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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 for your prescriptions depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you will pay a $10 copay at a preferred pharmacy or a $15 copay at a standard pharmacy. For preferred brand drugs, you will pay 45% coinsurance at a preferred pharmacy or 50% coinsurance at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PriorityMedicare Vital (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for the first five days, with no copay for the remaining days. Outpatient services, emergency services, and primary care visits have copays that vary, while preventive services are covered, and many services have no copay. The plan also covers hearing, vision, and dental services, including routine exams and eyewear, with some cost-sharing. Additionally, the plan offers coverage for home infusion, dialysis, medical equipment, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For days 1-5, the copay is $350, and for days 6-90, there is no copay. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for the PriorityMedicare Vital (PPO) plan covers outpatient hospital services with a copay between $0 and $350, observation services with a $120 copay, and ambulatory surgical center services with a $350 copay. Outpatient substance abuse services and outpatient blood services are also covered, with individual and group therapy sessions having a $20 copay, and outpatient blood services including an enhanced benefit.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Vital (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 by the PriorityMedicare Vital (PPO) plan, 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 PriorityMedicare Vital (PPO). Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Transportation has a $265 copay. Worldwide Urgent Coverage has a $55 copay. There is no coinsurance for any of these services.
Primary Care See details
The PriorityMedicare Vital (PPO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $0-$50 copay, Mental Health Specialty Services with a $20 copay for both 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
PriorityMedicare Vital (PPO) covers preventive services, including Medicare-covered preventive services with a required doctor referral, annual physical exams, health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan does not cover personal emergency response systems (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, or counseling services. Home and bathroom safety devices and modifications are covered up to $25 per month.
Hearing Services See details
Hearing Services includes routine hearing exams with no copay and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered, but 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, and contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames with no copay or coinsurance. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including oral exams with no copay, Dental X-Rays with no copay, and prophylaxis (cleaning) with no copay. Orthodontic Services are covered up to a maximum of $1500 per year, and some services like Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the PriorityMedicare Vital (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by the PriorityMedicare Vital (PPO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a coinsurance between 0% and 20%. Medical Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include all diagnostic services with no copay, but diagnostic procedures/tests and lab services are not covered. Radiological Services include diagnostic services with a coinsurance of at least 20% and outpatient X-ray services with a $40 copay. Therapeutic Radiological 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 additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PriorityMedicare Vital (PPO) plan. The plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Vital (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered 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 for up to 6 treatments per year, and over-the-counter items up to $25 per month, including nicotine replacement therapy and Naloxone. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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