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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 $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 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 an annual drug deductible of $100. For Tier 1 preferred generic drugs, you will pay a $2 copay for a 1-month supply at preferred pharmacies and mail-order services, or no copay for a 3-month supply. Tier 2 generic drugs carry a $10 copay for a 1-month supply at preferred locations, while standard pharmacies and mail-order services charge a $15 copay. For higher-tier medications, costs are structured as a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance at preferred pharmacies and a 25% coinsurance at standard pharmacies. Tier 4 non-preferred drugs carry a 35% to 40% coinsurance, while Tier 5 specialty drugs require a 31% coinsurance for a 1-month supply across all pharmacy and mail-order options.
Additional Benefits
The PriorityMedicare Value (HMO-POS) plan offers comprehensive medical coverage with no coinsurance for many key services, including inpatient hospital stays, outpatient care, and emergency services. Members enjoy no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care, while specialist visits require a copay of up to $35. Emergency room visits carry a $130 copay, and inpatient hospital stays require a daily copay of $325 for the first several days, after which there is no copay. For extra wellness benefits, the plan features dental coverage with no copay or coinsurance for routine services up to a $2,500 annual limit, alongside no copay for annual routine hearing exams. Vision care includes routine exams for a $35 copay and eyewear coverage up to $100 with no copay. Additionally, skilled nursing facility care is available with no copay for the first 20 days, and home health services are covered with no copay or coinsurance.
Inpatient Hospital See details
PriorityMedicare Value (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays incur a $325 daily copay for days 1 through 7 and no copay for additional days, while psychiatric stays require a $325 daily copay for days 1 through 5 and no copay for days 6 through 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by PriorityMedicare Value (HMO-POS) feature no coinsurance across all categories, with outpatient hospital copays ranging from $0 to $325 and observation services costing a $130 copay per stay. Ambulatory surgical center services require a $35 copay with no coinsurance, outpatient substance abuse sessions carry a $20 copay with no coinsurance, and outpatient blood services are available with no copay and no coinsurance.
Partial Hospitalization See details
PriorityMedicare Value (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
PriorityMedicare Value (HMO-POS) covers ground and air ambulance services with a $265 copay and no coinsurance, though prior authorization is required and the copay is not waived upon hospital admission. While transportation benefits are technically offered, only some services are covered, and trips to plan-approved or other health-related locations are not covered.
Emergency Services See details
PriorityMedicare Value (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $265, respectively.
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 with no coinsurance. Physical, occupational, and speech therapies have a $15 copay, mental health and psychiatric sessions carry a $20 copay, and all of these covered services feature no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under PriorityMedicare Value (HMO-POS) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered, but do not cover personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, extra tobacco cessation, remote access technologies, home safety modifications, or counseling.
Hearing Services See details
PriorityMedicare Value (HMO-POS) offers hearing services with no copay and no coinsurance for one annual routine hearing exam and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay between $295.00 and $1,495.00 for up to two devices per year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services covered under PriorityMedicare Value (HMO-POS) include one routine eye exam and one retinal imaging service per year for a $35 copay and no coinsurance, with no deductible. Eyewear, including glasses and contact lenses, is also covered with no copay and no coinsurance up to a $100 annual maximum.
Dental Services See details
PriorityMedicare Value (HMO-POS) offers partially covered dental services with a $2,500 annual maximum, featuring no copay and no coinsurance for routine exams, cleanings, x-rays, and most restorative services. Medicare-covered dental has a $0 to $325 copay with no coinsurance, 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
Home infusion bundled services are covered under PriorityMedicare Value (HMO-POS) with no copay, although prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
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 or 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. Members pay no copay for lab services, a $10 copay for diagnostic procedures and tests, a $35 copay for outpatient X-rays, a $25 copay for therapeutic radiological services, and a $225 copay for diagnostic radiological services.
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 cardiac rehabilitation services with no coinsurance, though some services are covered and others are not. Specifically, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Value (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Value (HMO-POS) partially covers other services, including acupuncture for a $20 copay and no coinsurance (limited to 6 treatments per year), ambulance stabilization for a $265 copay and no coinsurance, and annual wellness visits with no copay or coinsurance. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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