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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 $55.00. 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. The plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. After 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 a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services have copays depending on the specific service. Emergency, primary care, and specialist services are covered with copays, and preventive services are also included. The plan provides coverage for hearing and vision services, with copays for eye exams and hearing aids. Dental services, home infusion, and dialysis are covered with copays or coinsurance. Medical equipment and diagnostic services are covered, but some may have coinsurance. Home health services and skilled nursing facilities are also covered, but may require prior authorization or have copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $225 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $175, Observation Services with a $120 copay, Ambulatory Surgical Center (ASC) Services with a $175 copay, Outpatient Substance Abuse Services with a $20 copay for both Individual and Group Sessions, and Outpatient Blood Services with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this service.
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, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $210 copay.
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, specialist services with a copay between $0 and $40, mental health and psychiatric individual and group sessions with a $20 copay, physical therapy and speech-language pathology services with a $35 copay, telehealth benefits, and opioid treatment program services with a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The PriorityMedicare (HMO-POS) plan covers various preventive services, including Medicare-covered preventive services with a doctor referral, 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, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and kidney disease education services. The plan does not cover personal emergency response systems, medical nutrition therapy, 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 counseling services.
Hearing Services See details
Hearing services include hearing exams with no copay, and routine hearing exams with one visit per year. Prescription hearing aids are covered with a copay between $295 and $1495 for all types of hearing aids, and two visits per year; however, inner ear, outer ear, and over the ear hearing aids are not covered. Fitting/evaluation for hearing aids is covered. 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, and routine eye exams and other eye exam services with no copay. Eyewear is covered with a combined maximum benefit of $100 per year, and the plan also covers contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Upgrades are not covered.
Dental Services See details
The PriorityMedicare (HMO-POS) plan covers dental services, including oral exams with a copay of $0-$175, dental x-rays, prophylaxis (cleaning), and oral and maxillofacial surgery. Some services are covered as optional supplemental benefits, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, you pay a $35 copay, with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you pay coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the PriorityMedicare (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the PriorityMedicare (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while durable medical equipment for use outside the home is not covered. Prosthetic Devices have a 0-20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Equipment has limited coverage to specified manufacturers, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered by this plan. Diagnostic Procedures/Tests have a copay of $30, 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 PriorityMedicare (HMO-POS) 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, but the plan does not cover any of the sub-services. There is a copay for these services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PriorityMedicare (HMO-POS), 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 and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include acupuncture, with a $20 copay, and other services such as ambulance stabilization/non-transport with a $210 copay. Over-the-counter items, meal benefits, 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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