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PriorityMedicare Merit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Merit (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Merit (PPO) in 2025, please refer to our full plan details page.
PriorityMedicare Merit (PPO) is a PPO 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 Merit (PPO) 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 Merit (PPO).
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 Merit (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $104.00. 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 combined Maximum Out-Of-Pocket cost of $4100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $4100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Merit (PPO) 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 pharmacy you use. For preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy, and $15 at a standard pharmacy, with the same copays for mail order. Standard generic drugs have a 25% coinsurance, while preferred brand drugs have a 50% coinsurance. For non-preferred drugs, the coinsurance is 33%. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers a range of benefits, including inpatient hospital stays with copays ranging from $0 to $350 depending on the service and length of stay, and outpatient services with varying copays. The plan also covers emergency services, primary care with copays between $20 and $45, and preventive services. Additional benefits include hearing services, vision services, and dental services with varying copays and coverage limits. The plan also covers home infusion, dialysis, and medical equipment with coinsurance requirements. Diagnostic and radiological services, home health, and skilled nursing facility services are covered with copays or coinsurance.
Inpatient Hospital See details
The PriorityMedicare Merit (PPO) plan covers inpatient hospital services, including acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-6, and no copay for days 7-90, and for days 1-60. For Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90, and for days 6-60. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
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 $225, Observation Services have a $120 copay, Ambulatory Surgical Center (ASC) Services have a $225 copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by PriorityMedicare Merit (PPO) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The PriorityMedicare Merit (PPO) plan covers ambulance services with a $270 copay for both ground and air ambulance services, with no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered under the PriorityMedicare Merit (PPO) plan, with a $120 copay, and no coinsurance. Urgently Needed Services have a $55 copay and no coinsurance, while Worldwide Emergency Services have varying copays depending on the specific service.
Primary Care See details
The PriorityMedicare Merit (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and specialist services with a copay between $0 and $45. Mental health and psychiatric services have a $20 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $35 copay. The plan also covers additional telehealth benefits, and opioid treatment program services with a $20 copay.
Preventive Services See details
Preventive services, including services not usually covered by Medicare plans, are covered by the PriorityMedicare Merit (PPO) plan. Some additional services, such as Personal Emergency Response System (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), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids, which are both covered. Prescription hearing aids are covered, with a copay between $295.00 and $1495.00. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision Services include eye exams with a $45 copay, and eyewear with a combined maximum of $100 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams with no copay, and dental x-rays, and prophylaxis (cleaning) with no copay. Fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and implant services are offered as optional, supplemental benefits; contact the plan for details. 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. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Merit (PPO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies are covered, with a 20% coinsurance for DME and a 0-20% coinsurance for Prosthetic Devices. Medical Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the PriorityMedicare Merit (PPO) plan. Diagnostic Procedures/Tests have a $20 copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at least $125, Therapeutic Radiological Services have a copay of at least $30, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Merit (PPO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PriorityMedicare Merit (PPO) plan. None of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Merit (PPO) plan. You will have no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
The PriorityMedicare Merit (PPO) plan covers acupuncture with a $20 copay for up to 6 treatments per year. Other services such as over-the-counter items, meal benefits, and several other services are not covered.
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