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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 an enhanced alternative drug benefit with a $0 deductible. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $13 copay at preferred pharmacies. 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 premium will be reduced.
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 range from $0 to $350. The plan covers ambulance services with a $240 copay, and emergency services with a copay of $120. This plan includes coverage for primary care, preventive services, hearing exams with no copay, and vision services. Dental services include oral exams and cleanings with no copay. Additional benefits include home infusion, dialysis services with 20% coinsurance, and medical equipment with a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-7, and no copay for days 8-90; 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. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a $120 copay, and Ambulatory Surgical Center (ASC) 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, with a $55 copay. Prior authorization is required for this benefit.
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
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 copay between $0 and $40, other healthcare professional services with a copay between $0 and $40, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services. Mental health and psychiatric services are not covered.
Preventive Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, additional preventive services, health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits with a maximum benefit of $285 every year, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications with a maximum benefit of $50 every three months, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the welcome visit. The 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
The PriorityMedicare Thrive Plus (PPO) plan covers hearing exams with no copay, and also covers fitting and evaluation for hearing aids. Prescription hearing aids are covered with a copay between $295 and $1495, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a $40 copay. Eyewear is covered up to a combined maximum of $100 every year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
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, and prophylaxis (cleaning) with no copay. Endodontics has a 50% coinsurance, while orthodontic services have 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Thrive Plus (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a coinsurance between 0% and 20%, while 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 under 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 least $140, and Therapeutic Radiological Services have a copay of at least $30. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Thrive Plus (PPO) 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 generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Thrive Plus (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203.
Other Services See details
The PriorityMedicare Thrive Plus (PPO) plan covers acupuncture with a $20 copay, and Over-the-Counter (OTC) items with a maximum benefit coverage amount of $50 every three months. The plan also covers other services, including ambulance stabilization/non-transport with a $240 copay, and personalized health risk screenings with a $75 copay. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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