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PriorityMedicare Edge (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Edge (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Edge (PPO) in 2026, please refer to our full plan details page.
PriorityMedicare Edge (PPO) is a PPO plan offered by Corewell Health available for enrollment in 2025 to people living in West, SW, & SE counties, lower MI. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that PriorityMedicare Edge (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 Edge (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 Edge (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 has a $275.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $200.00 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 $6000.00 (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 $6000.00 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 Edge (PPO) plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you will pay as low as a $2 copay for a 1-month supply at preferred pharmacies and mail-order services, with no copay for a 3-month supply. Tier 2 generic drugs cost between $8 and $15 for a 1-month supply, though you can enjoy no copay for a 3-month supply when using preferred mail-order services. Higher-tier medications transition to coinsurance, with Tier 3 preferred brand drugs requiring 22% coinsurance at preferred pharmacies and 25% at standard pharmacies. Tier 4 non-preferred drugs range from 25% to 30% coinsurance depending on your pharmacy choice. Tier 5 specialty drugs require 30% coinsurance across all pharmacy and mail-order options for a 1-month supply.
Additional Benefits
The PriorityMedicare Edge (PPO) plan offers comprehensive coverage with no coinsurance for many key medical services, including inpatient hospital stays, outpatient procedures, and emergency care. Patients enjoy no copay for primary care and telehealth visits, while specialist visits, urgent care, and outpatient services require set copays. Inpatient hospital stays have a $350 daily copay for the first few days, after which there is no copay for the remainder of the stay. Preventive care, routine hearing exams, home health, and select dental services are available with no copay and no coinsurance. For specialized needs, diagnostic services and home infusions feature no copay, while durable medical equipment and dialysis require a 20% coinsurance. Vision exams, dental care, and prescription hearing aids are also covered, though they may require copays depending on the specific service.
Inpatient Hospital See details
PriorityMedicare Edge (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 through 7 of acute stays and days 1 through 5 of psychiatric stays, followed by no copay for remaining days. While unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Edge (PPO) covers outpatient hospital services with a $0 to $350 copay and observation services with a $130 copay per stay, both featuring no coinsurance and requiring prior authorization for hospital services. Ambulatory surgical center services require a $35 copay and prior authorization, outpatient substance abuse sessions have a $20 copay, and outpatient blood services have no copay, all with no coinsurance.
Partial Hospitalization See details
PriorityMedicare Edge (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
PriorityMedicare Edge (PPO) covers Medicare-approved ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PriorityMedicare Edge (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered with no coinsurance and copays of $130, $50, and $275 respectively.
Primary Care See details
PriorityMedicare Edge (PPO) partially covers primary care services with no coinsurance, though podiatry services are not covered. Covered benefits feature no copay for primary care and telehealth visits, while other services require copays ranging from $15 to $40 for specialists, chiropractic care, mental health, and physical therapy.
Preventive Services See details
Preventive services are partially covered by PriorityMedicare Edge (PPO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness programs. However, several sub-services are not covered, including personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, and counseling services.
Hearing Services See details
PriorityMedicare Edge (PPO) covers hearing exams with no copay and no coinsurance, which includes one routine exam yearly 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, though OTC hearing aids and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Edge (PPO) covers vision services, offering annual routine eye exams and retinal imaging for a $35 copay and no coinsurance. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $100 combined annual maximum.
Dental Services See details
PriorityMedicare Edge (PPO) partially covers dental services, offering exams, cleanings, x-rays, and select comprehensive services with no copay and no coinsurance, while Medicare-covered dental services require a $0 to $350 copay and no coinsurance. Other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by PriorityMedicare Edge (PPO) with no copay and require prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 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 under the PriorityMedicare Edge (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Edge (PPO) covers durable medical equipment and medical supplies with no copay and 20% coinsurance, and prosthetic devices with no copay and up to 20% coinsurance. Diabetic equipment is partially 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 Edge (PPO) diagnostic and radiological services require prior authorization and feature no coinsurance. For diagnostic services, there is no copay, though some services are covered but diagnostic procedures/tests and lab services are not covered. Covered radiological services require copays, including $20 for outpatient X-rays, a minimum of $40 for therapeutic radiological services, and a minimum of $270 for diagnostic radiological services.
Home Health Services See details
PriorityMedicare Edge (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Edge (PPO) covers Cardiac Rehabilitation Services with no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PriorityMedicare Edge (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
PriorityMedicare Edge (PPO) covers other services such as acupuncture with a $20 copay and no coinsurance for up to 6 treatments yearly, and ambulance stabilization with a $275 copay and no coinsurance. Over-the-counter items and annual wellness visits are available with no copay and no coinsurance, though meal benefits are not covered.
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