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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 $70.00. 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 no drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic drugs, you pay no copay for a three-month supply through preferred pharmacies or preferred mail order, or a low two-dollar copay for a one-month supply. Tier 2 generic drugs are also highly affordable, featuring no copay for a three-month supply via preferred mail order and a ten-dollar copay for a one-month supply at preferred pharmacies. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 3 preferred brand drugs requiring a twenty-five percent coinsurance across all pharmacy options. Tier 4 non-preferred drugs carry a thirty-two percent coinsurance at preferred locations and thirty-seven percent at standard locations. For Tier 5 specialty drugs, you will pay a thirty-three percent coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers comprehensive coverage with no copays and no coinsurance for primary care visits, telehealth services, preventive care, and home health services. For specialist visits, members can expect no copay to a $45 copay, while emergency room visits require a $130 copay that is waived if admitted within 24 hours. Inpatient hospital stays are covered with no coinsurance, requiring a daily copay of $275 for the first six days of acute care. This Medicare plan also features dental benefits with no copay or coinsurance for routine cleanings and exams, alongside routine hearing exams and fitting evaluations with no copay. Vision care includes routine eye exams for a $45 copay and eyewear covered up to a $100 annual maximum with no copay. Durable medical equipment and dialysis services are available with no copays and a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Merit (PPO) inpatient hospital care is partially covered with no coinsurance, requiring a daily copay of $275 for days 1 to 6 of acute stays and $350 for days 1 to 5 of psychiatric stays, followed by no copay for remaining days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Merit (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from $0 to $225 and observation services with a $130 copay per stay. Ambulatory surgical center services require a $45 copay with no coinsurance, outpatient substance abuse sessions have a $20 copay with no coinsurance, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by PriorityMedicare Merit (PPO) with a $55 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
PriorityMedicare Merit (PPO) covers ground and air ambulance services with a $270 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, 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 featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, requiring copays of $130 for emergency care, $55 for urgent care, and $270 for emergency transportation.
Primary Care See details
PriorityMedicare Merit (PPO) covers primary care physician services and telehealth benefits with no copay and no coinsurance, while specialist visits require a $0 to $45 copay and no coinsurance. Therapy services, including physical, occupational, and speech-language, have a $35 copay and no coinsurance, whereas mental health and psychiatric sessions require a $20 copay and no coinsurance. Chiropractic and 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. Sub-services that are not covered include personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, and home safety modifications.
Hearing Services See details
Hearing services are partially covered by PriorityMedicare Merit (PPO), which offers one routine hearing exam per year and unlimited fitting evaluations with no copay and no coinsurance. Covered prescription hearing aids have no coinsurance and a copay ranging from $295.00 to $1,495.00 for up to two visits per year, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
PriorityMedicare Merit (PPO) covers annual routine eye exams and retinal imaging with a $45 copay, no coinsurance, and no deductible. Eyewear is also covered with no copay, no coinsurance, and no deductible, providing up to a $100 combined annual maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by PriorityMedicare Merit (PPO), featuring no copay and no coinsurance for cleanings, exams, x-rays, and select comprehensive services like oral surgery. Medicare-covered dental services require prior authorization and have a $0 to $225 copay with no coinsurance, while orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
PriorityMedicare Merit (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% 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
PriorityMedicare Merit (PPO) covers medical equipment 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, but 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. Members pay no copay for lab services, a $20 copay for diagnostic procedures and tests, a $35 copay for outpatient X-rays, a $30 copay for therapeutic radiological services, and a minimum $125 copay for diagnostic radiological services.
Home Health Services See details
Home health services are covered by PriorityMedicare Merit (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered under PriorityMedicare Merit (PPO) with no coinsurance, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Merit (PPO) partially covers skilled nursing facility (SNF) care with no coinsurance, although additional days beyond the standard Medicare-covered limit are not covered. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, requiring prior authorization but no prior three-day hospital stay.
Other Services See details
PriorityMedicare Merit (PPO) partially covers other services, featuring annual wellness visits with no copay and no coinsurance, acupuncture limited to 6 treatments annually for a $20 copay and no coinsurance, and ambulance stabilization for a $270 copay and no coinsurance. Over-the-counter items, meal benefits, and dual-eligible SNP services are not covered.
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