Member cost shares will apply to advance care planning starting Jan. 1, 2027
Beginning Jan. 1, 2027, advance care planning will no longer be covered as a preventive service for commercial plans (group and individual). It will be covered with normal member cost share according to the terms of their plan.
New product offering more primary care choices for some members
Beginning Jan. 1, 2027, Priority Health will offer self-funded employer groups an optional buy-up called Primary Care Connect. Members with this buy-up can participate in direct primary care through Aligned Marketplace®. The goal is to reach members who don’t have an existing PCP relationship. All members, including those with access to Primary Care Connect, will continue to be covered for primary care sought through the Priority Health network.
2027 Medicare product updates
Priority Health is making updates to our Medicare Advantage plan offerings for the 2027 plan year beginning Jan. 1, including the introduction of two new plans, the retirement of two other plans and changes to plan availability in Northern Michigan. Providers should be aware of these changes when serving Priority Health Medicare members in 2027.
Supplemental cancer support program launching for some members
Beginning Jan. 1, 2027, Priority Health will offer self-funded employer groups an optional buy-up in partnership with Color Health® for cancer navigation, support and screening. This buy-up would supplement, not replace, the member’s existing cancer care.
Reminder: Do NOT collect upfront deductible or coinsurance payments from PriorityHRA members
Priority Health plans may include a health reimbursement arrangement (HRA). These commercial plan add-ons can be identified via the member ID card and in prism. Providers should not collect estimated deductible or coinsurance payments from Priority Health members with an HRA in advance of billing Priority Health. Instead, collect any required copays at the time of service and submit claims for other costs of care to Priority Health first. Priority Health will pay providers directly from the member's HRA for eligible expenses.
Providers may be asked to complete attestation form for eligible Medicare members to qualify for SSBCI
Beginning Jan. 1, 2027, Medicare members on PriorityMedicare Align, Latitude, D-SNP and Dual Premier may be eligible for Special Supplemental Benefits for the Chronically Ill (SSBCI). Some members who already receive SSBCI will have their eligibility renewed. For others, a provider must attest on the member’s behalf that they have all of the following: • One or more qualifying conditions • A high risk of hospitalization or other adverse health outcomes • A need for intensive care coordination • Clinical rationale for receiving SSBCI
Beginning October 1, some noncitizens will lose Medicaid coverage
Starting Oct. 1, 2026, federal rules will change Medicaid eligibility for certain noncitizens. Members impacted by this change will transition to Emergency Services Only (ESO) coverage through the state of Michigan and will no longer have Priority Health Medicaid coverage, effective immediately. Impacted members have been notified by both MDHHS and Priority Health.
HIDE-SNP members may qualify for LTSS
HIDE-SNP members may qualify for long term support services
6/22/2026: Reminder: Changing ACNs may change your patients’ access to you or their cost share
Providers, remember that if you change your ACN affiliation, it may have the unintended consequence of changing your network status for some plans, pushing you out of network or into a higher tier for patients you’re currently seeing, particularly if the member is on a narrow or tiered network plan.
6/22/2026: Members with a PHP TPA card have access to Priority Health’s network through the Cigna Strategic Alliance
Be on the lookout for a card with Priority Health and Cigna logos that says “Plan administered by PHP TPA services.” This is a PHP TPA card. Members with this plan have access to Priority Health’s PPO network and should be seen the way Cigna and Cigna-affiliated members in Michigan are seen through our Strategic Alliance with Cigna. Follow the directions on the back of the PHP TPA member ID card for requesting authorization (precertification) and submitting claims.
6/22/2026: New optional supplemental product offers member incentives for choosing top-performing providers
To meet member and employer demand for greater visibility into provider quality and more affordable healthcare, we’re offering a new optional supplemental product for commercial group employers in partnership with Garner Health that will identity top-performing providers in our network and cover out-of-pocket costs for participating members who choose to see these providers. The Garner product will be available to most employer groups and their members beginning August 1.
6/8/2026: Reminder: Medicare providers are required to see our dual eligible members regardless of Medicaid status
Are you in our Medicare network? If so, you’re required to see our dual-eligible members (D-SNP and Dual Premier) even if you’re not in our Medicaid network. This is true even if the member has Medicaid as their secondary coverage.