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PriorityMedicare Key (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Key (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Key (HMO-POS) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
PriorityMedicare Key (HMO-POS) is a HMO-POS plan offered by Priority Health available for the 2026 plan year to people living in 68 lower peninsula Michigan counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that PriorityMedicare Key (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PriorityMedicare Key (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For PriorityMedicare Key (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
Health deductible: information not available.
This plan has a $200.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5800.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5800.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The PriorityMedicare Key (HMO-POS) prescription drug plan has an annual drug deductible of $200. For Tier 1 preferred generics, you can pay as little as a $2 copay for a one-month supply, with no copay for a three-month supply through preferred pharmacies or preferred mail order. Tier 2 generics cost between $8 and $15 for a one-month supply, but you will pay no copay for a three-month supply when using preferred mail order. Higher-tier medications are covered via coinsurance rather than flat copayments. Tier 3 preferred brands require a 22% coinsurance at preferred pharmacies and 25% at standard pharmacies, while Tier 4 non-preferred drugs carry a 25% to 30% coinsurance. Specialty drugs in Tier 5 have a 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The PriorityMedicare Key (HMO-POS) plan offers comprehensive medical coverage with no copays or coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $350 daily copay for the first seven days and no copay for subsequent days, while specialist visits and outpatient hospital services range from a $15 to $350 copay with no coinsurance. Emergency care is available with a $130 copay, which is waived if the patient is admitted within 24 hours, and urgent care requires a $50 copay. Routine dental and hearing services feature no copays, although prescription hearing aids require copays ranging from $295 to $1,495. Diagnostic lab work and home infusion services also have no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Additionally, skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
PriorityMedicare Key (HMO-POS) covers inpatient acute hospital stays with no coinsurance and a $350 daily copay for days 1 to 7, with no copay for subsequent unlimited days. Inpatient psychiatric care is also covered with no coinsurance and a $275 daily copay for days 1 to 6, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare Key (HMO-POS) with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $40 copay for ambulatory surgical center services, both of which require prior authorization. Observation services require a $130 copay per stay, outpatient substance abuse sessions have a $20 copay, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
PriorityMedicare Key (HMO-POS) covers partial hospitalization services with a $55 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
PriorityMedicare Key (HMO-POS) covers ground and air ambulance services with a $270 copay per service and no coinsurance, subject to prior authorization. Non-emergency transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
PriorityMedicare Key (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, requiring a $130 copay for emergency care, a $50 copay for urgent care, and a $270 copay for emergency transportation.
Primary Care See details
PriorityMedicare Key (HMO-POS) offers partially covered primary care benefits with no copay and no coinsurance for primary care doctor visits and telehealth services, though podiatry services are not covered. Other covered services—including specialist visits, physical therapy, and mental health services—feature copays ranging from $15 to $40 and no coinsurance.
Preventive Services See details
PriorityMedicare Key (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, excluding personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by PriorityMedicare Key (HMO-POS), featuring routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from $295 to $1,495, but inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
PriorityMedicare Key (HMO-POS) covers routine eye exams and retinal imaging with a $40 copay and no coinsurance. Eyewear, including contacts and eyeglasses, is also covered with no copay and no coinsurance up to a $100 annual maximum allowance.
Dental Services See details
Dental services are partially covered by PriorityMedicare Key (HMO-POS), where Medicare-covered dental services require a $0 to $350 copay and no coinsurance, and other covered dental services have no copay and no coinsurance. Some specific sub-services, including other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PriorityMedicare Key (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs feature a coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under PriorityMedicare Key (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Key (HMO-POS) covers medical equipment with no copays, though a 20% coinsurance applies to durable medical equipment and medical supplies, and a 0% to 20% coinsurance applies to prosthetic devices. Diabetic equipment is covered with no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PriorityMedicare Key (HMO-POS) with no coinsurance, although prior authorization is required. Under this plan, lab services have no copay, diagnostic procedures and tests require a $10 copay, outpatient X-rays have a $35 copay, therapeutic radiology has a $25 copay, and diagnostic radiology has a $210 copay.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Key (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PriorityMedicare Key (HMO-POS) with no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Key (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no preceding three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Key (HMO-POS) provides partially covered other services, featuring an annual wellness visit and over-the-counter items with no copay and no coinsurance, alongside acupuncture with a $20 copay and no coinsurance for up to 6 treatments yearly. Ambulance stabilization is covered with a $270 copay and no coinsurance, while meal benefits are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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