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PriorityMedicare D-SNP (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare D-SNP (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on PriorityMedicare D-SNP (HMO D-SNP) in 2025, please refer to our full plan details page.
PriorityMedicare D-SNP (HMO D-SNP) is a HMO D-SNP plan offered by Corewell Health available for enrollment in 2025 to people living in 68 lower peninsula Michigan counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that PriorityMedicare D-SNP (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
PriorityMedicare D-SNP (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about PriorityMedicare D-SNP (HMO D-SNP).
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 D-SNP (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.60. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 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 Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 D-SNP (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $26.60. In the initial coverage phase, you pay the costs for your drugs until your total drug costs reach $2,000. After that, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The PriorityMedicare D-SNP (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1800 copay per admission, while outpatient services, including emergency and urgently needed services, have coinsurance requirements. Transportation, primary care, preventive services, hearing, vision, dental, and home health services are also covered, and the plan includes coverage for home infusion, dialysis, medical equipment, and diagnostic services, and skilled nursing. The plan provides additional benefits such as ambulance services, certain vision and dental services, and coverage for some over-the-counter items. Preventive services are available, including routine exams, and there is coverage for hearing aids, with specific limitations. Additional benefits include coverage for acupuncture, and over-the-counter items up to a certain monthly limit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Inpatient Hospital-Acute has a copay of $1800 per admission or stay, and additional days have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric additional days and non-Medicare-covered stays are also not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services with a 0% - 35% coinsurance, observation services with a 0% - 35% coinsurance, and Ambulatory Surgical Center (ASC) services with 35% coinsurance. Outpatient Substance Abuse Services (individual and group sessions) are not covered. Outpatient Blood Services are covered with a 35% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 35% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered, with a 35% coinsurance for both ground and air ambulance services, and no copay. Transportation services to any health-related location are covered for up to 30 one-way trips per year.
Emergency Services See details
Emergency Services are covered, with a $110 copay and no coinsurance. Urgently Needed Services are covered, with 35% coinsurance and no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are also covered.
Primary Care See details
The PriorityMedicare D-SNP (HMO D-SNP) plan covers Primary Care Physician Services and Chiropractic Services, with up to 24 routine chiropractic visits and 1 X-ray per year. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services have a 35% coinsurance, while Other Health Care Professional services have a coinsurance of 35%. Mental Health Specialty Services and Psychiatric Services are not covered, and Additional Telehealth Benefits are available for some services.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with a doctor referral, annual physical exams, additional preventive services, health education, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, nutritional/dietary benefits (12 visits), support for caregivers of enrollees, fitness benefits, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications ($70 per month), kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, while medical nutrition therapy, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and counseling services are not covered. Additional preventive services have a maximum plan benefit coverage amount, and home and bathroom safety devices and modifications have a maximum plan benefit coverage amount of $70 per month.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year. Fitting/evaluation for hearing aids is covered with no limit. Prescription hearing aids (all types) are covered with a limit of two every two years; however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The PriorityMedicare D-SNP (HMO D-SNP) plan covers routine eye exams and other eye exam services once per year, and eyewear with a combined maximum of $200 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered. Upgrades are not covered.
Dental Services See details
Dental Services are covered, with a yearly maximum of $1,500. Medicare Dental Services are covered with coinsurance between 0% and 35%, while other dental services cover oral exams (2 per year), dental x-rays (1 bitewing per year or 1 full mouth/panoramic every 2 years), prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), periodontics (2 per year), and oral and maxillofacial surgery (1 per year). Restorative services, adjunctive general services, endodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the PriorityMedicare D-SNP (HMO D-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered under the PriorityMedicare D-SNP (HMO D-SNP) plan, with no copay for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, and Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts all have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services. Diagnostic procedures and tests, lab services, and outpatient x-ray services have a coinsurance of at most 35%, while therapeutic radiological services have a coinsurance of at most 20%; all services have no copay.
Home Health Services See details
Home Health Services are covered by the PriorityMedicare D-SNP (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the PriorityMedicare D-SNP (HMO D-SNP) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by PriorityMedicare D-SNP (HMO D-SNP), with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include acupuncture and over-the-counter (OTC) items. Acupuncture is covered for 6 treatments per year. OTC items are covered up to $70.00 per month, and include nicotine replacement therapy and Naloxone.
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