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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 pharmacy. For example, preferred generic drugs have a $13 copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. 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 comprehensive coverage, including inpatient hospital stays with a $300 copay for the first 7 days, and no copay thereafter, as well as outpatient services with varying copays. The plan also covers emergency services, primary care, preventive services, hearing, vision, and dental services. Additional benefits include home health services with no copay, skilled nursing facility care with no copay for the first 20 days, and coverage for acupuncture. This plan also includes coverage for home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $300 copay for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has 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. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $350, observation services with a $120 copay, and ambulatory surgical center services with a $350 copay. Outpatient substance abuse services are not covered, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Thrive Plus (PPO) plan, and requires prior authorization. The copay for this benefit is $55.
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 and 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, and Urgently Needed Services have a $50 copay, while 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 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 are covered. Chiropractic services have a $20 copay, and routine chiropractic care has a $20 copay for up to 12 visits per year, and other chiropractic services have a $40 copay for up to 1 visit per year for X-rays. Occupational Therapy Services have a $15 copay, while Physical Therapy and Speech-Language Pathology Services have a $15 copay. Physician Specialist Services have a copay between $0 and $40. Other Health Care Professional services have a copay between $0 and $40. Mental Health Specialty Services, Podiatry Services, and Psychiatric Services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and additional services, are covered. The plan also covers 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 services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. However, personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but the copay is between $295 and $1495, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with a combined maximum benefit of $100 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also 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, dental x-rays, cleaning, and fluoride treatments, with varying limitations on visits and periodicity. Endodontics has a 50% coinsurance, and orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the PriorityMedicare Thrive Plus (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 0-20% coinsurance, and Medical Supplies with a 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PriorityMedicare Thrive Plus (PPO) plan. Diagnostic Procedures/Tests have a copay of $15, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $140, Therapeutic Radiological Services have a copay of at most $30, and 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. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the PriorityMedicare Thrive Plus (PPO) plan, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for covered services, but the amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Thrive Plus (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services includes coverage for acupuncture with a $20 copay, and over-the-counter (OTC) items with a maximum benefit coverage amount of $50 every three months. Other services include coverage for ambulance stabilization/non-transport with a $240 copay, annual wellness visits and personalized health risk screenings with a $75 copay. The plan does not cover meal benefits, 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, or Self-Directed Personal Assistance Services.
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