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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. For example, you'll pay a $10 copay for preferred generic drugs at a preferred pharmacy. In the initial coverage phase, after you meet your deductible, you will pay the costs for your drugs until your total drug costs reach $2000. Once you reach this amount, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The PriorityMedicare Vital (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. Emergency, primary care, preventive, hearing, vision, dental, and home health services are also covered, with some services having no copay. This plan includes additional benefits like home infusion, dialysis, and medical equipment coverage, with coinsurance or copays applying to some of these services. The plan also offers coverage for services such as skilled nursing facility, ambulance, and other services like acupuncture and OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $350 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and outpatient substance abuse services, are covered by PriorityMedicare Vital (PPO). 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, and both individual and group outpatient substance abuse sessions have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the PriorityMedicare Vital (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services each have a $265 copay, while 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, and 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
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 copay between $0 and $50, and mental health and psychiatric services with a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and other healthcare professional services have a copay between $0 and $50. Opioid treatment program services and additional telehealth benefits are also covered. Podiatry services are not covered.
Preventive Services See details
The PriorityMedicare Vital (PPO) plan covers preventive services, including annual physical exams and additional preventive services not usually covered by Medicare. The plan also covers health education, in-home safety assessments, post-discharge in-home medication reconciliation, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. However, the plan does not cover personal emergency response systems, medical nutrition therapy, 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.
Hearing Services See details
Hearing Services are covered, including hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams have no copay and are limited to one per year, while prescription hearing aids (all types) are limited to two every two years. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services include eye exams with a copay of $0-$50, and eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, all of which are unlimited, and upgrades, which are not covered. A combined maximum of $125 is offered for eyewear every year.
Dental Services See details
Dental services are covered, including oral exams with no copay, dental x-rays, and prophylaxis (cleaning) with no copay. Orthodontic services are covered up to a maximum of $1500 per year, and other services such as Fluoride Treatment, Endodontics, Prosthodontics, fixed, implant services, and Prosthodontics, removable are offered as optional, supplemental benefits. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Vital (PPO) plan. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a coinsurance of 0-20%, and Medical Supplies with a 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all diagnostic services. Diagnostic Procedures/Tests and Lab Services are not covered. For Diagnostic Radiological Services, you pay at least 20% coinsurance, and for Therapeutic Radiological Services, you pay a $40 copay. Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Vital (PPO) plan, with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PriorityMedicare Vital (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
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.
Other Services See details
Under the PriorityMedicare Vital (PPO) plan, acupuncture has a $20 copay per visit, up to 6 treatments per year. Over-the-counter (OTC) items are covered with a maximum benefit coverage amount of $25 every month. Other services like meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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