PriorityMedicare D-SNP Advantage

Your 2024 plan documents

PriorityMedicare D-SNP + Kroger is now PriorityMedicare D-SNP Advantage

Find out what our PriorityMedicare D-SNP Advantage (HMO) 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.

  • 2024 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.
  • 2024 Annual Notice of Change
    For existing members who have a 2024 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.
  • 2024 PriorityMedicare D-SNP Advantage formulary

2024 PriorityMedicare D-SNP Advantage coverage summary

This chart shows what the PriorityMedicare D-SNP Advantage plan 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.



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.

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. If you are receiving full Medicaid benefits, you are not responsible for paying any out-of-pocket costs toward the maximum out-of-pocket amount for covered Part A and Part B services.

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.

Dental services (by Delta Dental®)

$0 copay
  • Two oral exams and two cleanings per year (regular or periodontal maintenance)
  • One brush biopsy, one fluoride treatment and one set of bitewing x-rays each year
  • Periapical radiographs as needed
  • All other radiographs (full-mouth series or panoramic) every 24 months
  • Two additional periodontal maintenance cleanings (four total each year)
  • Non-surgical periodontal procedures (scaling and root planing)
  • Simple and surgical extraction of teeth (once per tooth per lifetime)
  • Crown repairs, once per tooth every 12 months
  • Fillings (resin and amalgam on anterior teeth), once per tooth, every 24 months
  • Bridges and dentures (once every 60 months) and relines and repairs to bridges and dentures (once every 36 months, per appliance)
  • Anesthesia, no limit when used during qualifying dental services

$4,000 annual maximum on all covered dental services

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
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.

Prescription drug benefits

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

Plan D prescription drugs, 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 Approved Drug List on this website.

All tiers

All drugs

Member must receive Extra Help (LIS) to receive this benefit.


Additional benefits

Transportation services


Up to 30 one-way trips every year to or from health related locations. Trips are limited to 40 miles per one-way trip.

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.


Per month (no rollover)

Your PriorityFlex card can be used towards over-the-counter (OTC) items, healthy food and produce, select utilities, and pest control services. 

Learn more about how to use your PriorityFlex benefit.

Member must receive Extra Help (LIS) to receive this benefit.

PriorityCare through Papa

$0 copay for 100 hours
of companion care per year

You will be connected with a "Papa Pal" for assistance with things like:

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

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