PriorityMedicare Dual Premier

Page last updated on: 10/17/25

PriorityMedicare Dual Premier® (HMO), our HIDE-SNP plan, will be available to eligible members in some southwest and southeast Michigan counties beginning Jan. 1, 2026.

Dual Premier is a Highly Integrated Dual-Eligible Special Needs Plan (HIDE-SNP), combining Medicare, Medicaid and Long-Term Services & Supports (LTSS) into one plan for an integrated member and provider experience. 

HIDE-SNP vs. D-SNP

HIDE-SNP is replacing D-SNP in certain Michigan regions in 2026 (then all Michigan regions in 2027). D-SNP is coordination-only—so members could have Medicare and Medicaid plans from different payers. Now it will be one plan, with one payer. Providers will have one health plan to interact with for each member, rather than two. This applies to member eligibility, claims, appeals and grievances, inquiries, etc.

Participating with PriorityMedicare Dual Premier

If you’re contracted with either our Medicare or Medicaid product lines, you should see our Dual Premier members. No new contract is needed. However, to be fully reimbursed, you must be enrolled in the Community Health Automated Medicaid Processing System (CHAMPS).

Map of Michigan with 10 counties highlighted.

Member eligibility requirements

Members must be 21 or over at the time of enrollment, must live in one of the eligible Michigan counties (see below) and be enrolled in both Medicare and full Medicaid. They also cannot be residing in a state-operated veteran’s home or be incarcerated, and they can’t be currently enrolled in hospice, unless the member elects hospice while on the Dual Premier plan.

In 2026, Dual Premier will be offered in the following counties: Barry, Berrien, Branch, Calhoun, Cass, Kalamazoo, Macomb, St. Joseph, Van Buren and Wayne. In 2027, HIDE-SNP will be offered in all regions of Michigan’s Lower Peninsula. D-SNP will no longer be offered in Michigan as of Jan. 1, 2027.

Identifying HIDE-SNP members

ID cards: Member ID cards will read "PriorityMedicare Dual Premier" in the upper-left corner and have the MDHHS logo in the upper-right corner.

Member Inquiry: In the prism Member Inquiry tool, Dual Premier members will be identified under “plan type” as “PriorityMedicare Dual Premier.”

Sample member ID card for PriorityMedicare Dual Premier.

Billing

Providers bill once. The Medicare side of the member’s plan pays out first, then Medicaid picks up the difference, if there is one. If the provider is out-of-network for Medicare or Medicaid, that side of the claim will be paid at the out-of-network level on the fee schedule.

Member cost share

Dual Premier members will have no costs from deductibles, premiums, coinsurance, copayments and cost sharing of any kind, with the exception of PPA or certain medication copays. Providers are forbidden from balance-billing HIDE-SNP members, even if out of network.

Member information

Eligible members should be directed to priorityhealth.com/mapd-plan-info/dual-plan-documents for more information. They can also find a full list of benefits on the Annual Notice of Changes.

LTSS

Long-term services and supports (LTSS) encompass the variety of health, health-related, and social services that assist individuals with functional limitations due to physical, cognitive or mental conditions and disabilities. Examples include:

  • Adaptive medical equipment & supplies
  • Adult day program
  • Chore services
  • Community transition services
  • Environmental modifications
  • Private duty nursing
  • Respite

LTSS are delivered in both institutional (e.g., nursing homes) settings, community-based settings and member homes.

Under HIDE-SNP, members who meet specific eligibility requirements will receive LTSS that will be provided through Priority Health’s partnership with the Michigan Area Agency on Aging (AAA). The AAAs will manage most administration (i.e. assessments, claims, etc.) using their network, since we don’t offer LTSS.

Members will either be identified by MDHHS as LTSS-eligible or by our Care Management team. Our initial estimate is that 10% of HIDE-SNP members will be eligible for LTSS.

Dual Premier provider manual

A downloadable Priority Health HIDE-SNP provider manual will be available here soon. For now, see our provider FAQs for more questions.

Dual Premier training events

Join our team at one of the following online webinars to learn more about the Dual Premier plan and HIDE-SNP. There will be an opportunity at each event to ask questions.