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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 $106.00. 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 coverage begins immediately. For Tier 1 preferred generic drugs, you will pay as low as a $2 copay for a one-month supply, with no copay for a three-month supply through preferred pharmacies or preferred mail order. Tier 2 generic drugs cost a $10 copay for a one-month supply at preferred locations, and choosing a three-month preferred mail order option results in no copay. For Tier 3 preferred brand drugs, you will pay a 25% coinsurance across all pharmacy types. Tier 4 non-preferred drugs carry a 32% coinsurance at preferred pharmacies and 37% at standard pharmacies, while Tier 5 specialty drugs require a 33% coinsurance for a one-month supply.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers comprehensive medical coverage with no coinsurance for many core services, including inpatient, outpatient, and emergency care. Primary care and telehealth visits are available with no copay, while specialist visits require a copay of $0 to $45. Inpatient hospital stays carry a $275 daily copay for the first six days, and emergency room visits require a $130 copay that is waived if you are admitted within 24 hours. For supplemental care, this plan features no copay for routine dental services and annual hearing exams, plus a $100 annual allowance for eyewear. Skilled nursing facility stays have no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Additionally, home health services are covered with no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Merit (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 6 of acute stays and a $350 daily copay for days 1 through 5 of psychiatric stays, followed by no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
PriorityMedicare Merit (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $225 copay (prior authorization required) and observation services with a $130 copay per stay. Ambulatory surgical center services require prior authorization and a $45 copay with no coinsurance, while outpatient substance abuse sessions have a $20 copay, and blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
PriorityMedicare Merit (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
PriorityMedicare Merit (PPO) covers Medicare-covered ground and air ambulance services with a $270 copay and no coinsurance, though prior authorization is required. For transportation, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
PriorityMedicare Merit (PPO) covers emergency services with a $130 copay and urgently needed services with a $55 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, featuring a $130 copay for emergency care, a $55 copay for urgent care, and a $270 copay for emergency transportation.
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. Therapy services require a $35 copay, and mental health, psychiatric, and opioid treatment sessions require a $20 copay, all with no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance (routine and other chiropractic services are not covered), while podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by PriorityMedicare Merit (PPO) with no copay and no coinsurance for covered options like annual physical exams and kidney disease education. Non-covered services under this benefit include personal emergency response systems, medical nutrition therapy, 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, caregiver support, additional smoking cessation counseling, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
PriorityMedicare Merit (PPO) offers partially covered hearing services, featuring one annual routine hearing exam and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295 to $1,495, though OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Merit (PPO) covers annual routine eye exams and retinal imaging with a $45 copay and no coinsurance. Eyewear, including glasses and contact lenses, is covered with no copay and no coinsurance up to a $100 combined annual maximum.
Dental Services See details
PriorityMedicare Merit (PPO) provides partially covered dental services with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a $0 to $225 copay and no coinsurance. Other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PriorityMedicare Merit (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
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
Medical equipment is covered by PriorityMedicare Merit (PPO) with no copays, requiring a 20% coinsurance for durable medical equipment (DME) and medical supplies, and 0% to 20% coinsurance for prosthetic devices. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare Merit (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic procedures carry a $20 copay, lab services have no copay, and radiological services require copays of $35 for outpatient X-rays, a minimum of $30 for therapeutic radiology, and a minimum of $125 for diagnostic radiology.
Home Health Services See details
PriorityMedicare Merit (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by PriorityMedicare Merit (PPO) with no coinsurance, but only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a ten dollar copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PriorityMedicare Merit (PPO) with no coinsurance and do not require a prior three-day inpatient hospital stay, although prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Merit (PPO) partially covers other services, offering an annual wellness visit with no copay or coinsurance, acupuncture for a $20 copay and no coinsurance (limited to 6 treatments per year), and ambulance stabilization for a $270 copay and no coinsurance. Over-the-counter items and meal benefits are not covered under this plan.
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