Your 2022 PriorityMedicare (D-SNP) plan information

Find out what our PriorityMedicare Dual Eligible Special Needs (D-SNP)SM (HMO) plan offers you. Review your benefits in the chart below or by downloading any of your coverage documents.

Your 2022 plan documents

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

2022 PriorityMedicare D-SNP coverage summary

This chart shows what the PriorityMedicare D-SNP plan offers to our members.

In-network benefits


The amount you'll pay for most covered medical services, in-network, before you start paying only copayments or coinsurance and Priority Health pays the balance.
D-SNP plans do not include a deductible.

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 Part D drug costs.
D-SNP plans do not include a maximum out-of-pocket amount.

Inpatient hospital care

$0 copay per day
Unlimited days

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 doctor visit
$0 copay
Each specialist visit

Authorization rules may apply for certain specialist visits.

Emergency and urgent care

$0 copay
Each emergency room visit
$0 copay
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

Preventive care

$0 copay
Annual physical exam and preventive services covered under Original Medicare

See a list of preventive services.

Preventive dental services (by Delta Dental®)

$0 copay
Two oral exams and two cleanings per year (regular or periodontal maintenance)
$0 copay
One set of bitewing x-rays and one brush biopsy per year, all other x-rays one every two years

Routine vision (by EyeMed)

$0 copay
One routine exam (including refraction) & one retinal imaging per year
$200 for eyewear
Each year 

Routine hearing (by TruHearing)

$0 copay
Per hearing exam
$0 copay
Per hearing aid exam each year. $0 for Advanced Aids, one per ear, per year.

Virtual care

$0 copay
Per 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.

Prescription drug benefits

Curious about which pharmacies are in your network? Learn more.

Part D prescription drug deductible


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 digital Approved Drug List.

Tier 1

$0, $1.35 or $3.95 per prescription
Generic drugs
$0, $4 or $9.85 per prescription
All other drugs
The amount depends on your LIS level.

Transportation services

Up to 30 one-way trips every year to or from health related locations. Trips are limited to 30 miles per one-way trip.

Transportation services are not covered by Medicare but they are covered by Medicaid.


Additional benefits

Diabetes management

Supplies and services

Includes diabetes monitoring supplies, self-management training, and shoes or inserts.

Authorization rules may apply.

Home health care

Per visit

Authorization rules may apply.

Over-the-counter (OTC) allowance

$150 allowance
Per quarter

Over-the-counter items are drugs and health related products that do not need a prescription. This includes items such as: allergy medication, eye drops, cough drops, nasal spray, vitamins and more. Items can be purchased in participating stores (Walmart, Walgreens, CVS, Kroger and more). You can also order these items over the phone or online at Healthy Benefits Plus.

Learn more about how to use your OTC benefit.

Companion care with Papa

$0 copay for 8 hours
Per month

You will be connected with a college student ("Papa Pal") for assistance with things like:

  • Technology support
  • Household chores
  • Transportation
  • Meal prep
  • Companionship

Learn more.

SilverSneakers® (fitness)

Gym memberships at participating SilverSneakers locations or free online workouts.

SilverSneakers® fitness membership—visit any participating facility or enjoy easy access to online workouts on the SilverSneakersGOTM  mobile app anywhere, anytime.

Learn more