What to know about Priority Health Medicare Advantage plans
Priority Health is a private company in Michigan that offers Medicare Advantage plans. The plans provide hospitalization and medical insurance, along with prescription drug coverage and other benefits.
Medicare Advantage is an alternative to Original Medicare parts A and B. This provides both hospital insurance and medical insurance.
This article provides an overview of Priority Health and its Medicare Advantage plans. It also looks at the types of Advantage plans Priority Health offers as well as coverage, costs, and enrollment options.
What is Priority Health?
This article originally appeared on Medical News Today
Priority Health is a Michigan-based nonprofit health insurance company that has been in business for more than 30 years.
The company offers individual and group policies in addition to Medicare Advantage and Medicaid plans.
Medicare Advantage plans are available in all counties of Michigan’s Lower Peninsula. Medigap plans are available throughout Michigan.
Priority Health offers a free well-being hub that provides medical information tailored to each person’s needs. The tool aims to help people manage their conditions and develop positive lifestyle habits.
In 2024, the company’s Medicare plans received a 4.5-star overall rating.
What is Medicare Advantage?
Medicare Advantage is the alternative to Original Medicare, which consists of Part A, which covers hospital insurance, and Part B, which covers medical insurance.
Companies offering Medicare Advantage plans contract with Medicare to provide all the Original Medicare coverage. They may also offer prescription drug coverage and other benefits such as dental and vision care.
One difference between Medicare Advantage plans and Original Medicare is the choice of healthcare providers. A person with Original Medicare can use any providers who accept Medicare, while someone with a Medicare Advantage plan must often use in-network providers to get lower costs.
Medicare Advantage plans also have different out-of-pocket costs than Original Medicare, and the plans put a yearly cap on healthcare expenses.
Learn about the pros and cons of Medicare Advantage.
What kind of Advantage plans does Priority Health offer?
Priority Health offers several Medicare Advantage plans, from PriorityMedicare Key to PriorityMedicare Select. However, all the plans are either health maintenance organization point-of-service (HMO-POS) or preferred provider organization (PPO).
Health maintenance organization point-of-service (HMO-POS)
In an HMO-POS, a person must choose from a network of doctors, hospitals, and other providers. The plan allows the use of out-of-network providers, but the costs may be higher.
The HMO-POS plan usually does not require a referral to see a specialist but requires prior authorization from a doctor for some services.
Preferred provider organization (PPO)
A PPO plan gives a person a financial incentive to use in-network providers, as the cost may be higher if they use out-of-network providers.
The PPO plan does not require a referral to see a specialist or prior authorization for services from out-of-network providers.
Priority Health Advantage plan coverage
Priority Health Advantage plans all provide coverage for:
hospitalization
doctor visits
lab tests
prescription drugs
The plans also offer telehealth and some dental, vision, and hearing care. An extra perk involves membership to SilverSneakers, a fitness program offering access to online education programs and group exercise classes at gyms.
Although the company offers plans only to Michigan residents, a person can still get benefits from Medicare-participating providers when traveling to other states. This means people can still have healthcare coverage when they are away from their homes in Michigan.
What are Priority Health Advantage plan costs?
Costs for Priority Health Advantage plans vary depending on the plan a person chooses and in which Michigan county they live.
In addition, the company offers preferred drug store pricing on prescription drugs and a $0 copay on tier 1 and tier 2 drugs through 90-day mail order.
Premiums
The monthly premiums for the company’s Medicare Advantage plans can vary.
For example, both PriorityMedicare Key and PriorityMedicare Edge have $0 premiums.
The monthly premium for PriorityMedicare Ideal is $19, while the monthly premium for PriorityMedicare Merit is $73.
Out-of-pocket costs
Annual out-of-pocket caps also vary. The lower-premium plans have higher annual caps.
For example, PriorityMedicare Key has a maximum in-network out-of-pocket cost of $5,000, while PriorityMedicare Merit has a figure of $4,100.
Copays
A person may need to pay a copay for:
primary care doctor visits
specialist doctor visits
hospital visits
prescription drugs
The amount a person may need to pay will depend on the individual plan.
Learn more about Medicare Advantage costs.
Advantage plan enrollment options
Before enrolling in a Priority Health Advantage plan, a person may want to use this search tool to see all the options in their area. It will show the Advantage plans from Priority Health, along with those from other private companies.
Once a person decides on a plan, they may sign up during one of three Medicare enrollment periods:
Medicare Advantage Open Enrollment Period: The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 of every year.
Initial Enrollment Period: The Initial Enrollment Period is a 7-month period that begins 3 months before a person turns 65 years, continues during their birthday month, and ends 3 months later.
Open Enrollment Period: The Open Enrollment Period for Medicare Advantage and Medicare prescription drug plans is from October 15 to December 7 of every year.
Learn more about Medicare enrollment periods.
Summary
Priority Health contracts with Medicare to offer a variety of Advantage plans. They are an alternative to Original Medicare (parts A and B) and provide all the same benefits.
All the Priority Health Medicare Advantage options are either health maintenance organization point-of-service (HMO-POS) or preferred provider organization (PPO) plans. A person with one of the plans may use out-of-network providers, but these may involve higher costs.
View the original article on Medical News Today
