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.
This article provides an overview of Priority Health and the Medicare Advantage plans. It also looks at the types of Advantage plans Priority Health offers, as well as coverage, costs, and enrollment options.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Priority Health is a Michigan-based nonprofit health insurance company in business for more than 30 years. According to the company website, only 10 cents of every dollar goes to administrative costs.
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 wellbeing hub, which provides medical information tailored to a person’s needs. The tool is designed to help people manage their conditions and develop positive lifestyle habits.
In 2020, the company’s Medicare plans received a 4-star overall rating.
Medicare Advantage is the alternative to original Medicare, which consists of Part A, hospital insurance, and Part B, medical insurance.
Companies offering Medicare Advantage plans contract with Medicare to provide all the original Medicare coverage, and 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.
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 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 it does require 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, nor does it require prior authorization for services from out-of-network providers.
Priority Health Advantage plans all provide coverage of hospitalization, doctor visits, lab tests, and prescription drugs. The plans also offer telehealth and some dental, vision, and hearing care. An extra perk involves membership to SilverSneakers, which is a fitness program that gives 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 who spend winters in a warmer state, such as Florida, can still have healthcare coverage at in-network costs when they are away from their home in Michigan.
Costs for Priority Health Advantage plans vary depending on the plan a person chooses and in which Michigan county they live. This online tool may be useful in calculating costs.
In addition, the company offers preferred drug store pricing on prescription drugs, and $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 range from $0–$205.
For example, both PriorityMedicare Key and PriorityMedicare Edge have $0 premiums, although the latter plan is available only to people living in some east and southeast counties in Michigan.
However, PriorityMedicare’s monthly premiums range from $78–$163, while the PriorityMedicare Select Monthly premiums vary from $136–$205.
Out-of-pocket costs
Annual out-of-pocket caps also vary, from $3,500–$6,000. The lower-premium plans have higher annual caps.
Copays
Copays for a primary care doctor’s visit range from $0–$20, and copays for a specialist range from $40–$50. Hospital copays vary from $200 –$375 per day for days 1 through 6. Copays for prescription drugs range from $1–$15.
Before a person enrolls in a Priority Health Advantage plan, they 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:
- The initial enrollment period is a 7-month time frame that begins 3 months before a person turns 65, continues during their birthday month, and ends 3 months later.
- The open enrollment period for Medicare Advantage and Medicare prescription drug plans is from October 15–December 7 of every year.
- The Medicare Advantage open enrollment period runs from January 1–March 31 of every year.
Priority Health contracts with Medicare to offer a variety of Advantage plans. They are an alternative to original Medicare (Part A and Part B) and provide all the same benefits.
All the Priority Health Medicare Advantage options are either HMO-POS or PPO plans. A person with one of the plans may use out-of-network providers, but they may involve higher costs.