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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 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 $72.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront deductible costs. For Tier 1 preferred generic drugs, you will pay no copay for a three-month supply through a preferred pharmacy or preferred mail order, while standard pharmacies charge up to an $18 copay. Tier 2 generic drugs cost as low as an $8 copay for a one-month supply at preferred locations, with no copay required for a three-month supply filled via preferred mail order. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 25% coinsurance across all pharmacy options, while Tier 4 non-preferred drugs range from 33% to 38% coinsurance depending on your pharmacy selection. Specialty drugs in Tier 5 are covered at a 33% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The PriorityMedicare (HMO-POS) plan features robust medical coverage with no coinsurance for many key services, including inpatient hospital stays, outpatient procedures, and emergency care. Patients enjoy no copay for primary care and telehealth visits, while specialist visits require a copay of up to $40. Inpatient stays are covered with a $225 daily copay for the first six days and no copay thereafter, while emergency room visits carry a $130 copay. Routine dental, vision, and hearing exams are highly accessible with no copays, though specialized services like hearing aids and advanced dental care require copayments. For recovery and ongoing care, home health services feature no copay, while skilled nursing facility stays have no copay for the first 20 days followed by a daily copay. Medical equipment and dialysis services generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
PriorityMedicare (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional days are covered for acute stays with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
PriorityMedicare (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $175 copay for outpatient hospital services and a $40 copay for ambulatory surgical center services, both requiring 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 or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by PriorityMedicare (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
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. Routine transportation services to health-related locations are 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, both with no coinsurance and waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $130, $50, and $210, respectively.
Primary Care See details
PriorityMedicare (HMO-POS) offers primary care physician and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $40 copay with no coinsurance. Physical, occupational, speech therapy, mental health, psychiatric, and opioid treatment services require copays ranging from $20 to $35 with no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under PriorityMedicare (HMO-POS) are partially covered with no copay and no coinsurance for covered services like annual physical exams and kidney disease education. However, several sub-services are not covered, including 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, home safety devices, and counseling.
Hearing Services See details
PriorityMedicare (HMO-POS) provides partially covered hearing services, featuring one annual routine hearing exam and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $295.00 and $1,495.00, though over-the-counter (OTC) hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by PriorityMedicare (HMO-POS) with no deductible or coinsurance, featuring a $40 copay for Medicare-covered exams and no copay for annual routine eye exams and retinal imaging. Eyewear is also covered with no copay or coinsurance up to a $100 combined maximum limit per year.
Dental Services See details
Dental services are partially covered by PriorityMedicare (HMO-POS), with Medicare-covered dental requiring a $0 to $175 copay and no coinsurance, and other covered services like exams, cleanings, and implants featuring no copay and no coinsurance. 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. Covered Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
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 medical equipment with no copay, featuring a 20% coinsurance for durable medical equipment and medical supplies, and no coinsurance to 20% coinsurance for prosthetic devices. While diabetic equipment is covered with no copay and no coinsurance, diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PriorityMedicare (HMO-POS) 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, and copays starting at $20 for therapeutic radiological services and $125 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered under PriorityMedicare (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare (HMO-POS) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
PriorityMedicare (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare (HMO-POS) partially covers other services, featuring an annual wellness visit with no copay and no coinsurance, acupuncture with a $20 copay and no coinsurance up to 6 treatments per year, and ambulance stabilization with a $210 copay and no coinsurance. Over-the-counter items and meal benefits are not covered.
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