PriorityMedicare Value

Your 2026 plan documents

Find out what our PriorityMedicare Value^SM (HMO-POS) 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.

2026 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.
2026 Annual Notice of Change
The Annual Notice of Change outlines the year-over-year changes to the plan, including basic benefits and embedded extras.
2026 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).

2026 PriorityMedicare Value coverage summary

This chart shows what our PriorityMedicare Value plan offers members.

Deductible
The amount you'll pay for most covered in-network medical services before you start paying only copayments or coinsurance and Priority Health pays the balance.	$0

Out-of-pocket maximum
This is the most you pay during a calendar year for in-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, Part D drug costs or services from out-of-network providers.	$5,100

Inpatient hospital care
Days 1-7	$325 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
Each primary care visit	$0 copay
Each specialist visit	$35 copay
Each palliative care physician visit	$0 copay

Authorization rules may apply.

Emergency and urgent care
Each emergency room visit	$130 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
Medicare-covered lab services	$10 copay
Anticoagulant lab services (if on blood thinners)	$0 copay

Diagnostic tests and procedures
Medicare-covered diagnostic procedures and tests	$10 copay

Authorization rules may apply.

Outpatient X-rays
Medicare-covered outpatient X-rays	$35 copay

Diagnostic radiology services
Medicare-covered diagnostic radiology services	$225 copay

Diagnostic radiology includes services such as MRIs and CT scans.

Authorization rules may apply.

Radiation therapy
Medicare-covered radiation therapy services, such as cancer treatment	$25 copay

Preventive care
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^®)
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^®)
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^®)
Fillings (once per tooth every 24 months), crown repairs (once per tooth every 12 months) and simple extractions (once per tooth per lifetime)	$0 copay
Root canals once per tooth per lifetime	50% coinsurance

$2,500 annual maximum to use towards the above.

Routine hearing (by TruHearing^TM)
Routine exam	$0 copay
Per year, per ear for hearing aids from top manufacturers	$295-$1,495 copay

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

Chiropractic services
Medicare-covered visit	$15 copay

Acupuncture services
Medicare-covered visit	$20 copay
Routine visit, up to six visits per year for other conditions	$20 copay

Priority Health Travel Pass

Priority Health 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
Each primary care, specialist or behavioral health provider virtual visit	$0 copay

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.

One Pass^®
Access to the largest nationwide network of gyms and fitness locations, live digital fitness classes, on-demand workouts, and home fitness kits. Learn more.	$0 copay

CogniFit^®
Get online brain training mode just for you to help improve your memory and focus all through your One Pass user account. Learn more.	$0 copay

Prescription drug benefits

Have questions on drug tiers and costs? Learn more.

You have lower copays when you use a preferred pharmacy. See if your pharmacy is on the "preferred" list.

Part D prescription drug, deductible
Tiers 1 and 2	$0
Tiers 3-5	$100

This deductible applies to the cost of drug tiers 3-5 on the plan's list of approved drugs, or "formulary." Download the formulary to see approved drugs or view the Approved Drugs List on this website.

Tier 1 (preferred generic drugs)
Preferred retail (30-day)	$2 copay
Standard retail (30-day)	$7 copay
Preferred mail order (100-day)	$0 copay