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PriorityMedicare (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare (HMO-POS) in 2025, please refer to our full plan details page.
PriorityMedicare (HMO-POS) is a HMO-POS plan offered by Corewell Health available for enrollment in 2025 to people living in 68 lower peninsula Michigan counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that PriorityMedicare (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 (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 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $70.00. 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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 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 (HMO-POS) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $8 copay at a preferred pharmacy, while standard generic drugs have 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The PriorityMedicare (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $225 per day for the first six days, followed by no copay for the remaining days. Outpatient services, primary care, and emergency services also come with copays, which vary by service type. Preventive services, hearing exams, dental exams, and home health services are covered with no copay. The plan also covers services like ambulance, vision, and diagnostic services, with copays or coinsurance depending on the specific service.
Inpatient Hospital See details
The PriorityMedicare (HMO-POS) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 6 days of a hospital stay, there is a $225 copay per day, and from days 7-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a copay between $0 and $175, observation services with a $120 copay, ambulatory surgical center services with a $175 copay, outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services. This plan waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the PriorityMedicare (HMO-POS) plan. Ground and air ambulance services have a $210 copay, with no coinsurance, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the PriorityMedicare (HMO-POS) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $210 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $20 copay, occupational therapy has a $35 copay, physician specialist services have a copay between $0 and $40, individual and group mental health and psychiatric sessions have a $20 copay, physical therapy and speech-language pathology services have a $35 copay, and opioid treatment program services have a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with a doctor referral, annual physical exams, additional preventive services, health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, as well as routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $295 and $1495, but prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services include eye exams with a $40 copay, and routine eye exams and other eye exam services with no copay. Eyewear is covered with a combined maximum benefit of $100 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
The PriorityMedicare (HMO-POS) plan covers dental services, including oral exams with no copay, dental x-rays, and prophylaxis (cleaning) with no copay. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the PriorityMedicare (HMO-POS) plan, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare (HMO-POS) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the PriorityMedicare (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 20%, while Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a $30 copay, Lab Services with no copay, Diagnostic Radiological Services with a $125 copay, Therapeutic Radiological Services with a $20 copay, and Outpatient X-Ray Services with a $35 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by PriorityMedicare (HMO-POS) with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PriorityMedicare (HMO-POS). However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the PriorityMedicare (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture with a $20 copay, limited to 6 treatments per year, and ambulance stabilization/non-transport services with a $210 copay; all other services are not covered.
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