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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 $118.00. 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 an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. 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 Part D covered drugs.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay of $275 for days 1-6, and $350 for psychiatric stays for days 1-5, with no copays for subsequent days. Outpatient services have copays ranging from $0 to $225, while primary care visits and specialist visits have copays between $0 and $45. Preventive services are covered, including routine hearing exams with no copay, and vision exams with a $45 copay. Dental, home infusion, dialysis, medical equipment, and diagnostic services are also covered with varying copays and coinsurance. Emergency, ambulance, and skilled nursing facility services are also covered with varying cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by PriorityMedicare Merit (PPO). For Inpatient Hospital-Acute, you pay a $275 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $350 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 Stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are 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 $225, observation services have a $120 copay, and ambulatory surgical center services have a $225 copay. Individual and group sessions for outpatient substance abuse have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Merit (PPO) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PriorityMedicare Merit (PPO) plan. Ground and air ambulance services have a copay of $270, with no coinsurance, while 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 by the PriorityMedicare Merit (PPO) plan. Emergency Services have a $120 copay, while Urgently Needed Services have a $55 copay; both have no coinsurance. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $270 copay; all have no coinsurance.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, Occupational Therapy Services have a $35 copay, Physician Specialist Services have a copay between $0 and $45, and Physical Therapy and Speech-Language Pathology Services have a $35 copay. Individual and Group Sessions for Mental Health Specialty Services, as well as Individual and Group Sessions for Psychiatric Services, have a $20 copay. Other Health Care Professional services have a copay between $0 and $45, and Opioid Treatment Program Services have a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The PriorityMedicare Merit (PPO) plan covers preventive services including Medicare-covered zero dollar preventive services, annual physical exams, health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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, 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 a fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $295 and $1495, while inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision Services includes eye exams with a $45 copay, and eyewear with a combined maximum plan benefit coverage of $100 every year for both in-network and out-of-network services; however, upgrades are not covered. You are allowed one routine eye exam and one other eye exam service per year.
Dental Services See details
The PriorityMedicare Merit (PPO) plan covers dental services, including oral exams with a copay of $0-$225, dental x-rays, prophylaxis (cleaning), and oral and maxillofacial surgery. Other dental services, such as fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), and implant services, are offered as optional, supplemental benefits. The plan does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required, including Part B insulin drugs with a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the PriorityMedicare Merit (PPO) plan. The coinsurance for Dialysis Services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) requiring prior authorization and a 20% coinsurance, while DME for use outside the home is not covered. Prosthetic Devices have a coinsurance of 0% to 20%, and Medical Supplies have a 20% coinsurance; however, Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a $20 copay, 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 under the PriorityMedicare Merit (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the PriorityMedicare Merit (PPO) plan, but require prior authorization. You will have no copay for days 1-20, but will have a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
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, EPSDT services, and more are not covered.
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