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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 $600.00 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 a $250 annual drug deductible before coverage begins for certain tiers. For Tier 1 preferred generic drugs, you can expect no copay for a 3-month supply through preferred pharmacies or preferred mail order, while a 1-month supply starts at a $2 copay. Tier 2 generic drugs also offer no copay for a 3-month supply via preferred mail order, though standard pharmacy copays range from $15 to $45. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, and Tier 4 non-preferred drugs carry a 25% coinsurance across all pharmacy types. Specialty drugs in Tier 5 require a 30% coinsurance for a 1-month supply at both standard and preferred pharmacies.
Additional Benefits
PriorityMedicare Thrive (PPO) offers comprehensive medical coverage featuring no copay for primary care physician visits, telehealth, annual physicals, and home health services, all with no coinsurance. For advanced care, members pay no coinsurance alongside predictable copays, including up to a $40 copay for specialists, a $130 copay for emergency room visits, and a $375 daily copay for the first seven days of inpatient hospital stays. This plan also provides robust supplemental benefits with no coinsurance, including routine hearing exams and preventive dental care up to $1,500 annually with no copay. While dialysis and durable medical equipment require a 20% coinsurance, members enjoy no copay for diabetic equipment, home infusion services, and over-the-counter items.
Inpatient Hospital See details
PriorityMedicare Thrive (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $375 for days 1 through 7 of acute stays and $350 for days 1 through 5 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
PriorityMedicare Thrive (PPO) covers outpatient hospital services with copays from $0 to $400 and observation services for a $130 copay per stay, both with no coinsurance. Additionally, ambulatory surgical center services require a $40 copay, outpatient substance abuse sessions have a $5 copay, and outpatient blood services carry no copay, all with no coinsurance.
Partial Hospitalization See details
PriorityMedicare Thrive (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization is required for some services.
Ambulance and Transportation Services See details
PriorityMedicare Thrive (PPO) partially covers Ambulance and Transportation Services, offering ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
PriorityMedicare Thrive (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and no deductible, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered with no coinsurance or deductible, requiring a $130 copay for emergency care, a $50 copay for urgent care, and a $290 copay for emergency transportation.
Primary Care See details
PriorityMedicare Thrive (PPO) primary care benefits are partially covered, as podiatry services are not covered under this plan. Covered services feature no coinsurance, offering no copay for primary care physician visits and telehealth, a $0 to $40 copay for specialists, a $20 copay for physical, occupational, and speech therapy, and copays ranging from $5 to $20 for chiropractic, mental health, psychiatric, and opioid treatment services.
Preventive Services See details
PriorityMedicare Thrive (PPO) offers partially covered preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and a fitness benefit. However, several supplemental options are not covered, such as personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by PriorityMedicare Thrive (PPO), offering one annual routine exam and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $295.00 to $1,495.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
PriorityMedicare Thrive (PPO) covers annual routine eye exams and retinal imaging with a $40 copay, no coinsurance, and no deductible. Eyewear, including contacts, lenses, and frames, is covered with no copay or coinsurance up to a $100 combined annual maximum benefit.
Dental Services See details
PriorityMedicare Thrive (PPO) partially covers dental services with a $1,500 annual limit, offering no copay and no coinsurance for most covered preventive and restorative care, while Medicare-covered dental services require a $0 to $400 copay and no coinsurance. Other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
PriorityMedicare Thrive (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from 0% (no coinsurance) to 20%, while Part B insulin drugs have a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by PriorityMedicare Thrive (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Thrive (PPO) partially covers medical equipment with no copays for covered items, though a 20% coinsurance applies to durable medical equipment and medical supplies, and a 0% to 20% coinsurance applies to prosthetic devices. While diabetic equipment is covered with no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
PriorityMedicare Thrive (PPO) covers diagnostic and radiological services with no coinsurance and prior authorization required, though diagnostic procedures, tests, and lab services are not covered. Diagnostic services and outpatient X-rays have no copay, while therapeutic radiological services require a minimum $40 copay and diagnostic radiological services require a minimum $275 copay.
Home Health Services See details
PriorityMedicare Thrive (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Thrive (PPO) covers Cardiac Rehabilitation Services with no coinsurance, but in practice, some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PriorityMedicare Thrive (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the 100-day limit are not covered.
Other Services See details
Other Services under PriorityMedicare Thrive (PPO) are partially covered, as meal benefits are not covered. Covered benefits include acupuncture with a $20 copay and no coinsurance, over-the-counter items and annual wellness visits with no copay and no coinsurance, personalized health risk screenings with a $150 copay and no coinsurance, and ambulance stabilization with a $290 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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