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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 annual prescription drug deductible of $100. For Tier 1 preferred generic drugs, you can pay as little as a $1 copay for a 1-month supply, or enjoy no copay for a 3-month supply when using preferred pharmacies or mail order. Tier 2 generic drugs cost a $7 copay for a 1-month supply at preferred pharmacies, with the added benefit of no copay for a 3-month supply filled via preferred mail order. Higher-tier medications under this plan require coinsurance instead of flat copayments. Tier 3 preferred brand drugs carry a 22% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs range from 35% to 40% coinsurance. Finally, Tier 5 specialty drugs require a 31% coinsurance for a 1-month supply at both standard and preferred pharmacies.
Additional Benefits
PriorityMedicare Thrive Plus (PPO) offers robust medical coverage with predictable out-of-pocket costs and no coinsurance for many key services. You will pay no copay for primary care visits, telehealth, and annual physicals, while specialist visits require up to a $40 copay. Inpatient hospital stays require a $300 daily copay for the first seven days with no copay thereafter, and emergency room visits carry a $130 copay. Supplemental benefits include dental coverage with no copay for most preventive and comprehensive services up to a $2,500 annual limit, alongside a $100 yearly eyewear allowance. Routine hearing exams have no copay, while prescription hearing aids require copays ranging from $295 to $1,495. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
PriorityMedicare Thrive Plus (PPO) inpatient hospital benefits are partially covered, as upgrades and non-Medicare-covered stays are not covered. Covered acute stays have no coinsurance and require a $300 daily copay for days 1 to 7 with no copay thereafter, while psychiatric stays have no coinsurance and a $290 daily copay for days 1 to 6 with no copay for days 7 to 90.
Outpatient Services See details
PriorityMedicare Thrive Plus (PPO) covers outpatient hospital services with copays from $0 to $350, observation services with a $130 copay, and ambulatory surgical center services with a $40 copay, all with no coinsurance. Outpatient blood services are available with no copay or coinsurance, and while some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
PriorityMedicare Thrive Plus (PPO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization may be required depending on the specific service.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by PriorityMedicare Thrive Plus (PPO), with ground and air ambulance services requiring prior authorization and carrying a $240 copay and no coinsurance. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
PriorityMedicare Thrive Plus (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance, featuring a $130 copay for emergency care, a $50 copay for urgent care, and a $240 copay for emergency transportation.
Primary Care See details
PriorityMedicare Thrive Plus (PPO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialists require a $0 to $40 copay and no coinsurance. Physical, occupational, speech, and chiropractic therapies are covered with a $15 to $20 copay and no coinsurance, but podiatry is not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
PriorityMedicare Thrive Plus (PPO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. However, additional preventive services are only 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
Hearing services are partially covered under PriorityMedicare Thrive Plus (PPO), providing routine hearing exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $295.00 to $1,495.00, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
PriorityMedicare Thrive Plus (PPO) covers vision services, featuring a $40 copay and no coinsurance for annual routine eye exams and retinal imaging. Eyewear, including contacts, lenses, and frames, is covered with no copay and no coinsurance up to a combined maximum benefit of $100 per year.
Dental Services See details
PriorityMedicare Thrive Plus (PPO) offers partially covered dental services with no copay and no coinsurance for most preventive and comprehensive benefits, up to a $2,500 annual limit. Medicare-covered dental services require a $0 to $350 copay (no coinsurance) and endodontics require a 50% coinsurance (no copay), while other diagnostic dental, other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PriorityMedicare Thrive Plus (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the PriorityMedicare Thrive Plus (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Thrive Plus (PPO) covers durable medical equipment and medical supplies with no copay and 20% coinsurance, and prosthetic devices with no copay and 0% to 20% coinsurance. Diabetic equipment is covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare Thrive Plus (PPO) diagnostic and radiological services are covered with no coinsurance, though prior authorization is required. For diagnostic services, some services are covered but diagnostic procedures/tests and lab services are not covered, while radiological services require no copay for outpatient X-rays, a $30.00 copay for therapeutic radiology, and a $140.00 copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the PriorityMedicare Thrive Plus (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Thrive Plus (PPO) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Thrive Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Thrive Plus (PPO) partially covers other services, excluding meal benefits, but provides acupuncture for a $20 copay and no coinsurance (limited to 6 treatments annually) and personalized health risk screenings for a $75 copay and no coinsurance. Over-the-counter (OTC) items and annual wellness visits are covered with no copay and no coinsurance, while ambulance stabilization requires a $240 copay and no coinsurance.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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