam (including refraction with dilation as necessary) & one retinal imaging per year | $0 copay |
Each year | $100 eyewear allowance |
Preventive dental services (by Delta Dental®) | |
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Two oral exams and two cleanings per year (regular or periodontal maintenance) | $0 copay |
One brush biopsy, one fluoride treatment and one set of bitewing x-rays each year | $0 copay |
Periapical radiographs as needed and all other radiographs (full-mouth series or panoramic x-rays) every 24 months | $0 copay |
Comprehensive dental services (by Delta Dental |
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