Medicare Advantage plan benefits
Medicare Advantage plans are offered by private insurance companies like Priority Health.
See a summary of benefits for the Priority Health Medicare Advantage plans:
Original Medicare Part A and Part B benefits
- Initial preventive physical examination (IPPE), also known as the "Welcome to Medicare" visit, is a preventive E&M service that includes 7 components; note that clinical lab tests and preventive services that are currently covered and paid for by Medicare Part B must be billed separately from the IPPE. See IPPE info on cms.gov.
- Annual wellness visit, including personalized prevention plan services:See AWP info on cms.gov.
- Abdominal aortic aneurysm ultrasound screening (one-time) for eligible beneficiaries: See MLN SE0711 on cms.gov.
- Alcohol misuse screening and behavioral counseling interventions in a primary care setting for individuals who screen positive. See the alcohol screening and counseling MLNMatters article on cms.gov.
- Bone mass measurement once every 2 years: See MLN SE0711 on cms.gov.
- Cancer screenings:
- Mammographyand clinical breast exam
- Cervical and vaginal cancer (Pap test and pelvic exam, includes the clinical breast exam)
- Colorectal cancer (fecal occult blood test, flexible sigmoidoscopy, colonoscopy, barium enema)
- PSA blood test and digital rectal exam
- Cardiovascular disease intensive behavioral therapy in a primary care setting, annual face-to-face visit: See the cardiovascular therapy MLNMatters article on cms.gov.
- Depression screening, annual: See the depression screening article on cms.gov.
- Diabetes screening and self-management training; medical nutrition therapy: See the Diabetes Preventive Services chart on cms.gov. See the Diabetes Self Management chart on CMS.
- Glaucoma screening: See the Quick Reference Chart on cms.gov.
- HIV screening: See the Quick Reference Chart on cms.gov.
- Immunizations for seasonal influenza, pneumococcal polysaccharide vaccine, and Hepatitis B virus:
Influenza vaccinations are covered in-network at $0 copayment. Pneumococcal vaccinations are covered in-network at a $0 copayment.
- Obesity screening and counseling for members with BMIs of 30 or higher (see Medicare preventive care guidelines for frequency)
- Prolonged preventive services in the office or other outpatient setting requiring direct patient contact beyond the usual service (see the Medicare preventive services)
- Sexually transmitted infections screening for members at high risk, including 2 face-to-face counseling sessions; see the Medicare Quick Reference information on the CMS preventive services tool.
- Therapy (PT/OT/ST) services: Learn about the annual cap on therapy services
- Tobacco use cessation counseling services: See the Quick Reference Chart on cms.gov.
Additional services covered by Priority Health Medicare plans
- Admission to skilled nursing facilities without having to be in the hospital 3 days prior to admission. See details.
- Routine dental services, with enhanced dental coverage also available.
- Routine vision services, with enhanced vision coverage also available.
- Routine hearing services
- Comprehensive physical is covered annually if billing guidelines are followed.
- In-home safety assessments and post-discharge medication reconciliation.
- Medication Therapy Management visits with pharmacists. See details.
- Nutritional education for members with medical conditions. Physician recommendation is required. See details.
- Unlimited medical hospital days
- Wellness programs, including membership in SilverSneakers® (gym membership or fitness videos)
- Worldwide emergency and urgent care coverage
Go to the Priority Health Medicare member web section for plan summaries (copayments & benefits overviews) and formulary information.
Health risk appraisals and high-risk members
Within 90 days of enrollment, Priority Health Medicare Advantage plan members are mailed a health risk appraisal survey to complete. This is a Medicare requirement for all Part C plans. Members who are identified as high-risk according to the health risk appraisal information are assigned to a Priority Health nurse care manager. The care manager coordinates services for the member and develops a care plan for him/her in consultation with the member's primary care physician's office.