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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 $110.00. 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 coverage begins immediately. For Tier 1 preferred generics, you pay no copay for a three-month supply through preferred pharmacies or preferred mail order, while standard pharmacies charge up to an $18 copay. Tier 2 generics cost as little as an $8 copay for a one-month supply at preferred pharmacies, with no copay for a three-month supply when using preferred mail order. For brand-name and specialty medications, your costs transition to coinsurance. Tier 3 preferred brands require a 25% coinsurance across all pharmacy options, while Tier 4 non-preferred drugs range from 33% to 38% coinsurance depending on your choice of preferred or standard services. Tier 5 specialty drugs incur a flat 33% coinsurance for a one-month supply at both preferred and standard locations.
Additional Benefits
PriorityMedicare (HMO-POS) offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, preventive care, and home health services. For inpatient hospital stays, members pay a $225 daily copay for days 1 through 6 and no copay for days 7 through 90. Specialist visits are also highly accessible, requiring a copay ranging from no copay to $40 with no coinsurance. Essential supplemental perks include routine vision and hearing exams, as well as preventive dental care, all with no copay. Prescription hearing aids require a copay between $295 and $1,495, while eyewear is covered up to a $100 annual limit. For medical equipment and Part B drugs, members can expect up to a 20% coinsurance, though diabetic equipment is covered with no copay and no coinsurance.
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 acute days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare (HMO-POS) with no coinsurance, featuring copays ranging from $0 to $175 for outpatient hospital services and a $130 copay per stay for observation services. Additionally, 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
Partial hospitalization services are covered by PriorityMedicare (HMO-POS) 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 per service and no coinsurance, though prior authorization is required. While transportation services are listed as covered, routine transportation to plan-approved or other health-related locations is not covered in practice.
Emergency Services See details
PriorityMedicare (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and fees 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) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits cost $0 to $40 with no coinsurance. Physical, occupational, and speech therapy require a $35 copay, mental health and psychiatric sessions have a $20 copay, and podiatry and chiropractic services are not covered.
Preventive Services See details
PriorityMedicare (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select additional benefits like fitness and nutritional counseling. These additional benefits are only partially covered, with services such as medical nutrition therapy, weight management programs, personal emergency response systems (PERS), and alternative therapies excluded.
Hearing Services See details
PriorityMedicare (HMO-POS) covers hearing services, including one annual routine hearing exam with no copay and no coinsurance, as well as unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $295.00 and $1,495.00, though 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 coinsurance or deductibles, offering annual routine eye exams and retinal imaging with no copay, and Medicare-covered eye exams for a $40 copay. Eyewear, including contacts and eyeglasses, is also covered with no copay or coinsurance up to a combined maximum of $100 per year.
Dental Services See details
PriorityMedicare (HMO-POS) partially covers dental services, offering preventive care, periodontics, and oral surgery with no copay and no coinsurance, while Medicare-covered dental services require a $0 to $175 copay and no coinsurance. Other diagnostic services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under PriorityMedicare (HMO-POS) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by PriorityMedicare (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare (HMO-POS) partially covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and medical supplies, and 0% to 20% coinsurance for prosthetics. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare (HMO-POS) covers diagnostic and radiological services with no coinsurance, although 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 copays starting at $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 offered by PriorityMedicare (HMO-POS) with no coinsurance, but only some services are covered as 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 and no prior three-day inpatient hospital stay requirement, though prior authorization is required. 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 period are not covered.
Other Services See details
PriorityMedicare (HMO-POS) partially covers other services, offering acupuncture for a $20 copay (limited to 6 treatments per year), ambulance stabilization for a $210 copay, and annual wellness visits with no copay, all with no coinsurance. Over-the-counter items, meal benefits, and Dual Eligible SNP services are not covered.
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