See if your providers and pharmacies are in-network before and after you enroll
Priority Health includes Michigan Medicine and thousands of other providers in one network. Your in-network benefit level is the same regardless of which in-network provider you choose.
2027 Medicare plan benefits
Priority Health Medicare Advantage with Part D combines medical and prescription drug coverage into one convenient health plan, helping simplify your health care experience. Review some of the benefits available to members below.
| Service | In-network benefit |
|---|---|
| Deductible | $0 |
| Maximum out-of-pocket (MOOP) | $3,000 |
| Primary care visits | $10 copay |
| Preventative annual exam | $0 copay |
| Virtual care visits | $0 copay |
| Specialist visits | $10 copay |
| Urgent care | $10 copay |
| Emergency care | $65 copay |
| X-rays/diagnostic tests | $0 copay |
Understand your Medicare prescription drug coverage
Priority Health Medicare Advantage includes Medicare Part D prescription drug coverage, helping you manage medication costs while providing access to participating pharmacies and mail-order options.
- With Priority Health Medicare Advantage you will only need one card for your medical and prescription coverage.
- You will want to check our Find a Provider tool to confirm your providers and pharmacy are in-network.
- You can continue to use Birdi for your mail order prescriptions.
- You will have the option of 100-day fills for select generic medications.
- If coming from another health plan, some preventive medications that were covered with a $0 copay, such as statins, will now have a copay.
- Insulin capped at $35/month.
Member copays and out-of-pocket cost sharing:
| 1-month supply at retail pharmacy | 3-month supply at retail pharmacy | 3-month supply at Birdi mail order pharmacy | |
|---|---|---|---|
| Tier-1 Generic | $10 copay | $30 copay | $20 copay |
| Tier 2 - Preferred brand and Specialty* | $20 copay | $60 copay | $40 copay |
| Tier 3 - Non-Preferred drug | $75 copay | $225 copay | $150 copay |
*Specialty medications are limited to 30-day supply per fill.
You will continue to pay the copays listed above until you reach your $2,400 out of pocket maximum for Part D prescription drug coverage. Once the maximum amount is met, you will reach the Catastrophic Coverage Stage. You will then pay $0 and the plan will pay 100% of your out-of-pocket Medicare Part D prescription drug costs. For additional details, please refer to the Evidence of Coverage.
Part D IRMAA and low income subsidy
Part D IRMAA and low income subsidy
- Part D IRMAA: An additional charge you may receive from Social Security Administration if your income is above the federal threshold. This additional Medicare Part D charge is determined by the Social Security Administration and is separate from your plan premium. Learn more about Part D IRMAA by visiting medicare.gov.
- Low-income subsidy (LIS): Depending on your income you may qualify for a reduction on your premiums and your prescription costs
Stay on top of preventive care
Stay on top of preventive care
Preventive care helps catch potential health issues early. Find recommended screenings, immunizations and routine care based on your age and life stage.
Diabetes supplies & continuous glucose monitor coverage
Diabetes supplies & continuous glucose monitor coverage
Priority Health offers coverage for eligible diabetes testing supplies and continuous glucose monitoring equipment. Understanding where to obtain these supplies can help you avoid unexpected costs.
$0 copay for eligible diabetes supplies
Covered diabetic supplies, including glucose monitors and test strips, are available at $0 cost share when using eligible products.
Preferred retail and mail-order products
Accu-Chek Guide and Contour products are covered through retail and mail-order pharmacies at $0 cost share.
Continuous glucose monitors (CGMs)
If you use a continuous glucose monitor or prefer a different brand, these products should be obtained through a durable medical equipment (DME) provider rather than a pharmacy. Eligible supplies remain available at $0 cost share through approved DME vendors.
Additional details on the diabetes prevention benefits available to you
Additional details on the diabetes prevention benefits available to you
- National Diabetes Prevention Program: Priority Health partners with leading health and community organizations throughout the year to provide our members access to the National Diabetes Prevention Program for a low or no cost.
- Care management support: all our plans include care management services at no cost to you to help you manage diabetes and other chronic conditions.
- Get help finding diabetic supplies: The Find a Provider tool can help you find pharmacies and durable medical equipment (DME) suppliers near you.
- Medication Therapy Management (MTM): MTM is a free service offered to Priority Health Medicare members that connects you with a certified pharmacist to help you manage your medications.
- Healthy coping skills: Teledoc Health Mental Health is a free mental health and wellness program that offers support for stress, depression, anxiety, sleep and more.
Additional programs services available to members
Additional programs services available to members
Your Priority Health Medicare Advantage plan may include access to programs and services that support your health, wellness and travel needs.
Get access to thousands of fitness locations nationwide with OnePass®
Stay active with a free One Pass® fitness membership when you become a Priority Health Medicare member.
Travel with confidence knowing you're covered with Travel Pass
With Travel Pass, you'll pay in-network costs when you visit any Medicare-participating provider in the U.S. and its territories outside of the lower peninsula of Michigan. That means, when you travel out of the lower peninsula of Michigan, your coverage travels with you. Plus, your plan will include Assist America® for global emergency travel assistance when you're more than 100 miles from home or in a foreign country.
Vendors that may communicate with you on behalf of Priority Health
Vendors that may communicate with you on behalf of Priority Health
Priority Health partners with trusted organizations to help support your health and ensure you receive important services and reminders. You may receive calls, emails or mailings from the following organizations.
- MedZown: Supports member engagement related to clinical trial opportunities and research participation.
- Priority Health Quality Customer Care: May contact members who are due or overdue for preventive screenings or other recommended health activities.
- Porter: Provides in-home health assessment services for eligible members.
- Signify Health: Provides in-home health assessment services designed to help members better understand and manage their health.
If you are contacted by one of these organizations, they are working with Priority Health to support your care, improve health outcomes and help you make the most of your health plan benefits.
Priority Health has HMO-POS and PPO plans with a Medicare contract. Enrollment in Priority Health Medicare depends on contract renewal.
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