- 2027 Member Handbook: Coming soon
The Member Handbook 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. - 2027 Annual Notice of Change
- 2027 Annual Notice of Change (Spanish)
For existing members who were on PriorityMedicare D-SNP in 2025, the Annual Notice of Change outlines the year-over-year changes to the plan, including basic benefits and embedded extras. - 2027 Evidence of Coverage
- 2027 Evidence of Coverage (Spanish): Coming soon
2027 PriorityMedicare Dual Premier coverage summary
If you have Medicaid, you will owe the $0 cost-share indicated below each benefit.
| 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. | $0 |
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 stay |
| Specialist visits | $0 |
Preventive care Annual wellness visit and preventive services covered under Original Medicare | Each visit: $0 copay |
Virtual care Each primary care, virtual care, specialist or behavioral health provider virtual visit. | 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". | $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" |
Visit the Approved Drug List to see if your prescriptions are covered.
Your 2026 plan documents
Your PriorityMedicare® Dual Premier (HMO D-SNP) plan is a highly integrated dual eligible (HIDE) special needs plan (SNP) that provides benefits of both Medicare and Medicaid, with one member ID card for all services. Review your benefits in the chart summary below or by downloading your coverage documents. These documents provide a detailed explanation about how your plan works.
- 2026 Member Handbook
The Member Handbook 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 were on PriorityMedicare D-SNP in 2025, the Annual Notice of Change outlines the year-over-year changes to the plan, including basic benefits and embedded extras. - 2026 approved drug list (formulary)
2026 PriorityMedicare Dual Premier coverage summary
If you have Medicaid, you will owe the $0 cost-share indicated below each benefit.
| Deductible | |
|---|---|
| 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. | $0 |
Dual Premier does not include a deductible.
| Out-of-pocket maximum | |
|---|---|
| There’s no cost sharing for medical services in PriorityMedicare Dual Premier, so your annual out-of-pocket costs will be $0. | $0 |
| Inpatient hospital care | |
|---|---|
| Unlimited days | $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 doctor visit | $0 copay |
| Each specialist visit | $0 copay |
Authorization rules may apply for certain specialist visits.
| Emergency and urgent care | |
|---|---|
| Each emergency room visit | $0 copay |
| Each urgent care visit | $0 copay |
Get emergency or urgent care services wherever you are in the United States or all over the world.
| Lab services | |
|---|---|
| Lab services | $0 copay |
| Preventive care | |
|---|---|
| Annual physical exam and preventive services covered under Original Medicare and Medicaid | $0 copay |
See a list of preventive services.
| Dental services (by Delta Dental®) | |
|---|---|
For more information, visit priorityhealth.com/michigan-medicaid/member. | $0 copay |
| Routine vision (by EyeMed) | |
|---|---|
| One routine exam (including refraction) & one retinal imaging per year. Routine eye exams must be done by an EyeMed Medicaid Provider. | $0 copay |
| Each year | $200 allowance for eyewear |
| Routine hearing (by TruHearing) | |
|---|---|
| Per hearing exam | $0 copay |
| Per hearing aid exam each year. $0 for Advanced Aids, per ear, every three years. | $0 copay |
| Virtual care | |
|---|---|
| Per 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.
Prescription drug benefits
Curious about which pharmacies are in your network? Learn more.
| Part D prescription drug deductible | |
|---|---|
| Deductible |
$615 (for members without Extra Help) $0 (for members with Extra Help) |
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.
| All tiers | |
|---|---|
| All drugs |
$0 T1 and T2 25% of the total cost T3-5 (for members without Extra Help) $0 - $16.65 (for members with Extra Help) |
| Transportation services | |
|---|---|
| Unlimited transportation to medical appointments through SafeRide | $0 |
Additional benefits
| Diabetes management | |
|---|---|
| Supplies and services | $0 |
Includes diabetes monitoring supplies, self-management training, and shoes or inserts.
Authorization rules may apply.
| Home health care | |
|---|---|
| Per visit | $0 |
Authorization rules may apply.
| PriorityFlex allowance | |
|---|---|
| Per month (no rollover) | $96 per month (Barry County) and $70 per month (all other counties) |
Use your PriorityFlex benefit to purchase over-the-counter (OTC) items, and if eligible, healthy food and produce, pest control services, select utilities, and household supplies and personal care items.
Learn more about how to use your PriorityFlex benefit.
*Benefit mentioned is part of a special supplemental benefit for chronically ill members with one of the following conditions: diabetes, chronic obstructive pulmonary disease (COPD), arrhythmias, depression, heart failure, prostate/breast/other cancers, and bipolar disorder. This is not a complete list of qualifying conditions. Even if you have a qualifying condition, you will not necessarily qualify to receive the benefit because coverage of the item or service depends on if you are chronically ill as defined by CMS and meet all applicable eligibility requirements. To see if you qualify, contact our Customer Care team by calling 833.939.0983 (TTY 711). From Oct. 1 – Mar. 31, we’re available seven days a week from 8 a.m. – 8 p.m. ET. From Apr. 1 – Sept. 30, we’re available Mon. – Fri. from 8 a.m. – 8 p.m. and Sat. 8 a.m. – noon ET.
Caregiver Support through Carallel
Unlimited caregiver support through caregiver advocates that can assist with housing and transportation needs and financial and legal guidance.
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.Learn more about One Pass.