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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. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for one-month, two-month, or three-month supplies filled through standard pharmacies or standard mail order. This makes managing everyday generic prescriptions highly affordable under this Medicare plan. For higher-tier medications, including Tier 3 preferred brand, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies and standard mail-order options for up to a three-month supply, or a one-month supply for Tier 5 specialty drugs. These straightforward cost-sharing tiers help you easily project your out-of-pocket prescription costs.
Additional Benefits
The PriorityMedicare Dual Premier (HMO D-SNP) plan offers comprehensive coverage with no copays and no coinsurance for primary care visits, specialist consultations, telehealth, and preventive services. Members also benefit from no copays or coinsurance for routine hearing and vision exams, which include annual allowances for eyewear and prescription hearing aids. Home health services and the first 20 days of a skilled nursing facility stay are also fully covered with no copay or coinsurance. For other medical needs, inpatient hospital admissions require a $2,000 copay, while emergency room visits carry a $115 copay that is waived if you are admitted. Outpatient hospital services, diagnostic tests, ambulance transport, and durable medical equipment feature no copay but require coinsurance ranging from 20% to 35%. Skilled nursing facility stays from days 21 through 100 require a daily copay of $218, and Medicare Part B insulin drugs are capped at a $35 copay.
Inpatient Hospital See details
PriorityMedicare Dual Premier (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,000 copay per admission and no coinsurance, though prior authorization is required. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services are covered by PriorityMedicare Dual Premier (HMO D-SNP) with no copays, though a 35% coinsurance applies to ambulatory surgical center, observation, and blood services, and up to 35% coinsurance applies to outpatient hospital services. For outpatient substance abuse, some services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
PriorityMedicare Dual Premier (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by PriorityMedicare Dual Premier (HMO D-SNP) with a 35% coinsurance and no copay for both ground and air transportation, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by PriorityMedicare Dual Premier (HMO D-SNP) with a $115 copay and no coinsurance, with the copay waived if you are 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) covers primary care, specialist, chiropractic, podiatry, telehealth, and opioid treatment services with no copay and no coinsurance. Occupational, physical, speech, and other healthcare professional services require no copay and a 30% to 35% coinsurance, and while mental health and psychiatric benefits are technically covered, only some services are covered as individual and group sessions are not covered.
Preventive Services See details
PriorityMedicare Dual Premier (HMO D-SNP) offers coverage for preventive services with no copay and no coinsurance, though the benefit is partially covered. Excluded from coverage are medical nutrition therapy, re-admission prevention, wigs for chemotherapy-related hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, additional smoking cessation counseling, remote access technologies, and counseling services.
Hearing Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers hearing services with no copay and no coinsurance, including one routine hearing exam annually, unlimited fitting evaluations, and up to two prescription hearing aids every three years. However, this benefit is only partially covered, as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers vision services with no copay, no coinsurance, and no deductible. This benefit includes one routine eye exam and one retinal imaging exam per year, as well as a $200 annual allowance for contact lenses, eyeglasses, frames, lenses, 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 services featuring no copay and a coinsurance ranging from no coinsurance to 35% with prior authorization. Non-covered services include preventive care like cleanings, exams, and x-rays, as well as comprehensive treatments like restorative services and orthodontics.
Home Infusion bundled Services See details
PriorityMedicare Dual Premier (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy apply. Covered Medicare Part B drugs, including chemotherapy and radiation, carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the PriorityMedicare Dual Premier (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
PriorityMedicare Dual Premier (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and a 20% coinsurance. Prior authorization is required for DME 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, subject to prior authorization. Diagnostic procedures, lab services, diagnostic radiology, and outpatient X-rays require a 35% coinsurance, while therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by PriorityMedicare Dual Premier (HMO D-SNP) with no copay and no coinsurance, though 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, though prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and a prior three-day inpatient hospital stay is not required.
Other Services See details
PriorityMedicare Dual Premier (HMO D-SNP) partially covers other services with no copay and no coinsurance, including up to six acupuncture treatments per year, over-the-counter items, ambulance stabilization, and annual wellness visits. Meal benefits are not covered under this plan.
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