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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 $43.00. 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 low $100 annual drug deductible. For Tier 1 preferred generic drugs, you will pay no copay for a 3-month supply through preferred pharmacies or preferred mail order. Tier 2 generic drugs start at a $10 copay for a 1-month supply, with no copay required for a 3-month supply filled via preferred mail order. Higher-tier medications under this plan are covered through coinsurance rather than flat copayments. Tier 3 preferred brand drugs require 22% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs require 35% to 40% coinsurance. Specialty drugs in Tier 5 carry a consistent 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 predictable cost-sharing, featuring no copay and no coinsurance for primary care visits, telehealth, and preventive services. For inpatient hospital stays, members pay a $325 copay for the first several days and no copay for subsequent days, while emergency room visits require a $130 copay that is waived if admitted. Most outpatient services and diagnostic labs require no coinsurance, though specialty care, therapies, and diagnostics carry low, fixed copayments. This plan also includes dental, vision, and hearing benefits, highlighted by no copays for routine hearing exams and most preventive dental care up to a $2,500 annual limit. While eyewear is covered up to $100 annually with no copay, prescription hearing aids require copays ranging from $295 to $1,495. For specialized needs, skilled nursing facility stays have no copay for the first 20 days, whereas durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
PriorityMedicare Value (HMO-POS) covers inpatient hospital services with no coinsurance, though prior authorization is required and some services like upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For acute stays, there is a $325 copay for days 1-7 and no copay for days 8-90, while psychiatric stays require a $325 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
PriorityMedicare Value (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services, a $130 copay per stay for observation services, and a $35 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 copay and no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
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 certain services under this 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. For transportation services, some services are covered, but transportation to plan-approved or any health-related locations is 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 with no coinsurance and waived 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) covers primary care and telehealth services with no copay and no coinsurance, while specialist and other health professional visits range from no copay to a $35 copay with no coinsurance. Physical, occupational, and speech therapies require a $15 copay, and mental health, psychiatric, and opioid treatments have a $20 copay, all with no coinsurance. Podiatry is not covered, and for chiropractic care, some services are covered but routine and other 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 all covered services. While benefits like annual physicals, kidney disease education, and fitness benefits are included, the plan does not cover personal emergency response systems, medical nutrition therapy, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, remote access technologies, home and bathroom safety devices, and counseling services.
Hearing Services See details
PriorityMedicare Value (HMO-POS) hearing services feature routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $295.00 to $1,495.00 for up to two aids yearly, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services covered by PriorityMedicare Value (HMO-POS) include one routine eye exam and one retinal imaging exam per year for a $35 copay and no coinsurance. Eyewear, including glasses and contacts, is covered with no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $100 annually.
Dental Services See details
PriorityMedicare Value (HMO-POS) provides partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental has a $0 to $325 copay (no coinsurance) and endodontics requires a 50% coinsurance with no copay. A $2,500 annual maximum benefit applies to select services, while other diagnostic services, other preventive 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. Part B insulin drugs require a $35 copay, while chemotherapy and other Part B drugs have no copay, with coinsurance for these drugs ranging from no coinsurance up to 20%.
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 durable medical equipment and medical supplies with no copay and 20% coinsurance, while prosthetic devices have no copay and 0% to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but 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. Lab services have no copay, diagnostic tests have a $10 copay, outpatient X-rays have a $35 copay, and therapeutic and diagnostic radiological services require minimum copays of $25 and $225, respectively.
Home Health Services See details
PriorityMedicare Value (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Value (HMO-POS) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Value (HMO-POS) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
PriorityMedicare Value (HMO-POS) covers acupuncture with a $20 copay and no coinsurance for up to 6 treatments per year, ambulance stabilization with a $265 copay and no coinsurance, and annual wellness visits with no copay and no coinsurance. Over-the-counter items and meal benefits are not covered.
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