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PriorityMedicare Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Value (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Value (HMO-POS) in 2026, please refer to our full plan details page.
PriorityMedicare Value (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 Value (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 Value (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 Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.00. 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 a $100.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5100.00 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 Value (HMO-POS) plan features a low $100 annual drug deductible. For Tier 1 preferred generic drugs, you pay no copay for a 3-month supply at preferred pharmacies or through preferred mail order, while a 1-month supply starts at a $2 copay. Tier 2 generic drugs are also highly affordable, costing as little as a $10 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. Brand-name and specialty drugs are covered under coinsurance, with Tier 3 preferred brands requiring 22% coinsurance at preferred pharmacies and 25% at standard pharmacies. Tier 4 non-preferred drugs carry a 35% to 40% coinsurance depending on your pharmacy choice, while Tier 5 specialty drugs require a flat 31% coinsurance for a 1-month supply across all pharmacy types.
Additional Benefits
The PriorityMedicare Value (HMO-POS) plan offers robust healthcare coverage featuring no copay and no coinsurance for primary care visits, home health services, and covered preventive care. For specialized treatment, patients pay no copay to a $35 copay for specialists and a $15 copay for physical, occupational, and speech therapies. Inpatient hospital stays require a $325 daily copay for the first several days and no copay for subsequent days, while outpatient hospital services range from no copay up to a $325 copay. Emergency care is covered with a $130 copay that is waived upon admission, and urgent care has a $50 copay. Routine dental and hearing exams are available with no copay, while routine eye exams require a $35 copay with no copay for basic eyewear up to a $100 annual limit. Additionally, diagnostic lab services feature no copay, and durable medical equipment is covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Value (HMO-POS) covers inpatient acute and psychiatric hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $325 daily copay for days 1-7 and no copay for subsequent unlimited days, while psychiatric stays require a $325 daily copay for days 1-5 and no copay for days 6-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Value (HMO-POS) covers outpatient hospital services with a copay of $0 to $325 and observation services with a $130 copay, both with no coinsurance. Ambulatory surgical center services require a $35 copay with no coinsurance, outpatient substance abuse sessions have a $20 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by PriorityMedicare Value (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
Ambulance and transportation services under PriorityMedicare Value (HMO-POS) feature covered ground and air ambulance services with a $265 copayment and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PriorityMedicare Value (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 with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $50 to $265.
Primary Care See details
PriorityMedicare Value (HMO-POS) offers primary care and telehealth services with no copay and no coinsurance, while specialist and other professional visits require a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapy services have a $15 copay, and mental health, psychiatric, and opioid treatment services require a $20 copay with no coinsurance, though podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
PriorityMedicare Value (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered options like annual physical exams, fitness benefits, and health education. However, several sub-services are not covered, including medical nutrition therapy, weight management programs, and personal emergency response systems (PERS).
Hearing Services See details
PriorityMedicare Value (HMO-POS) covers hearing services with no copay and no coinsurance for routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $295.00 to $1,495.00 for up to two devices per year, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
PriorityMedicare Value (HMO-POS) covers vision services with a $35 copay and no coinsurance for annual routine eye exams and retinal imaging. Eyewear, including lenses, frames, and contact lenses, is covered with no copay, no coinsurance, and no deductible, up to a $100 annual maximum benefit.
Dental Services See details
Dental services are partially covered by PriorityMedicare Value (HMO-POS), with Medicare-covered dental services requiring a $0 to $325 copay and no coinsurance. Most covered preventive and comprehensive services have no copay and no coinsurance, though endodontics requires a 50% coinsurance with no copay, and other diagnostic, other preventive, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Value (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the PriorityMedicare Value (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Value (HMO-POS) covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and medical supplies, and no coinsurance to 20% coinsurance for prosthetic devices. While diabetic equipment has no copay and no coinsurance, this benefit is only partially covered as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare Value (HMO-POS) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests have a $10 copay, outpatient x-rays cost $35, and diagnostic and therapeutic radiological services require minimum copays of $225 and $25, respectively.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Value (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Value (HMO-POS) provides coverage for Cardiac Rehabilitation Services with no coinsurance, but only some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Value (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Value (HMO-POS) covers select other services, featuring annual wellness visits with no copay or coinsurance, up to six acupuncture treatments per year for a $20 copay and no coinsurance, and ambulance stabilization for a $265 copay and no coinsurance. Meal benefits and over-the-counter items are not covered under this plan.
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