Priority Health are a nonprofit company that provide health benefits to people in Michigan. They offer several Medicare Advantage plans, which a person can compare on the Priority Health website.
Different types of Medicare Advantage plans are available, including:
- Health Maintenance Organization (HMO)
- Health Maintenance Organization Point-of-Service (HMO-POS)
- Preferred Provider Organization (PPO)
- Private Fee-for-Service (PFFS)
- Special Needs Plan (SNP)
- Medicare savings account (MSA)
Priority Health offer HMO-POS and PPO healthcare plans.
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.
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.
The plans usually offer additional benefits that can include vision, dental, and hearing care.
According to the Kaiser Family Foundation, in 2021, 89% of Medicare Advantage plans also include prescription drug coverage.
Priority Health are 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 maintain a list of covered drugs, known as a formulary, on their website.
Priority Health offer 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 is for care received in-network. The deductible for the POS is for care received out-of-network. According to Priority Health, a person must pay each deductible separately.
PPO plans
Priority Health also have a PPO plan that does not require a person to select a PCP. The person also will not need a referral to see a specialist and will 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 offer an HMO dual eligibility SNP (HMO D-SNP). This plan combines Medicare and Medicaid benefits.
To enroll in a Priority Health HMO 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 care management and coordination services.
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 chiropractic visits
- 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
- colorectal cancer screening
- depression screening
- diabetes screening
- glaucoma screening
- heart disease screening
- hepatitis B and C screening
- HIV screening
- HPV screening
- immunizations
- lung cancer screening
- prostate screening
- sexually transmitted infection screening
- quit smoking programs
The costs of Priority Health Medicare Advantage plans 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 pay 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.
Priority Health operate only 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.
Those who live outside the service area for up to 12 months can keep the plan, but a person’s permanent residency must remain within the service area.
Individuals can use the Priority Health Medicare plan comparison tool to look at their plan options.
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.
Priority Health are a nonprofit health insurance company that provide Medicare Advantage plans in Michigan. Many of their policies also have an out-of-state benefit for people who are traveling.
Priority Health administer HMO-POS and PPO Medicare Advantage plans. They also have a dual eligibility SNP for those enrolled in Medicare and fully eligible for Medicaid.
A person can search and compare all of the Medicare Advantage plans available in their area using Medicare’s online plan finder tool.