PriorityMedicare Edge (PPO)

by Priority Health Medicare

2027 Medicare Advantage plan available in Michigan

Plan ID H4875-020-1

Additional coverage:

RxHearingVisionDental

Medicare Advantage PPO $0 premium

Monthly plan premium $0 / mo

Annual deductible $405 / yr

Max out-of-pocket · in-network $7,100 / yr

Drug deductible $300 / yr

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Plan Overview

PriorityMedicare Edge (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Michigan and offered by the health insurance company Priority Health Medicare. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name PriorityMedicare Edge (PPO)

Insurance Carrier Priority Health Medicare

Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type PPO

Cost Summary

PriorityMedicare Edge (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $405 annual deductible and a maximum out-of-pocket cost sharing of $7,100. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Health portion of premium $0

Drug portion of premium $0

Annual Deductible $405 annual deductible / yr

Max Out-of-Pocket · in-network $7,100 / yr

Primary doctor visit $0 copay

Specialist visit $0-$40 copay

ER visit $130 copay

Ambulance $275 copay

Additional Benefits and Coverage

PriorityMedicare Edge (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. PriorityMedicare Edge (PPO) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage Yes

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Not covered

Home & bathroom safety devices Limited coverage

Meals for short duration Not covered

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: 40% coinsurance

Specialist visit In-network: $0-$40 copay
Out-of-network: 40% coinsurance

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0 copay
Out-of-network: 40% coinsurance

Lab services In-network: $0-$50 copay
Out-of-network: 0%-40% coinsurance

Diagnostic radiology services (like MRI) In-network: $20-$640 copay
Out-of-network: 40% coinsurance

Outpatient x-rays In-network: $20 copay
Out-of-network: 40% coinsurance

Emergency care $130 copay

Urgent care $50 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $450 per day for days 1-6
  $0 per day for days 7-90
  $450 Lifetime Reserve Days for days 1-6
  $0 Lifetime Reserve Days for days 7-60
  $0 per stay
Out-of-network:
  40% per stay

Outpatient hospital coverage In-network: $0-$425 copay
Out-of-network: 40% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $218 per day for days 21-100
Out-of-network:
  40% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: 40% coinsurance

Ambulance

Ground ambulance In-network: $275 copay
Out-of-network: $275 copay

Therapy services

Occupational therapy visit In-network: $40 copay
Out-of-network: 40% coinsurance

Physical therapy & speech & language therapy visit In-network: $40 copay
Out-of-network: 40% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist In-network: $20 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy with a psychiatrist In-network: $20 copay
Out-of-network: 40% coinsurance

Outpatient group therapy visit In-network: $20 copay
Out-of-network: 40% coinsurance

Outpatient individual therapy visit In-network: $20 copay
Out-of-network: 40% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 0%-20% coinsurance
Out-of-network: 30% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: 40% coinsurance

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $7.00 copay $0 copay

Generic $15.00 copay $0 copay

Preferred Brand 25% coinsurance $0 copay

Non-Preferred Drug 30% coinsurance $0 copay

Specialty Tier 30% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: 40% coinsurance

Fitting/evaluation In-network: $0 copay
Out-of-network: $0 copay

Hearing aids - prescription In-network: $399-$899 copay
Out-of-network: 50% coinsurance

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: $0 copay

Cleaning In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services Not covered

Endodontics Not covered

Periodontics In-network: $0 copay
Out-of-network: $0 copay

Prosthodontics, removable Not covered

Prosthodontics, fixed Not covered

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: $0 copay
Out-of-network: $0 copay

Orthodontics Not covered

Adjunctive general services Not covered

Vision

Routine eye exam In-network: $0 copay
Out-of-network: 40% coinsurance

Contact lenses In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: $0 copay

Upgrades In-network: $0 copay
Out-of-network: $0 copay

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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