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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 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:
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Drug Coverage
The PriorityMedicare Edge (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have an $8 copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan may also reduce your premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The PriorityMedicare Edge (PPO) plan offers a range of benefits beyond basic Medicare coverage. This plan includes coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. You'll also find coverage for ambulance services, emergency care, primary care, and preventive services. Additional benefits include hearing and vision services, with copays for exams and coverage for hearing aids and eyewear. Dental services are covered, including oral exams and cleaning, with some optional supplemental benefits. The plan also covers home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the PriorityMedicare Edge (PPO) plan, with copays ranging from $0 to $350 for outpatient hospital services, $120 for observation services, and $350 for ambulatory surgical center services. Individual and group sessions for outpatient substance abuse both have a copay of $20, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PriorityMedicare Edge (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, including ground and air ambulance services, each with a $275 copay. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $120, $30, $120, and $30, respectively, with no coinsurance. Worldwide Emergency Transportation has a copay of $275 with no coinsurance.
Primary Care See details
The PriorityMedicare Edge (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $0-$35 copay, mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits, and opioid treatment program services with a $20 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, support for caregivers, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education, and other preventive services. Additionally, Home and Bathroom Safety Devices and Modifications are covered up to $25 per month.
Hearing Services See details
Hearing exams are covered by the PriorityMedicare Edge (PPO) plan with no copay, while prescription hearing aids are covered with a copay between $295 and $1495. Routine hearing exams are limited to one per year, and prescription hearing aids are limited to two per year. Fitting/evaluation for hearing aids are covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and neither are OTC hearing aids.
Vision Services See details
Vision Services include eye exams with a $35 copay, and eyewear with a combined maximum of $100 per year for both in-network and out-of-network services. Contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames are covered, while upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, prophylaxis (cleaning), periodontics, and oral and maxillofacial surgery. Oral exams and prophylaxis (cleaning) have no copay, and are limited to two visits per year. Dental X-rays are limited to one per year. Fluoride treatment, restorative services, adjunctive general services, endodontics, prosthodontics (removable and fixed), implant services, and orthodontics are offered as an optional supplemental benefit. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require 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 under the PriorityMedicare Edge (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 0-20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the PriorityMedicare Edge (PPO) plan, with Diagnostic Procedures/Tests and Lab Services not covered. Diagnostic Radiological Services have a copay of at most $270, Therapeutic Radiological Services have a copay of at most $40, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Edge (PPO) plan with no copay or 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 not covered by the PriorityMedicare Edge (PPO) plan. Although the plan covers Cardiac Rehabilitation Services, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Edge (PPO) plan. 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 over-the-counter items with a maximum benefit of $25 per month, including nicotine replacement therapy and naloxone. The plan does not cover meal benefits, and the "Other Services" benefit does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Other 1 has a $275 copay for Ambulance Stabilization/Non-transport services, and Other 2 covers Annual Wellness Visits.
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