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PriorityMedicare Dual Premier (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for PriorityMedicare Dual Premier (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 Dual Premier (HMO D-SNP) in 2026, please refer to our full plan details page.
PriorityMedicare Dual Premier (HMO D-SNP) is a HMO D-SNP plan offered by Corewell Health available for enrollment in 2026 to people living in SE MI, Barry, Wayne and Macomb. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that PriorityMedicare Dual Premier (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 Dual Premier (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 Dual Premier (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 Dual Premier (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 $615.00 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 $9250.00 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 Dual Premier (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. This ensures affordable access to common maintenance medications for one-month, two-month, or three-month supplies. For Tier 3 preferred brand and Tier 4 non-preferred drugs, the plan requires a 25% coinsurance for all supply durations up to three months. Additionally, Tier 5 specialty drugs carry a 25% coinsurance, which is limited to a one-month supply at standard retail and mail-order pharmacies. These clear cost-sharing tiers help you accurately budget your yearly prescription medication costs.
Additional Benefits
The PriorityMedicare Dual Premier (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, specialist consultations, preventive services, and home health care. For inpatient hospital stays, members pay a $2,000 copay per admission with no coinsurance, while outpatient hospital services generally require no copay but carry up to a 35% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features supplemental benefits, including routine hearing and vision exams with no copay and no coinsurance, alongside a $200 annual eyewear allowance. While routine non-Medicare dental services are not covered, Medicare-covered dental care, dialysis, and durable medical equipment are available with no copays and coinsurance ranging from 0% to 35%. Additionally, skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
PriorityMedicare Dual Premier (HMO D-SNP) covers inpatient acute and psychiatric hospital services with a $2,000 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers outpatient services with no copays, but a 35% coinsurance applies to ambulatory surgical, observation, and blood services, and up to 35% coinsurance for outpatient hospital services. Additionally, some outpatient substance abuse services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by PriorityMedicare Dual Premier (HMO D-SNP) with no copay and a 30% coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers ground and air ambulance services with a 35% coinsurance and no copay, though prior authorization is required. Some transportation services are covered, but transportation to plan-approved or health-related locations is not covered.
Emergency Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a 30% coinsurance (up to $40 per visit) and no copay, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
PriorityMedicare Dual Premier (HMO D-SNP) offers primary care, specialist, chiropractic, podiatry, telehealth, and opioid treatment services with no copay and no coinsurance. Physical, occupational, and speech therapy services are covered with no copay and a 30% coinsurance, while services from other health care professionals require a 35% coinsurance and no copay. Mental health and psychiatric services are partially covered with no copay and no coinsurance, but individual and group sessions for both of these services are not covered.
Preventive Services See details
Preventive services are covered by PriorityMedicare Dual Premier (HMO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive benefits are partially covered, excluding medical nutrition therapy, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, additional smoking cessation counseling, remote access technologies, and counseling services.
Hearing Services See details
Hearing services are covered under PriorityMedicare Dual Premier (HMO D-SNP) with no copay and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers vision services with no copays, no coinsurance, and no deductibles. This benefit includes one routine eye exam and one retinal imaging exam per year, alongside a combined $200 annual allowance for eyewear, including contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by PriorityMedicare Dual Premier (HMO D-SNP), with coverage limited to Medicare-covered dental care featuring no copay and 0% to 35% coinsurance, subject to prior authorization. Non-Medicare dental services, including exams, cleanings, x-rays, restorative care, and orthodontics, are not covered.
Home Infusion bundled Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy, radiation, and other Part B drugs have no copay and require no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Dual Premier (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a 20% coinsurance. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers diagnostic and radiological services with no copay, though prior authorization is required. Patients will pay a minimum coinsurance of 35% for diagnostic tests, lab services, diagnostic radiology, and outpatient X-rays, and a minimum coinsurance of 20% for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Dual Premier (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
PriorityMedicare Dual Premier (HMO D-SNP) covers Skilled Nursing Facility (SNF) services 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 needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services under the PriorityMedicare Dual Premier (HMO D-SNP) are partially covered, offering no copay and no coinsurance for acupuncture (limited to 6 treatments per year), over-the-counter items, ambulance stabilization, and annual wellness visits. However, some services such as meal benefits and highly integrated services for dual eligible SNPs are not covered by the plan.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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