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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 $44.00. 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 used. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, 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 range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $325. Primary care, including specialist visits and mental health services, have copays, and preventive services are covered. The plan includes coverage for hearing, vision, and dental services, with copays for exams and varying cost-sharing for hearing aids and dental procedures. Emergency, ambulance, and home health services are covered, and the plan also covers medical equipment, diagnostic services, and skilled nursing facility stays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7, and no copay for days 8-90, while 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 with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, along with additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $325, observation services have a $120 copay, ambulatory surgical center services have a $325 copay, individual and group outpatient substance abuse sessions have a copay between $20 and $20, and outpatient blood services have a waived three-pint deductible.
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 by PriorityMedicare Value (HMO-POS). Ground and Air Ambulance services each have a $265 copay, with no coinsurance; however, 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 have a $120 copay, and Urgently Needed Services have a $55 copay. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $265 copay. All of these services have no coinsurance.
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, and physician specialist services with a copay between $0 and $35. Mental health specialty services, including individual and group sessions, have a $20 copay. Physical therapy and speech-language pathology services have a $15 copay, and opioid treatment program services have a $20 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services with a required doctor referral and additional preventive services. The plan also covers Health Education, In-Home Safety Assessments, Post discharge In-Home Medication Reconciliation, Nutritional/Dietary Benefits, Fitness Benefits, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, while Personal Emergency Response Systems, Medical Nutrition Therapy, Re-admission Prevention, Wigs for Hair Loss, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Counseling Services are not covered. Home and Bathroom Safety Devices and Modifications have a maximum benefit coverage amount of $25 every three months.
Hearing Services See details
Hearing exams are covered with no copay, with one routine hearing exam covered per year, and fitting/evaluation for hearing aids are covered. Prescription hearing aids are covered with a copay between $295 and $1495, with two hearing aids covered per year, but inner ear, outer ear, and over the ear hearing aids are not covered, 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 benefit of $100 per year. The plan also covers contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, but upgrades are not covered.
Dental Services See details
The PriorityMedicare Value (HMO-POS) plan covers dental services, including oral exams, dental X-rays, cleanings, and more. Oral exams and cleanings have no copay, while dental X-rays are covered once per year, and endodontics has a 50% coinsurance, and orthodontics has a $2,000 maximum plan benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PriorityMedicare Value (HMO-POS) plan. For Medicare Part B Insulin Drugs, there is a $35 copay with 0-20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Value (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the PriorityMedicare Value (HMO-POS) plan, with a 20% coinsurance for Durable Medical Equipment (DME). Prosthetic devices have a 0-20% coinsurance, while medical supplies have a 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The PriorityMedicare Value (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a $10 copay, Lab Services have no copay, Diagnostic Radiological Services have a $225 copay, Therapeutic Radiological Services have a $25 copay, 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 there is no information about the cost sharing such as the copay or coinsurance. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Value (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
The PriorityMedicare Value (HMO-POS) plan covers acupuncture with a $20 copay for up to 6 treatments per year, and also covers over-the-counter items with a maximum benefit of $25 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several others are not covered.
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