A non-government entity
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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 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:
Sign up for PriorityMedicare Value (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PriorityMedicare Value (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium is $17.60.
Additional Benefits
The PriorityMedicare Value (HMO-POS) plan offers a wide range of benefits, including inpatient hospital stays with a $325 copay, outpatient services, and partial hospitalization with a $55 copay. Emergency services, both domestic and worldwide, are covered with copays ranging from $55 to $265. Primary care, hearing, vision, and dental services are also included, with varying copays and coverage limits. Preventive services and home health services are available with no copay. The plan also covers durable medical equipment and diagnostic services with varying copays or coinsurance. Additionally, there are benefits for skilled nursing facilities, dialysis, and home infusion services. However, some services like cardiac rehabilitation, certain dental and vision upgrades, and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $325, observation services with a $120 copay, and ambulatory surgical center services with a $325 copay. Outpatient substance abuse services include individual and group sessions, both with a copay between $20 and $20, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this benefit.
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 each have a copay of $265, and there is no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency services are covered under the PriorityMedicare Value (HMO-POS) plan, with a $120 copay and no coinsurance. Urgently needed services have a $55 copay and no coinsurance. Worldwide Emergency Services are also covered, with a $120 copay for Worldwide Emergency Coverage, a $55 copay for Worldwide Urgent Coverage, and a $265 copay for Worldwide Emergency Transportation, with no coinsurance for any of these services.
Primary Care See details
The PriorityMedicare Value (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a copay between $0 and $35, mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services with a $20 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services, all with no copay. Other services such as Personal Emergency Response System (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, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, with routine hearing exams covered once per year and fitting/evaluation for hearing aids also covered. Prescription hearing aids (all types) are covered with a copay between $295 and $1495, up to 2 per year, while prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $35 copay and eyewear, with a combined maximum of $100 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a copay ranging from $0 to $325 depending on the service. Oral exams, dental x-rays, prophylaxis (cleaning), endodontics, periodontics, and oral and maxillofacial surgery are covered, but maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by PriorityMedicare Value (HMO-POS), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Value (HMO-POS) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetic Devices with a 0-20% coinsurance and no copay, and Medical Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, 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 Value (HMO-POS) plan. Diagnostic Procedures/Tests have a copay of $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a copay of at most $25, and Outpatient X-Ray Services have a copay of $35.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Value (HMO-POS) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PriorityMedicare Value (HMO-POS) plan. While the plan covers some cardiac rehabilitation services, none of the listed sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Value (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, "Other 1" services, and "Other 2" services. Acupuncture has a $20 copay per visit, and is limited to 6 treatments per year. OTC items are covered up to $25 every three months, and "Other 1" services have a $265 copay. "Other 2" services cover annual wellness visits. Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved