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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 $80.00. 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 $100 prescription drug deductible and offers affordable copays for generic medications. For Tier 1 preferred generic drugs, you will pay no copay for a 3-month supply filled at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $7 copay for a 1-month supply. Tier 2 generic drugs also feature no copay for a 3-month supply via preferred mail order, compared to a $15 copay for a 1-month supply at standard pharmacies. For brand-name and specialty drugs, your costs are determined by coinsurance rather than flat copays. Tier 3 preferred brands require 22% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs range from 35% to 40% coinsurance. Tier 5 specialty medications require 31% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The PriorityMedicare Value (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, while specialist visits require a copay of up to $35. For inpatient hospital stays, members pay no coinsurance but are responsible for a $325 daily copay for the first several days before transitioning to no copay. Emergency room visits carry a $130 copay, and skilled nursing facility stays require no copay for the first 20 days followed by a $218 daily copay. Dental benefits offer no copay or coinsurance for most preventive and comprehensive services up to a $2,500 annual limit, while routine eye exams carry a $35 copay. Routine hearing exams are available with no copay, though prescription hearing aids require a copay ranging from $295 to $1,495. Additionally, home health services require no copay or coinsurance, while durable medical equipment features a 20% coinsurance with no copay.
Inpatient Hospital See details
PriorityMedicare Value (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 to 7 for acute stays (with no copay for days 8 and beyond) and a $325 daily copay for days 1 to 5 for psychiatric stays (with no copay for days 6 to 90). Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare Value (HMO-POS) with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services and a $35 copay for ambulatory surgical center services. Additionally, members pay a $130 copay per stay for observation services, a $20 copay for outpatient substance abuse sessions, and no copay for outpatient blood services.
Partial Hospitalization See details
PriorityMedicare Value (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PriorityMedicare Value (HMO-POS) covers ground and air ambulance services with a $265 copay and no coinsurance, which require prior authorization. Transportation services 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 admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered with no coinsurance and copays of $50 for urgent care, $130 for emergency care, and $265 for emergency transportation.
Primary Care See details
PriorityMedicare Value (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $35 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services carry copays between $15 and $20 with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under PriorityMedicare Value (HMO-POS) with no copay and no coinsurance for covered services, which include annual physical exams, kidney disease education, and select fitness benefits. However, several additional services are not covered, including personal emergency response systems (PERS), medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by PriorityMedicare Value (HMO-POS), featuring one routine hearing exam and unlimited fitting evaluations per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $295 to $1,495, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
PriorityMedicare Value (HMO-POS) covers annual routine eye exams and retinal imaging with a $35 copay and no coinsurance. Eyewear, including contacts, lenses, and frames, is covered with no copay or coinsurance up to a $100 annual maximum benefit.
Dental Services See details
PriorityMedicare Value (HMO-POS) dental services are partially covered, featuring no copay and no coinsurance for most preventive and comprehensive benefits up to a $2,500 yearly maximum, though endodontics requires a 50% coinsurance and Medicare-covered services have a $0 to $325 copay with no coinsurance. Other diagnostic dental services, other preventive dental services, 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, though prior authorization is required. Associated Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance with no copay.
Dialysis Services See details
Dialysis Services are covered by PriorityMedicare Value (HMO-POS) 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 0% to 20% coinsurance for prosthetic devices. Diabetic equipment is partially covered with no copay and no coinsurance, though 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. Under this plan, there is no copay for lab services, a $10 copay for diagnostic procedures and tests, a $35 copay for outpatient x-rays, and minimum copays of $25 for therapeutic radiological services and $225 for diagnostic radiological services.
Home Health Services See details
PriorityMedicare Value (HMO-POS) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Value (HMO-POS) covers some Cardiac Rehabilitation Services with no coinsurance and a $10 copay, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Value (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services covered by PriorityMedicare Value (HMO-POS) include acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, ambulance stabilization/non-transport for a $265 copay and no coinsurance, and an annual wellness visit with no copay or coinsurance. Supplemental benefits such as over-the-counter items and meal benefits are not covered under this plan.
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