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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 $99.00. 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 a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a 30-day supply, preferred generic drugs have an $8 copay at preferred pharmacies, while standard generic drugs have 25% coinsurance at both preferred and standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PriorityMedicare (HMO-POS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $225 copay for the first six days, then no copay, while outpatient services have copays ranging from $0 to $175. The plan covers primary care with a $20 copay and specialist visits with a $0-$40 copay. The plan also includes coverage for vision, hearing, and dental services, with copays and coverage limits for specific services like eyewear and hearing aids. Other covered services include ambulance, emergency, and diagnostic services, along with home health, cardiac rehabilitation, and skilled nursing facility care. However, some services such as certain dental, hearing, and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-6, there is a $225 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$175, Observation Services with a $120 copay, Ambulatory Surgical Center (ASC) Services with a $175 copay, and Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by PriorityMedicare (HMO-POS) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. 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, Urgently Needed Services, and Worldwide Emergency Services are covered by PriorityMedicare (HMO-POS). Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Transportation has a $210 copay; all have no coinsurance.
Primary Care See details
The PriorityMedicare (HMO-POS) plan covers primary care physician services and chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. Physician specialist services have a copay between $0 and $40, while mental health specialty and psychiatric services each have a $20 copay for individual and group sessions. 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
The PriorityMedicare (HMO-POS) plan covers preventive services, including annual physical exams, 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. However, 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 (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 exams are covered with no copay, including 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 for the inner, outer, and over the ear are not covered, and OTC hearing aids 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. Eyewear is covered, with a combined maximum of $100 every year, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered. Upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare dental services with a copay of $0-$175, and other dental services including oral exams with a copay of $0, 2 visits per year, and dental x-rays with a copay of $0, and bitewing x-rays covered once per year. Orthodontic services are partially covered, but maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the PriorityMedicare (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The PriorityMedicare (HMO-POS) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices are covered with 0-20% coinsurance, 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 under the PriorityMedicare (HMO-POS) plan. Diagnostic Procedures/Tests have a copay of $30, while Lab Services have no copay. Diagnostic Radiological Services have a minimum copay of $125, Therapeutic Radiological Services have a minimum copay of $20, and Outpatient X-Ray Services have a copay of $35.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare (HMO-POS) plan with no copay and no coinsurance, but 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 the PriorityMedicare (HMO-POS) plan, but the specific services, including Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services, are not covered. The plan has a copay for these services; however, the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay; for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The PriorityMedicare (HMO-POS) plan covers acupuncture with a $20 copay, up to 6 treatments per year. Other services, including over-the-counter items, meal benefits, and multiple other services, are not covered.
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