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. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, if you use a preferred pharmacy, you will pay a $10 copay for preferred generic drugs, or 25% coinsurance for standard generic drugs. After your total drug costs reach $2,000, you enter the next coverage phase. Once your yearly out-of-pocket drug costs reach $2,000, you pay nothing for covered drugs.
Additional Benefits
The PriorityMedicare Value (HMO-POS) plan offers a wide range of benefits with varying costs. It includes coverage for inpatient and outpatient hospital services, emergency services, and ambulance services, with copays ranging from $0 to $325. Additionally, the plan covers primary care, preventive services, hearing, vision, and dental services. This plan provides coverage for home health services, skilled nursing facilities, and other services such as acupuncture. You can expect a copay for many services, including doctor visits, hearing aids, and vision exams. The plan also covers medical equipment, diagnostic services, and dialysis services with coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-7, and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you 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, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered; additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $325, Observation Services have a $120 copay, Ambulatory Surgical Center Services have a $325 copay, and Outpatient Substance Abuse Individual and Group Sessions have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Value (HMO-POS) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PriorityMedicare Value (HMO-POS) plan. Ground and air ambulance services have a $265 copay, with no coinsurance, but 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.
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 with a doctor referral, annual physical exams, health education, in-home safety assessments, post-discharge in-home medication reconciliation, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Home and bathroom safety devices and modifications are covered up to $25 every three months. However, Personal Emergency Response Systems (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, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered for one visit every year. Prescription hearing aids are covered with a copay between $295 and $1495 for two hearing aids every year, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are also 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 per year, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. Eyeglass upgrades are not covered.
Dental Services See details
Dental services are covered, with specific services like oral exams, dental x-rays, and cleanings covered. Endodontics have a 50% coinsurance, while Maxillofacial Prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. 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 by 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 Prosthetic Devices with a coinsurance between 0% and 20%, with no copay for either. 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, including Diagnostic Procedures/Tests with a $10 copay, Lab Services with no copay, Diagnostic Radiological Services with a $225 copay, Therapeutic Radiological Services with a $25 copay, and Outpatient X-Ray Services with a $35 copay. Prior authorization is required for these services.
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. 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for covered 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. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the PriorityMedicare Value (HMO-POS) plan, acupuncture has a $20 copay for up to 6 treatments per year, and over-the-counter items are covered up to $25 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others 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