Your 2027 plan documents
This chart shows what the PriorityMedicare D-SNP offers to our members. If you have Medicaid, you will owe the $0 cost-share we indicate below in each benefit. If you lose Medicaid eligibility, your cost-share will vary depending on the service you receive.
Your coverage documents provide detailed explanations about how your plan works.
View your full Vision, Dental and Hearing coverage details.
- Evidence of Coverage
- Evidence of Coverage (Spanish)
- Annual Notice of Change
- Annual Notice of Change (Spanish)
| Coverage summary | |
|---|---|
Deductible This plan does not have a medical deductible, which means you only pay your copayment or coinsurance when your plan starts. | $650 |
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. | $9,850 |
Doctor office visits Authorization rules may apply for certain specialist visits. | Each primary care visit: $0 copay Each specialist visit: $0 copay |
Inpatient hospital care No limit to the number of days covered by the plan each hospital stay. Authorization rules may apply. | $0 copay per day |
Preventive care Annual wellness visit and preventive services covered under Original Medicare | Each visit: $0 copay |
Virtual care 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. | Each visit: $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.
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.
For existing members, the Annual Notice of Change outlines the year-over-year changes to the plan, including the basic benefits and embedded extras.
2027 Formulary & drug coverage
| Medicare DSNP 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). | 2027 Priority Health Medicare DSNP formulary |
| Prescription drugs | Cost |
|---|---|
Part D prescription drug deductible This deductible applies to the cost of all drugs on the plan's list of approved drugs or "formulary". View the Approved Drug List. | $700 (T3-5) - If you do not receive "Extra Help" $0 (T3-5) - If you do receive "Extra Help"
|
| Tiers 1 and 2 | $0 |
| Tiers 3-5 | 25% if you do not receive "Extra Help" $0-$14.40 if you do receive "Extra Help" |
Your 2026 plan documents
Find out what our PriorityMedicareSM Dual Eligible Special Needs Plan (D-SNP) (HMO) offers you. Review your benefits in the chart below or by downloading 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 For existing members who have a 2026 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.
- 2026 PriorityMedicare D-SNP formulary
| Coverage summary | |
|---|---|
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. D-SNPs do not include a deductible. | $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. | $9,250 |
Doctor office visits Authorization rules may apply for certain specialist visits. | Each primary care visit: $0 copay Each specialist visit: $0 copay |
Inpatient hospital care No limit to the number of days covered by the plan each hospital stay. Authorization rules may apply. | $0 copay per day |
Preventive care Annual wellness visit and preventive services covered under Original Medicare | Each visit: $0 copay |
Virtual care 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. | Each visit: $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.
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.
For existing members, the Annual Notice of Change outlines the year-over-year changes to the plan, including the basic benefits and embedded extras.
2026 Formulary & drug coverage
| Medicare DSNP 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 Priority Health Medicare DSNP formulary |
| Prescription drugs | Cost |
|---|---|
Part D prescription drug, deductible This deductible applies to the cost of all drugs on the plan's list of approved drugs or "formulary". | $615 (T3-5) - If you do not receive "Extra Help" $0 (T3-5) - If you do receive "Extra Help"
|
| Tiers 1 and 2 | $0 |
| Tiers 3-5 | 25% if you do not receive "Extra Help" $0-$12.65 if you do receive "Extra Help" |
| Additional benefits | |
|---|---|
Transportation services Up to 30 one-way trips every year to or from health related locations. Trips are limited to 100 miles, members may also be reimbursed for mileage, up to 100 miles each way. | $0 |
Diabetes management Includes diabetes monitoring supplies, self-management training and shoes or inserts Authorization rules may apply. | $0 supplies and services |
| Home health care | $0 per visit |
PriorityFlex allowance (No rollover) | $70 per month Learn more about how to use your PriorityFlex benefit. |
Carallel Caregiver Support Assistance for caregivers with health insurance, emotional support, stress management, housing & transportation, financial and legal guidance | $0 unlimited Learn more about Caregiver Support. |
One Pass® Fitness membership and well-being network that provides access to an extensive network of gym locations and online workout classes. | $0 Learn more about One Pass. |