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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 $120.00. 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 3-month supply when using preferred pharmacies or preferred mail order services. Tier 2 generic medications cost as low as an $8 copay for a 1-month supply at preferred locations, with the option for a 3-month supply at no copay through preferred mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs carry a 33% coinsurance at preferred pharmacies and mail order, which increases to 38% at standard locations, while Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply.
Additional Benefits
The PriorityMedicare (HMO-POS) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copays for primary care visits, telehealth, and routine preventive services. For inpatient hospital stays, members pay a $225 daily copay for days 1 through 6 and no copay for days 7 through 90. Outpatient hospital services require no copay or a copay up to $175, while emergency room visits incur a $130 copay with no coinsurance. Specialist visits require a copay of up to $40, and routine dental, vision, and hearing exams are available with no copays or coinsurance. Prescription hearing aids require copays ranging from $295 to $1,495, whereas routine eyewear is covered with no copay up to a $100 annual maximum. Additionally, home health services have no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare (HMO-POS) inpatient hospital care is partially covered with no coinsurance and requires prior authorization, costing a $225 copay per day for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare (HMO-POS) with no coinsurance, featuring a $0 to $175 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center services require a $40 copay, outpatient substance abuse sessions have a $20 copay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
PriorityMedicare (HMO-POS) covers partial hospitalization services with a $55 copay and no coinsurance, although 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. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
PriorityMedicare (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays of $130, $50, and $210, respectively, with no coinsurance.
Primary Care See details
Primary care benefits under PriorityMedicare (HMO-POS) include primary care physician visits and telehealth services with no copay and no coinsurance, alongside specialist visits with a $0 to $40 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services are also covered with no coinsurance and copays ranging from $20 to $35, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
PriorityMedicare (HMO-POS) covers preventive services with no copay and no coinsurance, though additional preventive benefits are only partially covered. Uncovered sub-services include PERS, 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 modifications, 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 or coinsurance. While up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295.00 to $1,495.00, inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
PriorityMedicare (HMO-POS) vision services cover Medicare-covered eye exams with a $40 copay and no coinsurance, while routine eye exams and retinal imaging are available once per year with no copay or coinsurance. Eyewear, including contacts, eyeglasses, frames, and lenses, is covered with no copay, no coinsurance, and no deductible up to a $100 annual maximum.
Dental Services See details
Dental services are partially covered by PriorityMedicare (HMO-POS), featuring a $0 to $175 copay and no coinsurance for Medicare-covered dental services, and no copay and no coinsurance for most other covered services. While routine cleanings, exams, and select surgeries are covered, this plan does not cover other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
PriorityMedicare (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have coinsurance ranging from no coinsurance up to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by PriorityMedicare (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by PriorityMedicare (HMO-POS) with no copays for covered items, though a 20% coinsurance applies to durable medical equipment (DME) and medical supplies, and up to 20% coinsurance for prosthetic devices. Diabetic equipment is 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. Members will pay no copay for lab services, a $30 copay for diagnostic procedures, a $35 copay for outpatient X-rays, and minimum copays of $20 for therapeutic radiology and $125 for diagnostic radiology.
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 and a $10 copay. This copay applies to Medicare-covered cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
PriorityMedicare (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring 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 inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
PriorityMedicare (HMO-POS) provides partial coverage for other services, featuring acupuncture for a $20 copay and no coinsurance (limited to 6 treatments per year), ambulance stabilization for a $210 copay and no coinsurance, and annual wellness visits with no copay or coinsurance. Supplemental benefits such as over-the-counter items and meals are not covered under this plan.
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