PriorityMedicare Edge (PPO)

PriorityMedicare Edge (PPO) is a PPO plan offered by Priority Health available for the 2026 plan year 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.

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:

Drug Coverage

The PriorityMedicare Edge (PPO) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you will pay a low $2 copay for a 1-month supply, or no copay for a 3-month supply when using a preferred pharmacy or preferred mail order. Tier 2 generic prescriptions cost $8 for a 1-month supply at preferred locations, with the option for a 3-month supply at no copay through preferred mail order. Higher tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance at preferred pharmacies and 25% coinsurance at standard pharmacies. Tier 4 non-preferred drugs have a 25% to 30% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply at all pharmacy types.

Additional Benefits

The PriorityMedicare Edge (PPO) plan provides comprehensive coverage for essential healthcare needs with affordable out-of-pocket costs. Members benefit from no copay for primary care physician visits, annual physicals, and routine preventive services, while specialist visits require a low copay ranging from $0 to $35 with no coinsurance. Emergency care is accessible with a $130 copay, and urgent care visits require a $50 copay, with all coinsurance waived for these services. In addition to medical care, the plan features built-in dental, vision, and hearing benefits, including no copay for preventive dental care, routine hearing exams, and up to $100 annually for eyewear. Inpatient hospital stays carry a $350 daily copay for the first seven days with no copay for subsequent days, while home health services and the first 20 days in a skilled nursing facility require no copay. Durable medical equipment and dialysis services are covered with a standard 20% coinsurance and no copay.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.