A non-government entity
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 2025, 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 4.5 out of 5 stars in 2025.
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 $195.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $5700.00 (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 $5700.00 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:
Sign up for PriorityMedicare Edge (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The PriorityMedicare Edge (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $8 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 (LIS), your Part D costs are $0.
Additional Benefits
The PriorityMedicare Edge (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency services and primary care visits have copays, while preventive services, routine hearing exams, oral exams, and dental cleanings have no copay. This plan also covers services like ambulance, vision, and dental care, along with home health services and skilled nursing facilities with copays. Additional benefits include acupuncture, over-the-counter items, and home infusion services, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $350 copay for days 1-7 of Inpatient Hospital-Acute and days 1-5 of Inpatient Hospital Psychiatric, and no copay for the remaining days. Additional days for Inpatient Hospital-Acute are covered, and Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare Edge (PPO), including outpatient hospital services with a copay between $0 and $350, observation services with a $120 copay, and ambulatory surgical center services with a $350 copay. Outpatient substance abuse services include individual and group sessions, both with a copay between $20 and $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Edge (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, offered by PriorityMedicare Edge (PPO), cover both ground and air ambulance services with a $275 copay, and 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 under the PriorityMedicare Edge (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services has a $30 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The PriorityMedicare Edge (PPO) plan covers primary care physician services and chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while physician specialist services have a copay between $0 and $35. Mental health and psychiatric individual and group sessions have a $20 copay, and physical therapy and speech-language pathology services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and also include coverage for annual physical exams, additional preventive services, health education, in-home safety assessments, nutritional/dietary benefits, support for caregivers, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. Home and bathroom safety devices and modifications are covered up to $25 per month. Personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, additional sessions of smoking cessation, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $295 and $1495, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The PriorityMedicare Edge (PPO) plan covers vision services, including routine eye exams with a $35 copay. Eyewear is also covered, with a combined maximum benefit of $100 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
The PriorityMedicare Edge (PPO) plan covers dental services including oral exams with no copay, dental x-rays, and prophylaxis (cleaning) with no copay. Fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), implant services, and orthodontic services are optional supplemental benefits. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the PriorityMedicare Edge (PPO) plan, requiring prior authorization. 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 by the PriorityMedicare Edge (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered items, and no copay for either. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PriorityMedicare Edge (PPO) plan, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $270.00, Therapeutic Radiological Services have a copay of at most $40.00, and Outpatient X-Ray Services have a $20.00 copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Edge (PPO) plan, with no copay or coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the PriorityMedicare Edge (PPO) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Edge (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 Edge (PPO) plan covers acupuncture with a $20 copay for up to 6 treatments per year, and also covers over-the-counter items with a maximum benefit of $25 per month. The plan does not cover meal benefits, and most other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved