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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. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $13 copay at a preferred pharmacy, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly Part D premium may be reduced from $39.00 to $12.40.
Additional Benefits
The PriorityMedicare Thrive Plus (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency, primary care, preventive, hearing, vision, and dental services are all covered, with some services having no copay and others requiring a copay or coinsurance. The plan also covers home health, skilled nursing facilities, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization required. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you 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 Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered. Outpatient hospital services have a copay between $0 and $350, observation services have a $120 copay, and ambulatory surgical center services have a $350 copay. Outpatient substance abuse services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Thrive Plus (PPO) plan with a $55 copay, and prior authorization is required. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by PriorityMedicare Thrive Plus (PPO). Ground and Air Ambulance Services have a $240 copay, with 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 by the PriorityMedicare Thrive Plus (PPO) plan. Emergency Services have a $120 copay and no coinsurance, and Urgently Needed Services have a $50 copay and no coinsurance. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $240 copay; all have no coinsurance.
Primary Care See details
The PriorityMedicare Thrive Plus (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $0-$40 copay, other healthcare professional services with a $0-$40 copay, physical therapy, speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services. Individual and group sessions for mental health and psychiatric services, and podiatry services are not covered.
Preventive Services See details
PriorityMedicare Thrive Plus (PPO) covers preventive services, including Medicare-covered services with a required doctor referral, annual physical exams, and additional preventive services that require prior authorization. This plan also covers fitness benefits up to $285 per year and home and bathroom safety devices and modifications up to $50 every three months. Some services, like Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams are covered once per year. Fitting/evaluation for hearing aids are also covered. Prescription hearing aids are covered with a copay between $295 and $1495 per year for all types of hearing aids except inner ear, outer ear, and over the ear.
Vision Services See details
Vision Services include eye exams with a $40 copay, and other eyewear benefits like contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered. Eyewear has a combined maximum benefit of $100 every year, and upgrades are not covered.
Dental Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers a variety of dental services, including oral exams, dental X-rays, and cleanings, with no copay. Endodontics has a 50% coinsurance, and the plan covers orthodontics with a maximum benefit of $2,000 per year. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Thrive Plus (PPO) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered by the PriorityMedicare Thrive Plus (PPO) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and Prosthetic Devices with a coinsurance of 0% to 20%; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay of $15, lab services with no copay, diagnostic radiological services with a copay of at most $140, therapeutic radiological services with a copay of at most $30, and outpatient X-ray services with no copay. All services require prior authorization.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the PriorityMedicare Thrive Plus (PPO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the PriorityMedicare Thrive Plus (PPO) plan, but prior authorization is required. 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 for up to 6 treatments per year, and over-the-counter items with a maximum coverage amount of $50 every three months. The plan also covers Ambulance Stabilization/Non-transport with a $240 copay, Annual Wellness Visits, and Personalized Health Risk Screenings with a $75 copay. However, the plan does not cover Meal Benefit, 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.
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