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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 2025, 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 4.5 out of 5 stars in 2025.
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 $240.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5700.00 (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 $5700.00 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 has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy (LIS), you may have reduced premiums.
Additional Benefits
The PriorityMedicare Thrive (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. Primary care services have no copay, while specialist visits and therapies like physical and occupational therapy have copays between $5 and $40. The plan also includes preventive services, hearing and vision care, and dental coverage. Additional benefits include coverage for ambulance services with a $290 copay, and emergency services with a $120 copay. There are also benefits for home health services with no copay, and skilled nursing facility care, with a copay after the first 20 days. The plan also offers coverage for acupuncture, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $320 copay for days 1-7, and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $400, observation services have a $120 copay, and ambulatory surgical center services have a $400 copay. Individual and group sessions for outpatient substance abuse have a copay of $5.00. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the PriorityMedicare Thrive (PPO) plan, but prior authorization is required. You will have a $55 copay for this service.
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 have a $290 copay and no coinsurance, 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. Emergency Services have a $120 copay, Urgently Needed Services have a $40 copay, Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay. Chiropractic Services have a $20 copay, including routine care with a $20 copay for up to 12 visits per year and other services with a $20 copay for 1 visit per year. Occupational Therapy Services have a $25 copay, while Physician Specialist Services have a copay ranging from $0 to $40. Mental Health Specialty Services have a $5 copay for both individual and group sessions, and Psychiatric Services have a $5 copay for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits are covered, and Opioid Treatment Program Services have a $5 copay.
Preventive Services See details
Preventive Services are covered by PriorityMedicare Thrive (PPO), including Medicare-covered preventive services with a doctor referral, annual physical exams, additional preventive services with prior authorization, health education, in-home safety assessments, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit; however, 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, and counseling services are not covered. Additionally, the plan covers a Fitness Benefit with a maximum plan benefit coverage amount of $185.00 every year, Home and Bathroom Safety Devices and Modifications with a maximum plan benefit coverage amount of $60.00 every three months, and a Nutritional/Dietary Benefit.
Hearing Services See details
Hearing Services are covered, including routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $295 and $1495 for two visits every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The PriorityMedicare Thrive (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear, with a combined maximum benefit of $100 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, but upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams with no copay, dental x-rays, prophylaxis (cleaning), and oral and maxillofacial surgery. Orthodontic services have a maximum benefit of $1,500 per year. Other services such as fluoride treatment, endodontics, prosthodontics (removable and fixed), and implant services are offered as optional supplemental benefits, and maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the PriorityMedicare Thrive (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by PriorityMedicare Thrive (PPO), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 0-20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies/Therapeutic Shoes/Inserts are not covered. Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by PriorityMedicare Thrive (PPO). Diagnostic procedures/tests and lab services are not covered. Diagnostic Radiological Services have a copay of at most $275.00, Therapeutic Radiological Services have a copay of at most $40.00, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare Thrive (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 Thrive (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the PriorityMedicare Thrive (PPO) plan, but require prior authorization. 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 Thrive (PPO) plan covers acupuncture with a $20 copay for up to 6 treatments per year, and over-the-counter (OTC) items with a maximum benefit of $60 every three months. The plan also covers "Other 1" services with a $290 copay, and "Other 3" services with a $150 copay. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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