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PriorityMedicare Vital (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Vital (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Vital (PPO) in 2026, please refer to our full plan details page.
PriorityMedicare Vital (PPO) is a PPO plan offered by Corewell Health available for enrollment in 2025 to people living in West, SW, and SE counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that PriorityMedicare Vital (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 Vital (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 Vital (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. Additionally, this plan comes with a Part B Premium reduction of $45.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $450.00 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 $6300.00 (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 $6300.00 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 Vital (PPO) plan features an annual drug deductible of $450 before coverage begins. For Tier 1 preferred generic drugs, you will pay a $1 copay for a one-month supply at preferred pharmacies, while a three-month supply has no copay. Tier 2 generic drugs cost a $10 copay for a one-month supply at preferred pharmacies, and you will pay no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies, compared to a $47 copay at standard pharmacies. For higher-tier medications, Tier 4 non-preferred drugs incur a 25% coinsurance across all pharmacy options. Tier 5 specialty drugs require a 27% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The PriorityMedicare Vital (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits, annual physical exams, and home health services. Specialist office visits feature a low copay ranging from $0 to $50, while emergency room visits require a $130 copay that is waived if you are admitted. For hospital stays, members pay a $350 copay for the first several days of inpatient care and no copay for subsequent days. This plan also provides valuable supplemental benefits, including no copay for routine dental services up to a $1,500 yearly limit and routine hearing exams. Vision benefits feature a $50 copay for routine eye exams alongside an annual $125 eyewear allowance with no copay. Additionally, skilled nursing facility stays require no copay for the first 20 days, while durable medical equipment and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
PriorityMedicare Vital (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $350 copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
PriorityMedicare Vital (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital visits and a $130 copay per stay for observation services. Additionally, ambulatory surgical center services require a $50 copay, outpatient substance abuse sessions have a $20 copay, and outpatient blood services are covered with no copay or deductible.
Partial Hospitalization See details
PriorityMedicare Vital (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
PriorityMedicare Vital (PPO) covers ground and air ambulance services with a $265 copay and no coinsurance, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
PriorityMedicare Vital (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, and transportation services are also covered with no coinsurance and copays of $130, $50, and $265 respectively.
Primary Care See details
PriorityMedicare Vital (PPO) primary care benefits are partially covered because podiatry services are not covered. Covered services feature no coinsurance, with no copay for primary care visits, telehealth, and opioid treatment, a $20 copay for mental health and psychiatric sessions, a $30 copay for physical, occupational, and speech therapies, and a $0 to $50 copay for specialist visits.
Preventive Services See details
PriorityMedicare Vital (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. However, the benefit is only partially covered, as services such as counseling, medical nutrition therapy, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
PriorityMedicare Vital (PPO) hearing services are partially covered, offering one routine exam annually and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered every two years with a copay ranging from $99 to $399 and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services offered by PriorityMedicare Vital (PPO) include annual routine eye exams and retinal imaging for a $50 copay and no coinsurance, with no deductible. Eyewear, including contacts and eyeglasses, is covered with no copay or coinsurance up to a combined annual maximum benefit of $125.
Dental Services See details
PriorityMedicare Vital (PPO) dental services are partially covered with no coinsurance, featuring a $0 to $350 copay for Medicare-covered dental and no copay for other covered services up to a $1,500 annual limit. While routine exams, cleanings, and select restorative services are covered, orthodontics, maxillofacial prosthetics, other diagnostic services, and other preventive services are not covered.
Home Infusion bundled Services See details
PriorityMedicare Vital (PPO) covers Home Infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs range from no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under PriorityMedicare Vital (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by PriorityMedicare Vital (PPO), featuring no copay and 20% coinsurance for durable medical equipment and medical supplies, and no copay with 0% to 20% coinsurance for prosthetics. Diabetic equipment is covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by PriorityMedicare Vital (PPO), though diagnostic services are only partially covered because diagnostic procedures, tests, and lab services are not covered. Covered diagnostic services require no copay and no coinsurance, while radiological services require prior authorization and range from a $40.00 copay with no coinsurance for outpatient x-rays to a 20% coinsurance plus a copay for diagnostic radiological services, and a minimum $40.00 copay plus coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by PriorityMedicare Vital (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Vital (PPO) covers some cardiac rehabilitation services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Vital (PPO) covers Skilled Nursing Facility (SNF) services 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 for admission, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
PriorityMedicare Vital (PPO) partially covers other services, offering annual wellness visits and over-the-counter items with no copay and no coinsurance, acupuncture with a $20 copay and no coinsurance for up to six yearly treatments, and ambulance stabilization with a $265 copay and no coinsurance. Meal benefits are not covered.
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