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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 2025, 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 4.5 out of 5 stars in 2025.
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 $375.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $5600.00 (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 $5600.00 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 has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, in the initial coverage phase, preferred generic drugs have a $10 copay at a preferred pharmacy, while standard generic drugs have a $42 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The PriorityMedicare Vital (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a $350 copay for the first five days, and no copay for days 6-90. Outpatient services have varying copays, while emergency services have a $120 copay. Primary care visits are covered with no copay, and preventive services are also covered at no cost to you. This plan includes coverage for hearing and vision services, such as routine hearing exams with no copay and eyewear with a combined maximum benefit of $125 per year, as well as dental services like oral exams with a copay ranging from $0 to $350. Additionally, the plan covers home health services with no copay, and skilled nursing facility stays, with no copay for the first 20 days.
Inpatient Hospital See details
The PriorityMedicare Vital (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. For days 1-5, there is a $350 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services, are covered by the PriorityMedicare Vital (PPO) plan. Outpatient hospital services have a copay between $0 and $350, observation services have a $120 copay, Ambulatory Surgical Center (ASC) Services have a $350 copay, individual and group sessions for outpatient substance abuse have a $20 copay, and outpatient blood services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the PriorityMedicare Vital (PPO) plan. This benefit has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by PriorityMedicare Vital (PPO), with a $265 copay for both ground and air ambulance services 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 by the PriorityMedicare Vital (PPO) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $55 copay, Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $265 copay.
Primary Care See details
Primary Care, as part of the PriorityMedicare Vital (PPO) plan, includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay between $0 and $50, and Mental Health Specialty Services with a $20 copay for individual and group sessions. The plan also covers Other Health Care Professional services with a copay between $0 and $50, Psychiatric Services with a $20 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services. Podiatry Services are not covered.
Preventive Services See details
The PriorityMedicare Vital (PPO) plan covers preventive services, including annual physical exams and other services not usually covered by Medicare plans, with no copay. Additional services such as Health Education, In-Home Safety Assessment, Nutritional/Dietary Benefit, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Kidney Disease Education Services are covered. The plan does not cover Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams have no copay and are limited to one visit per year, while fitting/evaluation for hearing aids has no limits. Prescription Hearing Aids (all types) are covered for two hearing aids every two years. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$50, and eyewear with a combined maximum benefit of $125 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams with a copay ranging from $0 to $350 and other services like dental x-rays, cleanings, and oral surgery; however, maxillofacial prosthetics and orthodontics are not covered. Orthodontic services have a maximum plan benefit of $1500 per year.
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%. The plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Vital (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits under the PriorityMedicare Vital (PPO) plan include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with up to 20% coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Medical Supplies are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a coinsurance of at least 20%, while Therapeutic Radiological Services have a copay of $40, and Outpatient X-Ray Services have a copay of $40.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Vital (PPO) plan with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PriorityMedicare Vital (PPO) plan. Specifically, 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 Vital (PPO) plan. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The PriorityMedicare Vital (PPO) plan covers acupuncture with a $20 copay per visit, up to 6 treatments per year, and over-the-counter items with a $25 monthly maximum. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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