Priority Health Medicare Advantage plans: What to know
Priority Health is a nonprofit company that provides health benefits to people in Michigan. They offer several Medicare Advantage plans, which people can compare on the Priority Health website.
The cost of Priority Health Medicare Advantage plans may depend on plan specifics and coverage levels. Plans may offer benefits, such as certain preventive screenings and coverage for services when traveling out of state.
This article explains what to expect from Priority Health Medicare Advantage plans, including cost, coverage, and how to choose the right one for you.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
About Medicare Advantage
This article originally appeared on Medical News Today
Private insurance companies administer Medicare Advantage plans, also known as Medicare Part C.
These health insurance plans combine the benefits of Medicare Part A and Part B and may offer additional benefits, such as vision, dental, and hearing care.
According to the Kaiser Family Foundation, in 2024, 97% of people with Medicare Advantage plans available for open enrollment are in plans that offer prescription coverage.
Different types of Medicare Advantage plans are available, including:
Health Maintenance Organization Point-of-Service (HMO-POS)
Preferred Provider Organization (PPO)
Priority Health offers HMO-POS and PPO healthcare plans.
About Priority Health
Priority Health is a nonprofit healthcare company offering a range of health insurance plans, including:
individual
family
Medicare Advantage
Medigap
All plans include prescription drug coverage, and Priority Health maintains a list of covered drugs, known as a formulary, on their website.
Priority Health plans
Priority Health offers Medicare Advantage HMO-POS and PPO plans.
HMO-POS plans
People with an HMO plan may choose to receive their care from a network of participating healthcare providers. Individuals must select an in-network primary care physician (PCP), and they will require a referral to visit a specialist.
There is more flexibility in an HMO-POS plan, as a person can choose to visit an out-of-network healthcare provider.
A Priority Health HMO-POS plan follows this rule. It also requires a person to select a PCP to coordinate their care. Usually, the PCP does not need to provide a referral for an individual to see a specialist.
Some out-of-network services will require prior authorization from Priority Health.
The plan has two deductibles—one for the HMO and one for the POS. The deductible for the HMO applies to care received in-network, and the deductible for the POS applies to care received out-of-network. A person must pay each deductible separately.
PPO plans
Priority Health also offers a PPO plan that does not require a person to select a PCP. The person does not need a referral to see a specialist and does not need prior authorization for services outside the network.
The person pays a combined deductible for in-network and out-of-network services.
Other plans
Priority Health also offers a dual eligibility SNP (D-SNP). This plan combines Medicare and Medicaid benefits.
To enroll in a Priority Health D-SNP, a person must have original Medicare (parts A and B) and be eligible for full Medicaid benefits.
The plan includes prescription drug benefits and a care management team.
Priority Health plan coverage
Priority Health Medicare Advantage plans offer benefits that include:
$0 copayment after day 6 of an inpatient stay
no limit on the number of inpatient days that the plan covers
set copayment amount for emergency room and urgent care center visits
fixed copayments for diagnostic tests, radiation therapy, and outpatient X-rays
chiropractic care and acupuncture services
BrainHQ — an online exercise program for cognitive health
SilverSneakers — a health and fitness program with a $0 copayment
Most plans also have a $0 copayment for wellness visits and preventive services, including:
annual wellness visit
bone mass measurement
diabetes screening
heart disease screening
hepatitis B and C screening
HIV screening
HPV screening
immunizations
sexually transmitted infection screening and counseling
How much do Priority Health plans cost?
Priority Health Medicare Advantage plan costs vary depending on the specific plan and coverage level that a person chooses.
People must also pay the Medicare Part B premium. Some plans have a deductible associated with the in-network services.
Each plan has an out-of-pocket maximum, meaning a cap on the amount of money a person pays for in-network and some out-of-network services each year. Priority Health then pays 100% of eligible costs.
The out-of-pocket maximums include copayments and coinsurance but do not include drug costs or the monthly premium to Priority Health.
Location for Priority Health plan coverage
Priority Health only operates in Michigan, but some plans have an out-of-state travel benefit that allows a person to pay in-network costs when traveling outside Michigan.
A person must receive care from a Medicare-participating provider.
How to compare plans
Individuals can use the Priority Health Medicare plan comparison tool to look at plan options in their ZIP code.
The Medicare website also has a Find a Medicare Plan tool that allows a person to compare all the Medicare Advantage plans available in their area.
For those wanting impartial advice on health insurance, State Health Insurance Assistance Programs (SHIP) offer individual counseling to help people choose the right healthcare plan. The SHIP in Michigan is called the Michigan Medicare Assistance Program.
Summary
Priority Health is a nonprofit health insurance company that provides Medicare Advantage plans in Michigan. Some of their policies also offer out-of-state benefits for people who are traveling.
Priority Health administers HMO-POS and PPO Medicare Advantage plans. It also offers a dual eligibility SNP for Medicare beneficiaries who are fully eligible for Medicaid.
People can search and compare all of the Medicare Advantage plans available in their area using Medicare’s online plan finder tool.
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View the original article on Medical News Today
