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PriorityMedicare Thrive (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Thrive (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare Thrive (PPO) in 2026, please refer to our full plan details page.
PriorityMedicare Thrive (PPO) is a PPO plan offered by Corewell Health available for enrollment in 2025 to people living in 68 lower peninsula counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that PriorityMedicare Thrive (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 Thrive (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 Thrive (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 $270.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $250.00 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 $6200.00 (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 $6200.00 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 Thrive (PPO) plan features an annual prescription drug deductible of $250. For Tier 1 preferred generic drugs, you will pay a $2 copay for a 1-month supply at preferred pharmacies or preferred mail order, with no copay for a 3-month supply. Tier 2 generic drugs cost an $8 copay for a 1-month supply at preferred locations, and you can receive a 3-month supply with no copay when using preferred mail order. For brand-name and specialty medications, the plan charges coinsurance instead of flat copays. You will pay a 21% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply across all pharmacy and mail-order options.
Additional Benefits
PriorityMedicare Thrive (PPO) offers comprehensive medical coverage with no copays for primary care visits, telehealth, and home health services, while specialist visits require copays between $5 and $40. For hospital care, there is no coinsurance, though inpatient stays require a daily copay for the first several days and outpatient services carry copays up to $400. Emergency care is covered with a $130 copay, and urgent care has a $50 copay, both of which are waived upon hospital admission. This plan features no copays or coinsurance for most routine dental and preventive services, alongside a $40 copay for routine eye exams and no copay for eyewear up to a $100 annual limit. Routine hearing exams are covered with no copay, while prescription hearing aids require copays between $295 and $1,495. Additionally, durable medical equipment and dialysis services require a 20% coinsurance, though many other covered services feature no coinsurance.
Inpatient Hospital See details
PriorityMedicare Thrive (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 7 of acute stays and a $350 daily copay for days 1 through 5 of psychiatric stays, followed by no copay for remaining days. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
PriorityMedicare Thrive (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $400 and observation services with a $130 copay per stay. Ambulatory surgical center services require a $40 copay, outpatient substance abuse sessions have a $5 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
PriorityMedicare Thrive (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
PriorityMedicare Thrive (PPO) covers ground and air ambulance services with a $290 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
PriorityMedicare Thrive (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $50 to $290.
Primary Care See details
PriorityMedicare Thrive (PPO) primary care benefits are partially covered, offering primary care physician visits and telehealth services with no copay and no coinsurance, while podiatry services are not covered. Other covered services, such as specialist visits, chiropractic care, therapy, and mental health services, require copays ranging from $5 to $40 with no coinsurance.
Preventive Services See details
PriorityMedicare Thrive (PPO) partially covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and a fitness benefit. Sub-services that are not covered under this plan include personal emergency response systems, medical nutrition therapy, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation, remote access technologies, and counseling.
Hearing Services See details
Hearing services under PriorityMedicare Thrive (PPO) are partially covered, offering routine hearing exams and fitting evaluations with no copay and no coinsurance. While up to two prescription hearing aids per year are covered with no coinsurance and a copay ranging from $295.00 to $1,495.00, OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Thrive (PPO) covers vision services with no deductibles, featuring a $40 copay and no coinsurance for annual routine eye exams and retinal imaging. Eyewear, such as contacts and eyeglasses, is covered with no copay or coinsurance up to a combined annual limit of $100.
Dental Services See details
PriorityMedicare Thrive (PPO) covers dental services with no copay and no coinsurance for most preventive and comprehensive benefits, while Medicare-covered dental services require a copay of $0 to $400 with no coinsurance. The plan is partially covered as it does not cover other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
PriorityMedicare Thrive (PPO) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by PriorityMedicare Thrive (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by PriorityMedicare Thrive (PPO) with no copays, though coinsurance and prior authorization requirements vary by item. Durable medical equipment and medical supplies carry a 20% coinsurance (0% to 20% for prosthetics), while diabetic equipment is partially covered with no coinsurance, excluding diabetic supplies and therapeutic shoes or inserts which are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare Thrive (PPO) diagnostic and radiological services are covered with no coinsurance and require prior authorization. Some diagnostic services are covered with no copay, though diagnostic procedures, tests, and lab services are not covered. Radiological services feature no copay for outpatient X-rays, a minimum $40 copay for therapeutic radiology, and a minimum $275 copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Thrive (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by PriorityMedicare Thrive (PPO) with no coinsurance, but some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Thrive (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, although a three-day inpatient hospital stay is not required prior to admission, and additional days beyond the 100-day limit are not covered.
Other Services See details
PriorityMedicare Thrive (PPO) offers partially covered other services with no coinsurance, though meal benefits are not covered. Covered benefits include annual wellness visits and over-the-counter items with no copay, acupuncture for a $20 copay (limited to 6 treatments per year), personalized health risk screenings for a $150 copay, and ambulance stabilization for a $290 copay.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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