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PriorityMedicare Thrive Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Thrive Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Thrive Plus (PPO) in 2026, please refer to our full plan details page.
PriorityMedicare Thrive Plus (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 Thrive Plus (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 Thrive Plus (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 Thrive Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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 a $100.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5600.00 (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 $5600.00 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 Thrive Plus (PPO) plan features a low $100 drug deductible and offers affordable copays for generic medications. For Tier 1 preferred generics, you pay a $1 copay for a one-month supply at preferred pharmacies, and there is no copay for a three-month supply through preferred pharmacies or preferred mail order. Tier 2 generics cost $7 for a one-month supply at preferred pharmacies, and you will pay no copay for a three-month supply when using preferred mail order. For higher-tier medications, costs are based on coinsurance percentages. Tier 3 preferred brands require a 22% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs require 35% to 40% coinsurance. Specialty drugs in Tier 5 carry a 31% coinsurance for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The PriorityMedicare Thrive Plus (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a copay ranging from no copay to $40, while inpatient hospital stays carry a $300 daily copay for the first seven days with no coinsurance. Emergency care is available with a $130 copay, which is waived if admitted, and urgent care requires a $50 copay. For routine care, the plan provides most dental services and annual hearing exams with no copay, while routine eye exams require a $40 copay. Skilled nursing facility stays feature no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance. Members also benefit from covered over-the-counter items with no copay and no coinsurance, alongside prescription hearing aid coverage with copays between $295 and $1,495.
Inpatient Hospital See details
PriorityMedicare Thrive Plus (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 through 7 of acute care (no copay for day 8 and beyond) and a $290 daily copay for days 1 through 6 of psychiatric care (no copay for days 7 through 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Thrive Plus (PPO) covers outpatient hospital services with a $0 to $350 copay, observation services at a $130 copay per stay, and ambulatory surgical center services with a $40 copay, all with no coinsurance. Outpatient blood services are covered with no copay, coinsurance, or deductible, while outpatient substance abuse services have no copay or coinsurance but individual and group sessions are not covered.
Partial Hospitalization See details
PriorityMedicare Thrive Plus (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PriorityMedicare Thrive Plus (PPO) covers Medicare-covered ground and air ambulance services with a $240 copay and no coinsurance, with prior authorization required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
PriorityMedicare Thrive Plus (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with copays ranging from $50 to $240 and no coinsurance.
Primary Care See details
PriorityMedicare Thrive Plus (PPO) offers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialists and other health professionals require a $0 to $40 copay with no coinsurance. Physical, occupational, and speech therapies require a $15 copay, and chiropractic services require a $15 to $20 copay, all with no coinsurance. Podiatry is not covered, and for mental health and psychiatric services, some services are covered but individual and group sessions are not covered.
Preventive Services See details
PriorityMedicare Thrive Plus (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, excluding personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, remote access technologies, and counseling.
Hearing Services See details
PriorityMedicare Thrive Plus (PPO) offers partially covered hearing services, featuring one routine hearing exam annually with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $295 and $1,495, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Thrive Plus (PPO) covers routine eye exams and retinal imaging with a $40 copay, no coinsurance, and no deductible. Eyewear, including contacts and glasses, is covered with no copay, no coinsurance, and no deductible, up to a $100 combined annual maximum benefit.
Dental Services See details
PriorityMedicare Thrive Plus (PPO) offers partially covered dental services with no copay and no coinsurance for most services, though Medicare-covered dental requires a $0 to $350 copay (no coinsurance) and endodontics has a 50% coinsurance (no copay) up to a $2,500 annual limit. Other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Thrive Plus (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 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 by PriorityMedicare Thrive Plus (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Thrive Plus (PPO) partially covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment (DME) and medical supplies, and no coinsurance to 20% coinsurance for prosthetic devices. Diabetic equipment is 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 Thrive Plus (PPO) partially covers diagnostic and radiological services with no coinsurance, requiring prior authorization for covered services. While diagnostic procedures, tests, and lab services are not covered, radiological services are covered with no copay for outpatient X-rays, a minimum $30 copay for therapeutic services, and a minimum $140 copay for diagnostic radiological services.
Home Health Services See details
PriorityMedicare Thrive Plus (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Thrive Plus (PPO) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by PriorityMedicare Thrive Plus (PPO) with no coinsurance and require prior authorization, without requiring a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by PriorityMedicare Thrive Plus (PPO), excluding meal benefits and dual eligible SNPs. Covered benefits include annual wellness visits and over-the-counter items with no copay and no coinsurance, acupuncture for a $20 copay and no coinsurance (up to 6 treatments per year), personalized health risk screenings for a $75 copay and no coinsurance, and ambulance stabilization for a $240 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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