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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 annual drug deductible and offers highly affordable options for generic medications. For Tier 1 preferred generics, you can pay as little as a $1 copay for a 1-month supply, or no copay for a 3-month supply when using preferred pharmacies or preferred mail order. Tier 2 generics are also cost-effective, with a $7 copay for a 1-month supply at preferred pharmacies and no copay for a 3-month supply through preferred mail order. For brand-name and specialty drugs, your costs will shift to coinsurance percentages. Tier 3 preferred brands require 22% coinsurance at preferred pharmacies and mail order, compared to 25% at standard locations. Tier 4 non-preferred drugs carry a 35% to 40% coinsurance, while Tier 5 specialty drugs require 31% coinsurance for a 1-month supply regardless of your pharmacy choice.
Additional Benefits
PriorityMedicare Thrive Plus (PPO) offers robust medical coverage with no copay or coinsurance for primary care visits, annual physicals, and home health services. For specialized medical care, members pay copays ranging from $0 to $40 for specialist visits, while inpatient hospital stays require a $300 daily copay for the first seven days and no copay for additional days. Emergency services are available worldwide with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. The plan also includes valuable dental, vision, and hearing benefits, featuring no copay for preventive dental care up to a $2,500 annual limit and no copay for eyewear up to a $100 annual maximum. Routine hearing exams have no copay, and prescription hearing aids are covered with copays ranging from $295 to $1,495. For dialysis and durable medical equipment, members will typically pay no copay and a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Thrive Plus (PPO) covers inpatient acute hospital stays with no coinsurance and a $300 daily copay for days 1 to 7, followed by no copay for unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance and a $290 daily copay for days 1 to 6, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare Thrive Plus (PPO) with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services, a $130 copay per stay for observation services, and a $40 copay for ambulatory surgical center services. Outpatient blood services have no copay or coinsurance, and while some outpatient substance abuse services are covered with no copay or coinsurance, 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 ground and air ambulance services with a $240 copay and no coinsurance, subject to prior authorization. However, transportation services to plan-approved or any health-related locations are 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 featuring no coinsurance and waived copayments 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
Primary care benefits under PriorityMedicare Thrive Plus (PPO) feature no copay and no coinsurance for primary care visits, telehealth, and opioid treatment. Specialist visits, therapies, and chiropractic care require copays ranging from $0 to $40 with no coinsurance, while podiatry is not covered and individual or group sessions for psychiatric and mental health services are excluded.
Preventive Services See details
Preventive services are partially covered by PriorityMedicare Thrive Plus (PPO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and fitness benefits. While health education and nutritional counseling are included, several sub-services such as weight management, alternative therapies, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are covered by PriorityMedicare Thrive Plus (PPO), featuring no copay and no coinsurance for one annual routine exam and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $295 to $1,495 for up to two aids per year, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
PriorityMedicare Thrive Plus (PPO) covers vision services, offering eye exams with a $40 copay and no coinsurance, and eyewear with no copay and no coinsurance up to a $100 annual maximum. There are no deductibles for these services, which cover routine exams, retinal imaging, contact lenses, eyeglass frames, lenses, and upgrades.
Dental Services See details
PriorityMedicare Thrive Plus (PPO) offers partially covered dental services with a $2,500 annual limit for both in- and out-of-network care. Medicare-covered dental has a $0 to $350 copay and no coinsurance, while preventive and most comprehensive services have no copay and no coinsurance, with the exception of endodontics which has no copay and 50% coinsurance. 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, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by PriorityMedicare Thrive Plus (PPO) with no copay and 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. While some diabetic equipment services are covered with no copay or coinsurance, diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the PriorityMedicare Thrive Plus (PPO) plan with no coinsurance, though diagnostic services are only partially covered as diagnostic procedures, tests, and lab services are not covered. These services require prior authorization and feature no copay for outpatient x-rays, a minimum $30 copay for therapeutic radiological services, and a minimum $140 copay for diagnostic radiological services.
Home Health Services See details
Home health services are covered by PriorityMedicare Thrive Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under PriorityMedicare Thrive Plus (PPO); however, only some services are covered as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Thrive Plus (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization is required and additional days beyond the Medicare limit are not covered. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100.
Other Services See details
PriorityMedicare Thrive Plus (PPO) provides partially covered other services, excluding meal benefits and dual eligible SNPs with highly integrated services. Covered benefits include acupuncture with a $20.00 copay and no coinsurance, over-the-counter items and annual wellness visits with no copay and no coinsurance, ambulance stabilization with a $240.00 copay and no coinsurance, and personalized health risk screenings with a $75.00 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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