A non-government entity
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 2026, 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 2026.
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 $81.00. 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:
Sign up for PriorityMedicare (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PriorityMedicare (HMO-POS) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay as little as a $1 copay for a 1-month supply at preferred pharmacies or through preferred mail order, with no copay for a 3-month supply. Tier 2 generic drugs cost an $8 copay for a 1-month supply at preferred pharmacies, and you can get a 3-month supply with no copay when using preferred mail order. For higher-tier prescriptions, the plan transitions to coinsurance, with Tier 3 preferred brand drugs requiring a 25% coinsurance across all pharmacy types. Tier 4 non-preferred drugs carry a 33% coinsurance at preferred pharmacies and mail-order services, which increases to 38% at standard pharmacies. Specialty drugs in Tier 5 are covered with a 33% coinsurance for a 1-month supply regardless of where you fill your prescription.
Additional Benefits
The PriorityMedicare (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, routine dental care, and eye exams are also available with no copay, while Medicare-covered dental and outpatient services feature low copays and no coinsurance. Inpatient hospital stays require a $225 daily copay for the first six days, after which there is no copay. Emergency room care has a $130 copay that is waived upon admission, and ambulance transportation requires a $210 copay. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance. For skilled nursing facility care, members enjoy no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
PriorityMedicare (HMO-POS) covers inpatient hospital and psychiatric stays with no coinsurance, requiring prior authorization and a $225 daily copay for days 1 through 6, and no copay for days 7 through 90. Additional acute care days are unlimited with no copay, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $175 and observation services with a $130 copay per stay. Ambulatory surgical center services require a $40 copay and no coinsurance, outpatient substance abuse sessions have a $20 copay and no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by PriorityMedicare (HMO-POS) with a $55.00 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
PriorityMedicare (HMO-POS) covers ground and air ambulance services with a $210 copay and no coinsurance, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered under this plan.
Emergency Services See details
PriorityMedicare (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $50 copay, with no coinsurance for either service and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $210, respectively.
Primary Care See details
PriorityMedicare (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits cost a $0 to $40 copay with no coinsurance. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, while mental health, psychiatric, and opioid treatments have a $20 copay with no coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by PriorityMedicare (HMO-POS) with no copay and no coinsurance for covered benefits, which include annual physical exams, kidney disease education, and select fitness benefits. Several sub-services are not covered under this plan, including personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, home-based palliative care, and counseling services.
Hearing Services See details
PriorityMedicare (HMO-POS) provides partially covered hearing services, featuring routine hearing exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295.00 to $1,495.00, though OTC, inner-ear, outer-ear, and over-the-ear hearing aids are not covered.
Vision Services See details
PriorityMedicare (HMO-POS) covers routine eye exams and retinal imaging with no copay and no coinsurance, while Medicare-covered eye exams require a $40 copay and no coinsurance. Eyewear, including contacts and eyeglasses, is covered with no copay, no coinsurance, and no deductible up to a $100 combined annual maximum.
Dental Services See details
PriorityMedicare (HMO-POS) dental services are partially covered, offering no copay and no coinsurance for preventive care such as exams, cleanings, and x-rays, while Medicare-covered dental services have a $0 to $175 copay and no coinsurance. Some sub-services, including orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services, are not covered.
Home Infusion bundled Services See details
PriorityMedicare (HMO-POS) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
PriorityMedicare (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare (HMO-POS) covers durable medical equipment and medical supplies with no copay and a 20% coinsurance, while prosthetic devices have no copay and a 0% to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Under this plan, there is no copay for lab services, a $30 copay for diagnostic procedures and tests, a $35 copay for outpatient x-rays, a $20 copay for therapeutic radiological services, and a $125 copay for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered by PriorityMedicare (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 (HMO-POS) with no coinsurance, but only some services are covered. Specifically, 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 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare (HMO-POS) partially covers other services, offering annual wellness visits with no copay and no coinsurance, acupuncture with a $20 copay and no coinsurance (limited to 6 treatments per year), and ambulance stabilization for a $210 copay and no coinsurance. Over-the-counter items, meal benefits, and dual-eligible SNP services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved