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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 $75.00. 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. This 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 the pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The PriorityMedicare (HMO-POS) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency services. It also provides coverage for primary care, preventive services, hearing, vision, and dental services. You will have a copay for many services, and some services also have coinsurance. This plan includes additional benefits such as home health services with no copay, and cardiac rehabilitation services. However, certain services like home and bathroom safety devices, and some dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage with PriorityMedicare (HMO-POS) includes acute and psychiatric care with a copay of $225 for days 1-6, and no copay for days 7-90 for acute, and days 7-60 for psychiatric. Additional days for acute inpatient hospital are covered with no copay, while non-Medicare-covered stays and upgrades for acute and additional days for psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 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 under the PriorityMedicare (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PriorityMedicare (HMO-POS) plan. Ground and Air Ambulance Services have a $210 copay with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by the PriorityMedicare (HMO-POS) plan, with a $120 copay and no coinsurance. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation have copays of $120, $50, and $210, respectively, with no coinsurance.
Primary Care See details
The PriorityMedicare (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a copay between $0 and $40, mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, and opioid treatment program services with a $20 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered by PriorityMedicare (HMO-POS). This plan also covers health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Personal emergency response systems (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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, fitting/evaluation for hearing aids, and prescription hearing aids, all of which are covered. Prescription hearing aids (all types) have a copay between $295 and $1495, and the plan covers up to 2 hearing aids per year. OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The PriorityMedicare (HMO-POS) plan covers vision services, including eye exams with a $40 copay, routine eye exams and other eye exam services with no copay, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. This plan offers a combined maximum of $100 per year for eyewear. Upgrades are not covered.
Dental Services See details
The PriorityMedicare (HMO-POS) plan covers Medicare dental services with a copay between $0 and $175, and other dental services including oral exams (2 visits per year), dental x-rays (1 bitewing x-ray per year, or 1 full mouth/panoramic x-ray every 2 years), prophylaxis (cleaning, 2 visits per year), and oral and maxillofacial surgery (1 visit per year). The plan also offers optional, supplemental benefits for fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics, removable, implant services, and prosthodontics, fixed, and does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and 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 include Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 0% and 20%, and 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. Diagnostic Procedures/Tests have a copay of $30, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $125, Therapeutic Radiological Services have a copay of at least $20, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by PriorityMedicare (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PriorityMedicare (HMO-POS), but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but no further details are provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services 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 for SNF are not covered.
Other Services See details
Other Services include acupuncture, which has a $20 copay, and Other 1, which has a $210 copay for Ambulance Stabilization/Non-transport. Other services such as Over-the-Counter (OTC) Items, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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