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PriorityMedicare Smart Savings (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Smart Savings (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Smart Savings (HMO-POS) in 2026, please refer to our full plan details page.
PriorityMedicare Smart Savings (HMO-POS) is a HMO-POS plan offered by Corewell Health available for enrollment in 2026 to people living in lower peninsula MI counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that PriorityMedicare Smart Savings (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 Smart Savings (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 Smart Savings (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $100.00. You must continue to pay paying your reduced 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 $500.00 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 $9250.00 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 Smart Savings (HMO-POS) plan has an annual prescription drug deductible of $500. For Tier 1 preferred generic drugs, you will pay no copay for a 3-month supply at preferred pharmacies or preferred mail order, while a 1-month supply costs just a $1.00 copay. Tier 2 generic drugs are also highly affordable, starting at an $8.00 copay for a 1-month supply at preferred pharmacies and offering no copay for a 3-month supply filled through preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a $42.00 copay for a 1-month supply at preferred pharmacies. Tier 4 non-preferred drugs carry a 25% coinsurance, and Tier 5 specialty drugs require a 27% coinsurance for a 1-month supply. Using standard pharmacies or standard mail order is also an option, though these choices generally result in higher copays for your prescriptions.
Additional Benefits
The PriorityMedicare Smart Savings (HMO-POS) plan offers robust coverage for core medical services with clear cost-sharing and no coinsurance for most care. You will pay no copay for primary care visits, telehealth, and preventive services, while specialist visits range from a $15 to $55 copay. Inpatient hospital stays require a $380 daily copay for days one through seven with no copay thereafter, and emergency room visits have a $115 copay. Ancillary benefits include routine dental and hearing exams with no copay, while routine eye exams require a $55 copay and eyewear is covered up to a $100 annual maximum. Home health services feature no copay, whereas dialysis and durable medical equipment require no copay and a 20% coinsurance. Skilled nursing facility care is also covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
PriorityMedicare Smart Savings (HMO-POS) covers inpatient acute hospital stays requiring prior authorization with no coinsurance and a $380 daily copay for days 1 to 7, and no copay thereafter, excluding upgrades and non-Medicare-covered stays. Psychiatric inpatient stays also require prior authorization and have no coinsurance, featuring a $275 daily copay for days 1 to 6 and no copay for days 7 to 90, though additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Smart Savings (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $450 copay and observation services with a $115 copay per stay. Ambulatory surgical center services require a $55 copay and no coinsurance, outpatient substance abuse sessions have a $20 copay and no coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
PriorityMedicare Smart Savings (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PriorityMedicare Smart Savings (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance, requiring prior authorization. For transportation, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by PriorityMedicare Smart Savings (HMO-POS) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays of $115, $40, and $325 respectively.
Primary Care See details
Primary Care benefits under PriorityMedicare Smart Savings (HMO-POS) are partially covered, as podiatry services are not covered. Covered services feature no coinsurance, with copays ranging from no copay for primary care and telehealth visits to copays between $15 and $55 for specialists, chiropractic, therapy, and mental health services.
Preventive Services See details
PriorityMedicare Smart Savings (HMO-POS) offers coverage for preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. While additional benefits like fitness programs and health education are included, this benefit is only partially covered as it excludes services such as weight management, counseling, and personal emergency response systems.
Hearing Services See details
PriorityMedicare Smart Savings (HMO-POS) covers hearing services with no copay and no coinsurance for routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $295.00 to $1,495.00 for up to two aids per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
PriorityMedicare Smart Savings (HMO-POS) covers annual routine eye exams and retinal imaging with a $55 copay, no coinsurance, and no deductible. Eyewear, including contacts and eyeglasses, is also covered with no copay, no coinsurance, and no deductible, up to a $100 annual combined maximum.
Dental Services See details
PriorityMedicare Smart Savings (HMO-POS) provides partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services have a copay of $0 to $450 and no coinsurance. Other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Smart Savings (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the PriorityMedicare Smart Savings (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Smart Savings (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 covered with no copay and no coinsurance, but this benefit is only partially covered as diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PriorityMedicare Smart Savings (HMO-POS) with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures have a $30 copay, outpatient x-rays and therapeutic radiology have a $45 copay, and diagnostic radiological services require a minimum $300 copay.
Home Health Services See details
Home health services are covered under the PriorityMedicare Smart Savings (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by PriorityMedicare Smart Savings (HMO-POS), as all sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD)—are not covered, carrying a $10 copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by PriorityMedicare Smart Savings (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Smart Savings (HMO-POS) provides partial coverage for other services, featuring an annual wellness visit with no copay and no coinsurance, acupuncture limited to six treatments per year for a $20 copay and no coinsurance, and ambulance stabilization for a $325 copay and no coinsurance. Over-the-counter items and meal benefits are not covered under this plan.
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