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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 a $200 annual drug deductible and offers cost-effective options for generic medications. For Tier 1 preferred generics, you can expect a $2 copay for a 1-month supply, with no copay for a 3-month supply when using a preferred pharmacy or preferred mail order. Tier 2 generic drugs cost as little as an $8 copay for a 1-month supply, and also feature no copay for a 3-month supply through preferred mail order. Brand-name and specialty medications are subject to coinsurance rather than flat copays. Tier 3 preferred brands require 22% coinsurance at preferred locations and 25% at standard locations, while Tier 4 non-preferred drugs range from 25% to 30% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The PriorityMedicare Edge (PPO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth, preventive care, and home health services. For inpatient hospital stays, members pay a $350 daily copay for the first several days and no copay thereafter, while outpatient hospital services range from no copay to a $350 copay. Emergency room visits require a $130 copay and urgent care has a $50 copay, with no coinsurance for either service. Routine dental exams, cleanings, and hearing evaluations are covered with no copay or coinsurance, while routine eye exams carry a $35 copay. Specialist office visits require a copay of up to $40, and durable medical equipment is covered with no copay and a 20% coinsurance. Additionally, members can take advantage of over-the-counter items and annual wellness visits with no copay and no coinsurance.
Inpatient Hospital See details
PriorityMedicare Edge (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1-7 of acute stays and days 1-5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and certain sub-services such as room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Edge (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from no copay to $350 for outpatient hospital services and a $35 copay for ambulatory surgical center services, both requiring prior authorization. Additionally, outpatient substance abuse services carry a $20 copay, observation services cost a $130 copay per stay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
PriorityMedicare Edge (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by PriorityMedicare Edge (PPO), with ground and air ambulance services requiring a $275 copay, no coinsurance, and prior authorization. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
PriorityMedicare Edge (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $275 respectively.
Primary Care See details
PriorityMedicare Edge (PPO) provides partially covered primary care services with no coinsurance, featuring no copay for primary care doctor visits and telehealth. Copays for other covered services like specialists, therapy, and chiropractic care range up to $40, while podiatry services are not covered.
Preventive Services See details
PriorityMedicare Edge (PPO) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. However, sub-services such as personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, additional smoking cessation, remote access technologies, and counseling services are not covered.
Hearing Services See details
PriorityMedicare Edge (PPO) hearing services are partially covered, featuring routine hearing exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295 to $1,495, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Edge (PPO) covers annual routine eye exams and retinal imaging with a $35 copay, no coinsurance, and no deductible. Eyewear, including contacts and eyeglasses, is covered with no copay, no coinsurance, and no deductible up to a combined maximum benefit of $100 per year.
Dental Services See details
Dental services are covered by PriorityMedicare Edge (PPO) with no copay and no coinsurance for exams, cleanings, x-rays, periodontics, and oral surgery, while Medicare-covered dental services require prior authorization and have a copay ranging from no copay to $350 with no coinsurance. However, other diagnostic and preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Edge (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
PriorityMedicare Edge (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Edge (PPO) covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and medical supplies, and 0% to 20% coinsurance for prosthetic devices. 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
Diagnostic and radiological services are covered under the PriorityMedicare Edge (PPO) plan with no coinsurance, though prior authorization is required. Some diagnostic services are covered with no copay, but diagnostic procedures, tests, and lab services are not covered, while radiological services require copays of $20 for X-rays, a $40 minimum for therapeutic radiology, and a $270 minimum for diagnostic radiology.
Home Health Services See details
PriorityMedicare Edge (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PriorityMedicare Edge (PPO) with no coinsurance, but some services are not covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
PriorityMedicare Edge (PPO) covers other services including acupuncture for a $20 copay and no coinsurance (limit of 6 treatments per year), and ambulance stabilization for a $275 copay and no coinsurance. Over-the-counter items and annual wellness visits are covered with no copay and no coinsurance, while meal benefits are not covered.
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