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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 $83.00. 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 generics, you will pay as low as a $2 copay for a one-month supply at preferred pharmacies, with no copay for a three-month supply through preferred pharmacies or preferred mail order. Tier 2 generic drugs require a $10 copay for a one-month supply at preferred pharmacies, and you can enjoy no copay for a three-month supply when using preferred mail order. For brand-name and specialty medications, the plan transitions to coinsurance. Tier 3 preferred brand drugs carry a 25% coinsurance at all pharmacies, while Tier 4 non-preferred drugs require a 32% coinsurance at preferred pharmacies and 37% at standard pharmacies. Tier 5 specialty drugs are covered with a 33% coinsurance for a one-month supply at both preferred and standard locations.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers robust medical coverage with no copays or coinsurance for primary care, telehealth, preventive services, and home health visits. Specialist consultations are highly affordable with copays ranging from no copay up to $45, while emergency room visits carry a flat $130 copay that is waived if you are admitted to the hospital. For inpatient hospital stays, members pay a daily copay for the first several days, after which care is covered with no copay. Additional benefits include routine dental and hearing exams with no copays, as well as a $100 annual allowance for eyewear and partial coverage for prescription hearing aids. Diagnostic lab services feature no copay, whereas medical needs like durable medical equipment and dialysis require a 20% coinsurance. Skilled nursing facility stays are also covered, featuring no copay for the first 20 days of care.
Inpatient Hospital See details
PriorityMedicare Merit (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $275 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $350 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as 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, featuring copays ranging from no copay up to $225 for outpatient hospital services and a $130 copay per stay for observation services. 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 benefits are covered by PriorityMedicare Merit (PPO) with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by PriorityMedicare Merit (PPO) with a $270 copay and no coinsurance for both ground and air transportation, subject to prior authorization. Transportation services to plan-approved or other health-related locations are 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 with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $55, and $270, respectively.
Primary Care See details
PriorityMedicare Merit (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits have a $0 to $45 copay and therapy services require a $35 copay, both with no coinsurance. Mental health, psychiatric, and opioid treatments carry a $20 copay and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
PriorityMedicare Merit (PPO) offers preventive services with no copay and no coinsurance, though the benefit is only partially covered. Services not covered under this plan 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, additional smoking cessation counseling, remote access technologies, home and bathroom safety devices, and counseling.
Hearing Services See details
PriorityMedicare Merit (PPO) covers hearing services, including one routine hearing exam and unlimited fitting evaluations per year with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $295.00 to $1,495.00 for up to two aids yearly, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by PriorityMedicare Merit (PPO), which includes routine eye exams for a $45 copay and no coinsurance. Eyewear is also covered with no copay or coinsurance, up to a combined maximum benefit of $100 per year for contacts, lenses, and frames.
Dental Services See details
Dental services are partially covered by PriorityMedicare Merit (PPO), featuring no copay and no coinsurance for most preventive and comprehensive services, while Medicare-covered dental services require a copay of $0 to $225 and no coinsurance. Other diagnostic dental services, other preventive dental 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 is required and a coinsurance of no coinsurance to 20% applies to Medicare Part B chemotherapy, radiation, and other drugs. Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance, and Part D home infusion drugs are included as a mandatory supplemental benefit.
Dialysis Services See details
PriorityMedicare Merit (PPO) covers dialysis services 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 a 20% coinsurance, and prosthetic devices with no copay and 0% to 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare Merit (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. There is no copay for lab services, while diagnostic procedures and tests have a $20 copay, outpatient X-rays have a $35 copay, and therapeutic and diagnostic radiological services require minimum copays of $30 and $125, respectively.
Home Health Services See details
PriorityMedicare Merit (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by PriorityMedicare Merit (PPO) with no coinsurance, though only some services are covered because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by PriorityMedicare Merit (PPO) with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Merit (PPO) covers other services including acupuncture for a $20 copay and no coinsurance (limited to 6 treatments per year), ambulance stabilization/non-transport with a $270 copay and no coinsurance, and annual wellness visits with no copay and no coinsurance. Over-the-counter (OTC) items and meal benefits are not covered.
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