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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 $570.00 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 $5900.00 (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 $5900.00 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 no 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 preferred generic drugs, you will pay a $10 copay at a preferred pharmacy or a $18 copay at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The PriorityMedicare Thrive (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays that vary by service. Emergency services and ambulance services have copays, and primary care, including mental health services, has copays. Preventive, hearing, vision, and dental services are covered, often with copays, and there is coverage for home infusion, dialysis, medical equipment, and diagnostic services with either copays or coinsurance. Skilled nursing and home health services are available with copays or no cost, while other services like acupuncture and over-the-counter items are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under PriorityMedicare Thrive (PPO), including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by PriorityMedicare Thrive (PPO). 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.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by PriorityMedicare Thrive (PPO). Ground and Air Ambulance Services have a $290 copay, 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 under the PriorityMedicare Thrive (PPO) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $40 copay, and 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 with a $20 copay, Occupational Therapy Services with a $25 copay, and Physician Specialist Services with a copay between $0 and $40. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a $5 copay for individual or group sessions, while Physical Therapy and Speech-Language Pathology Services have a $25 copay. Other Health Care Professional services have a copay between $0 and $40.
Preventive Services See details
The PriorityMedicare Thrive (PPO) plan covers preventive services, including Medicare-covered services with no copay and additional services with prior authorization. Some services such as Personal Emergency Response Systems, Medical Nutrition Therapy, and Re-admission Prevention are not covered.
Hearing Services See details
PriorityMedicare Thrive (PPO) covers hearing exams with no copay, and also covers routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $295 and $1495, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, and eyewear. Eyewear has a combined maximum benefit of $100 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are unlimited. Upgrades are not covered.
Dental Services See details
Dental services are covered, with no copay for Medicare dental services, and a copay of $0-$400 for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and oral and maxillofacial surgery are covered. Fluoride treatment, endodontics, prosthodontics (removable and fixed), implant services, and orthodontics 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, depending on the service. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%, depending on the service.
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 under the PriorityMedicare Thrive (PPO) plan, with a 20% coinsurance for Durable Medical Equipment (DME) and a coinsurance of 0-20% for Prosthetic Devices. 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 are covered, although Diagnostic Procedures/Tests and Lab Services are not. Diagnostic Radiological Services have a copay of at most $275, Therapeutic Radiological Services have a copay of at most $40, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Thrive (PPO), 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. 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 Thrive (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered 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, and over-the-counter items with a maximum benefit of $60 every three months. Other services include ambulance stabilization/non-transport with a $290 copay, annual wellness visits, and personalized health risk screenings with a $150 copay.
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