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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 $72.00. 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 a $0 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. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The PriorityMedicare Merit (PPO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, and outpatient services range from no copay to $225. Emergency, primary care, preventive, and home health services are also covered, with some services requiring a copay. The plan includes coverage for hearing, vision, and dental services, with specific copays and limitations for each. Additionally, the plan covers home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance. Other services such as acupuncture and skilled nursing facilities are covered, while certain services like cardiac rehabilitation and personal care services are not.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $275 copay for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a $350 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered, and non-Medicare covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered under the PriorityMedicare Merit (PPO) plan. Outpatient Hospital Services have a copay between $0 and $225, Observation Services have a $120 copay, and ASC Services have a $225 copay, while Individual and Group Sessions for Outpatient Substance Abuse each have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Merit (PPO) plan, but requires prior authorization. You will have 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 $270 copay, and there is no coinsurance. 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 under the PriorityMedicare Merit (PPO) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have a $120 copay for Worldwide Emergency Coverage, a $55 copay for Worldwide Urgent Coverage, and a $270 copay for Worldwide Emergency Transportation.
Primary Care See details
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 are covered under the PriorityMedicare Merit (PPO) plan. Chiropractic Services have a $20 copay. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a copay between $0 and $45. Individual and Group Sessions for Mental Health Specialty Services, and Psychiatric Services have a $20 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Opioid Treatment Program Services have a $20 copay. Podiatry Services are not covered. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans, and include no copay for Medicare-covered services. Some services are not covered, including Personal Emergency Response System (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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services includes routine hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $295 and $1495, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services include eye exams with a $45 copay. Eyewear is covered with a combined maximum of $100 per year for both in-network and out-of-network services, while contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams with no copay, 2 visits per year, and dental x-rays with no copay, limited to 1 x-ray per year. Other dental services such as fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics, and implant services are offered as optional, supplemental benefits. Orthodontics and Maxillofacial Prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PriorityMedicare Merit (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis services are covered by PriorityMedicare Merit (PPO) with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and authorization required, as well as Prosthetics/Medical Supplies, and Diabetic Equipment. Prosthetic Devices have a coinsurance of 0-20%, and Medical Supplies have a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under PriorityMedicare Merit (PPO). Diagnostic Procedures/Tests have a $20 copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $125, Therapeutic Radiological Services have a copay of at most $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 additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
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 by the PriorityMedicare Merit (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
The PriorityMedicare Merit (PPO) plan covers acupuncture with a $20 copay for a maximum of 6 treatments per year, and "Other 1" services with a $270 copay. Over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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