PriorityFlex

Page last updated on: 10/02/25

PriorityFlex is a benefit available to eligible PriorityMedicare® D-SNP and PriorityMedicare® Dual Premier members.

We’re committed to supporting you at every step of your health journey. That’s why eligible D-SNP members receive a PriorityFlex card – designed to give you more flexibility and support when you need it most.

You can use the monthly allowance on your PriorityFlex card to purchase over-the-counter (OTC) items and home and bathroom safety devices and modifications. If you are eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI) you can also use your PriorityFlex allowance to purchase the following:

  • Personal care items (i.e. shampoo and body wash)
  • Household supplies (i.e. laundry detergent and paper towels)
  • Pest Control Services
  • Select utilities (gas, electric, trash, water, sewer, and phone)
  • Healthy food and produce
  • Meal delivery

Your PriorityFlex card arrives in the mail pre-loaded with funds, ready to use on the day your plan begins. It will be reloaded automatically each quarter. Be sure to use all the funds each month; any unused allowance does not roll over.

In order to be eligible for the benefits offered under Special Supplemental Benefits for the Chronically Ill, you need to have at least one of the chronic conditions listed below, a high risk of hospitalization or other adverse health outcomes and a need for intensive care management.
  • Chronic alcohol and other drug dependence
  • Autoimmune disorders limited to: Polyarteritis nodosa, Polymyalgia rheumatica, Polymyositis, Dermatomyositis, Rheumatoid arthritis, Systemic lupus erythematosus, and sclerdoma
  • Cancer
  • Cardiovascular disorders limited to: Cardiac arrhythmias, Coronary artery disease, Peripheral vascular disease
  • Chronic gastrointestinal disease: chronic liver disease, non-alcoholic fatty liver disease (NAFLD), Hepatitis B Hepatitis C, Pancreatitis, Irritable bowel syndrome, inflammatory bowel disease

  • Chronic kidney disease (CKD): CKD requiring dialysis/End-stage renal disease (ESRD) (SDRD), CKD not requiring dialysis

  • Dementia
  • Diabetes mellitus, pre-diabetes (fasting glucose: 100-125 mg/dl or Hgb A1C: 5.7-6.4
  • Post-organ transplantation care
  • Severe hematologic disorders limited to: Aplastic anemia, Hemophilia, Immune thrombocytopenic purpura, Myelodysplatic syndrome, Sickle-cell disease (excluding sickle-cell trait), and Chronic venous thromboembolic disorder
  • HIV/AIDS
  • Conditions that may cause similar function challenges and require similar services: spinal cord injury, paralysis, limb loss, stroke, arthritis, chronic conditions that impair vision, hearing (deafness), taste, touch and smell, conditions that require continued therapy, services in order for individuals to maintain or retain functioning
  • Chronic lung disorders limited to: Asthma, Chronic bronchitis, Emphysema, Pulmonary fibrosis, and Pulmonary hypertension
  • Chronic and disabling mental health conditions limited to: Bipolar disorders, Major depressive disorders, Paranoid disorder, Schizophrenia, and Schizoaffective disorder, post-traumatic stress disorder (PTSD), eating disorders and anxiety disorders
  • Neurologic disorders limited to: Amyotrophic lateral sclerosis (ALS), cerebral palsy, Epilepsy, Extensive paralysis (i.e., hemiplegia,
  • quadriplegia, paraplegia, monoplegia), Huntington’s disease, Multiple sclerosis, Parkinson’s disease, Polyneuropathy, Spinal stenosis, and Stroke-related neurologic deficit, chronic fatigue syndrome, spinal cord injuries, traumatic brain injury
  • Stroke
  • Overweight, obesity and metabolic syndrome
  • Conditions that may cause cognitive impairment: Alzheimer’s disease, intellectual and developmental disabilities, traumatic brain injury, disabling mental illness associated with cognitive impairment, mild cognitive impairment.
  • Chronic Hypertension
  • Osteoporosis
  • Chronic back pain

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.

Priority Health has a D-SNP (HMO) plan with a Medicare contract and a contract with the State Medicaid program. Enrollment in Priority Medicare D-SNP (HMO) depends on contract renewal.

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