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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 2026, 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 out of 5 stars in 2026.
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 $129.00. 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 $4200.00 (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 $4200.00 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 3-month supply through preferred pharmacies or preferred mail order, compared to a $21 copay at standard pharmacies. Tier 2 generic drugs cost a $10 copay for a 1-month supply at preferred locations, or no copay for a 3-month supply when using preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a 25% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs carry a 32% coinsurance at preferred locations compared to 37% at standard locations, while Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply. Utilizing preferred pharmacies and preferred mail-order services is the most effective way to minimize your out-of-pocket prescription costs under this plan.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers robust healthcare coverage with no coinsurance for many core services, focusing instead on predictable copays. You will pay no copay for primary care visits, home health services, and covered preventive care, while specialist visits range from no copay to a $45 copay. Inpatient hospital stays require a $275 daily copay for the first six days with no copay thereafter, while emergency room visits carry a $130 copay. Specialty care benefits under this plan include preventive and comprehensive dental services with no copay or coinsurance, alongside routine hearing exams at no cost. Prescription hearing aids require a copay ranging from $295 to $1,495, and routine eye exams carry a $45 copay with a $100 annual allowance for eyewear. For durable medical equipment and dialysis, you will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Merit (PPO) covers inpatient acute hospital stays with no coinsurance and a $275 daily copay for days 1 through 6, followed by no copay for remaining days, though upgrades and non-Medicare stays are not covered. Inpatient psychiatric care is also covered with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90, with additional psychiatric days not covered.
Outpatient Services See details
PriorityMedicare Merit (PPO) covers outpatient services with no coinsurance, offering outpatient blood services with no copay and ambulatory surgical center services with a $45 copay. Outpatient hospital services carry a copay of $0 to $225, observation services require a $130 copay per stay, and individual or group substance abuse sessions have a $20 copay.
Partial Hospitalization See details
PriorityMedicare Merit (PPO) covers partial hospitalization services with a $55 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by PriorityMedicare Merit (PPO), which offers Medicare-covered ground and air ambulance services with a $270 copay and no coinsurance. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
PriorityMedicare Merit (PPO) covers emergency services with a $130 copay and urgently needed services with a $55 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $55 to $270.
Primary Care See details
PriorityMedicare Merit (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $0 to $45 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 copay and mental health services have a $20 copay with no coinsurance, but podiatry is not covered and only some chiropractic services are covered, as routine and other chiropractic services are excluded.
Preventive Services See details
PriorityMedicare Merit (PPO) offers partially covered preventive services with no copay and no coinsurance for covered care such as annual physical exams, health education, and fitness benefits. Excluded sub-services that are not covered include 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, smoking cessation sessions, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
PriorityMedicare Merit (PPO) partially covers hearing services, featuring routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copayment ranging from $295.00 to $1,495.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Merit (PPO) covers vision services, featuring one routine eye exam and one retinal imaging exam annually for a $45 copay and no coinsurance. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a combined maximum benefit of $100 every year.
Dental Services See details
PriorityMedicare Merit (PPO) offers partially covered dental services, featuring no copay and no coinsurance for covered preventive and comprehensive services like oral exams, cleanings, x-rays, periodontics, and oral surgery, while Medicare-covered dental services require a $0 to $225 copay and no coinsurance. Other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Merit (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other drugs are covered with no copay and range from no coinsurance to 20% coinsurance, while covered insulin requires a $35 copay with the same coinsurance range.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Merit (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Merit (PPO) covers durable medical equipment and medical supplies with no copay and 20% coinsurance (0% to 20% coinsurance for prosthetic devices), with prior authorization required. Diabetic equipment is covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PriorityMedicare Merit (PPO) with no coinsurance, although prior authorization is required. There is no copay for lab services, while diagnostic procedures cost $20, outpatient X-rays cost $35, and therapeutic and diagnostic radiological services require copays starting at $30 and $125, respectively.
Home Health Services See details
Home health services are covered by PriorityMedicare Merit (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Merit (PPO) covers Cardiac Rehabilitation Services with no coinsurance, although in practice only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Merit (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other Services are partially covered by PriorityMedicare Merit (PPO), featuring an Annual Wellness Visit with no copay and no coinsurance, acupuncture for a $20 copay and no coinsurance up to 6 treatments annually, and ambulance stabilization for a $270 copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered.
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