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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 2025, 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 4.5 out of 5 stars in 2025.
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 $39.00. 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 $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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a preferred generic drug, you will pay a $13 copay at a preferred pharmacy, and a 25% coinsurance for a standard generic drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The PriorityMedicare Thrive Plus (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary based on the service. Emergency and urgent care services are covered with copays, and primary care and preventive services are available, with some services having no copay. This plan includes coverage for hearing, vision, and dental services, with copays for exams and varying costs for hearing aids, eyewear, and dental procedures. Additionally, the plan covers home health services with no copay, skilled nursing facility stays with a copay, and offers other services like acupuncture and over-the-counter items with copays or maximum benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required for both. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you'll pay a $290 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services are covered by the PriorityMedicare Thrive Plus (PPO) plan. Outpatient Hospital Services have a copay between $0 and $350, Observation Services have a $120 copay, and Ambulatory Surgical Center (ASC) Services have a $350 copay. Outpatient Substance Abuse Services (Individual and Group Sessions) are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by PriorityMedicare Thrive Plus (PPO) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the PriorityMedicare Thrive Plus (PPO) plan. Ground and Air Ambulance Services have a $240 copay, with no coinsurance, while 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 by the PriorityMedicare Thrive Plus (PPO) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $240 copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, while Other Chiropractic Services have a $40 copay. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have a $15 copay, and Physician Specialist Services have a copay between $0 and $40. Mental Health Specialty Services and Psychiatric Services are not covered.
Preventive Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers preventive services, including annual physical exams, health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits (up to $285 per year), enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications (up to $50 every three months), kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. This plan does not cover 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 services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, or counseling services.
Hearing Services See details
Hearing exams are covered with no copay, and include routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $295 and $1495, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a $40 copay, and eyewear with a combined maximum benefit of $100 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers a range of dental services, including oral exams with no copay, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics with a 50% coinsurance, periodontics, oral and maxillofacial surgery, and orthodontic services up to a maximum of $2,000 per year. Prosthodontics, removable, implant services, and prosthodontics, fixed, are optional supplemental benefits. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by PriorityMedicare Thrive Plus (PPO) with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by the PriorityMedicare Thrive Plus (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices have a coinsurance of 0% to 20%. Medical Supplies have a 20% coinsurance. However, 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, including diagnostic procedures and tests, are covered with a copay of $15.00. Lab services have no copay, while diagnostic radiological services have a copay of at most $140.00, and therapeutic radiological services have a copay of at most $30.00. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Thrive Plus (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 by the PriorityMedicare Thrive Plus (PPO) plan. While the plan mentions some services are covered, the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Thrive Plus (PPO) plan. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers acupuncture with a $20 copay, and over-the-counter items with a $50 maximum benefit every three months. Other services include a $240 copay for ambulance stabilization/non-transport and a $75 copay for personalized health risk screening, while meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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