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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 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 $69.00. 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:
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Drug Coverage
The PriorityMedicare Value (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while standard generic drugs have 25% coinsurance at either pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. This plan may also offer a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The PriorityMedicare Value (HMO-POS) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $325, depending on the service. It also covers primary care, specialist visits, and mental health services with copays between $0 and $35. Additional benefits include ambulance services with a $265 copay, emergency services with a $120 copay, and hearing and vision services. Dental services are covered, including oral exams and x-rays with no copay, and cleaning with no copay. The plan also covers home health services, dialysis services, and durable medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7, and no copay for days 8-90, with no coinsurance; additional days and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days and non-Medicare stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all 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, including individual and group sessions, have a $20 copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the PriorityMedicare Value (HMO-POS) plan. Ground and Air Ambulance Services have a $265 copay, and there is no coinsurance. 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 under the PriorityMedicare Value (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Transportation has a $265 copay. Worldwide Urgent Coverage has a $55 copay. There is 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, 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 are covered, including Medicare-covered preventive services with a doctor referral, annual physical exams, additional preventive services, health education, in-home safety assessments, and nutritional/dietary benefits. 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, Counseling Services, and Remote Access Technologies are not covered. The plan also covers Fitness Benefits, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with no copay, as well as fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $295 and $1495, but prescription hearing aids that are inner ear, outer ear, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The PriorityMedicare Value (HMO-POS) plan covers vision services, including eye exams with a $35 copay. Eyewear is covered with a combined maximum of $100 every year, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. Upgrades are not covered.
Dental Services See details
The PriorityMedicare Value (HMO-POS) plan covers dental services including oral exams with no copay, and dental x-rays and cleaning with no copay. Endodontics has a 50% coinsurance, and orthodontics has a maximum plan benefit of $2000.00 per year. Other services like maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Value (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
The PriorityMedicare Value (HMO-POS) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires authorization, but does not cover Durable Medical Equipment for use outside the home. Prosthetic Devices are covered with a coinsurance between 0% and 20%, and Medical Supplies are covered with a 20% coinsurance. Diabetic Equipment is covered, but the plan does not cover Diabetic Supplies or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by 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 minimum copay of $225, Therapeutic Radiological Services have a minimum copay of $25, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Value (HMO-POS) plan 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 by the PriorityMedicare Value (HMO-POS) plan, but the plan does not cover any of the sub-services. There is a copay for covered services, but the specific amount is not listed.
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. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the PriorityMedicare Value (HMO-POS) plan, acupuncture is covered with a $20 copay for up to 6 treatments per year, and over-the-counter items are covered with a maximum benefit of $25 every three months. Other services such as 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), and others are not covered.
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