PriorityMedicare Key (HMO-POS)

PriorityMedicare Key (HMO-POS) H2320-022 Plan Details
4.5 out of 5 stars

PriorityMedicare Key (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Priority Health
Plan ID: H2320-022

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

PriorityMedicare Key (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Priority Health
Plan ID: H2320-022

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

PriorityMedicare Key (HMO-POS) H2320-022 Plan Details
4.5 out of 5 stars

PriorityMedicare Key (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Priority Health
Plan ID: H2320-022

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $5000
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00

POS (Out-of-Network):

Doctor Office Visit:
Coinsurance for Medicare Covered Primary Care Office Visit 50%.
Deductible may apply.
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0.00 to $45.00

POS (Out-of-Network):

Doctor Specialty Visit:
Coinsurance for Medicare Covered Physician Specialist Office Visit 50%.
Deductible may apply.

Prior Authorization may be required for Doctor Specialty Visit.
Prior authorization required
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$320.00 per day for days 1 to 7
$0.00 per day for days 8 to 90

(POS) Out-of-Network:
Coinsurance for Acute Hospital Services per Stay 50%.
Deductible does apply

Prior Authorization may be required for Acute Hospital Services
Prior authorization required
Urgent Care
Copayment for Urgent Care $50.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $50.00

Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours
Emergency Room Visit
Copayment for Emergency Care $120.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours.

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $120.00
Copayment for Worldwide Emergency Care waived if you are admitted to the hospital within 24 hours.
Copayment for Worldwide Emergency Transportation $270.00
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $270.00

Air Ambulance:
Copayment for Air Ambulance Services $270.00

POS (Out-of-Network):

Ground Ambulance:
Copayment for Ground Ambulance Services $270.00

Air Ambulance:
Copayment for Air Ambulance Services $270.00

Please see Evidence of Coverage for Prior Authorization rules
Prior authorization required

Health Care Services and Medical Supplies

PriorityMedicare Key (HMO-POS) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $20.00

Routine (Non Medicare-covered) Care:
Copayment for Routine Care $20.00
  • Maximum 12 Routine Care every year
Copayment for X-ray $35.00
  • Maximum 1 Set every year

POS (Out-of-Network):
Coinsurance for Medicare Covered Chiropractic Services 50%. Deductible applies.
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:
Copayment for Medicare-covered Diabetic Supplies $0.00
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00
Diabetic Supplies and Services limited to those from specified manufacturers when obtained from a retail or mail order pharmacy (Please see Evidence of Coverage)

POS (Out-of-Network):
Coinsurance for Medicare Covered Diabetic Supplies and Services 50%. Deductible does apply

Prior Authorization may be required.
Prior authorization required
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization may be required for Durable Medical Equipment.

POS (Out-of-Network):

Durable Medical Equipment:
Coinsurance for Medicare-covered Durable Medical Equipment 30%.
Deductible does apply

Prior Authorization may be required for Durable Medical Equipment.
Prior authorization required
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $10.00
Copayment for Medicare-covered Lab Services $0.00 to $10.00
Prior Authorization may be required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $160.00
Copayment for Medicare-covered Therapeutic Radiological Services $25.00
Copayment for Medicare-covered X-Ray Services $35.00
Prior Authorization may be required for Outpatient Diag/Therapeutic Rad Services.

POS (Out-of-Network)
50% per day, per provider, for Outpatient Diag Procs/Tests/Lab Services.
50% per day, per provider for Outpatient Diag/Therapeutic Rad Services.
Deductible does apply
Prior authorization required
Home Health Care
In-Network: Copayment for Medicare-covered Home Health Services $0.00

POS (Out-of-Network:)

Home Health Services:
Copayment for Medicare-covered Home Health Services $0.00. Deductible does apply

Prior Authorization may be required for Home Health Services.
Prior authorization required
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$275.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization may be required for Psychiatric Hospital Services

(POS) Out-of-Network:
Coinsurance for Psychiatric Hospital Services per Stay 50%. Deductible applies.
Prior authorization required
Mental Health Outpatient Care
In-Network:
Copayment for Medicare-covered Individual Sessions $20.00
Copayment for Medicare-covered Group Sessions $20.00

POS (Out-of-Network):
Coinsurance for Medicare Covered Individual Sessions 50%
Coinsurance for Medicare Covered Group Sessions 50%
Deductible applies.
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $290.00

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $120.00

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $290.00

POS (Out-of-Network):

Outpatient Hospital and ASC Services:
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 50%
Coinsurance for Medicare Covered Outpatient Hospital Services 50%
Deductible does apply

Prior Authorization may be required for Outpatient Hospital Services and Ambulatory Surgical Center Services

Prior authorization required
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $20.00
Copayment for Medicare-covered Group Sessions $20.00

POS (Out-of-Network):
Coinsurance for Medicare Covered Individual or Group Sessions 50%.
Deductible does apply
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) PLUS Items:
Copayment for Over-The-Counter (OTC) PLUS Items $0.00

You have a $100 allowance per quarter to use on OTC items. If eligible, this allowance can be used on healthy food and produce.

Maximum Plan Benefit of $100.00 every three months
Deductible does not apply
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $0.00 to $45.00

POS (Out-of-Network):
Coinsurance for Medicare Covered Podiatry Services 50%.
Deductible does apply
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$203.00 per day for days 21 to 100
Prior Authorization may be required for Skilled Nursing Facility Services

(POS) Out-of-Network:
50% coinsurance per stay.
Deductible does apply
Prior authorization required

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network:
Copayment for Medicare-covered Benefits $0.00 to $290.00
Routine (Non Medicare-covered) Dental:

$0 copay for two exams, two cleanings (regular or periodontal), one set of bitewing x-rays, one brush biopsy and all other x-rays.

A $2,500 allowance to use towards simple (non-surgical extractions), fillings, crown repairs, and anesthesia when used in conjunction with the other services (see EOC for more details).

Maximum Plan Benefit of $2500.00 every year for Non Medicare-covered comprehensive.

POS (Out-of-Network):
Medicare Covered Dental Services:
Coinsurance for Medicare Covered Comprehensive Dental 50%. Deductible applies.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network:

Medicare Covered Vision Services:
$0 for annual glaucoma screenings.
$0 for Medicare-covered eyewear after cataract surgery.
$45 for each Medicare-covered exam to diagnose and treat diseases or conditions of the eye.
$0 for annual diabetic retinopathy screening.

Routine (Non-Medicare) Eye Exams & Eyewear
$0 copay for annual routine vision exam
$0 annual retinal imaging
$100 eyewear allowance to use towards eyeglasses (lenses and frames).

POS (Out-of-Network):

Routine (Non-Medicare) Eye Exams & Eyewear
Up to $50 reimbursement for routine eye exam
Up to $20 reimbursement for routine retinal imaging
Up to $100 reimbursement towards eyeglasses (lenses and frames).
Deductible does not apply.

Medicare Covered Vision Care
50% Coinsurance for Medicare Covered vision care.
Deductible does apply.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $0.00 to $45.00
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00

Hearing Aids:
Copayment for Hearing Aids $295.00 to $1495.00
  • Maximum 2 Hearing Aids every year

POS (Out-of-Network):

Medicare Covered Hearing Services:
Coinsurance for Medicare Covered Hearing Exams 50%
Deductible does apply

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shotsHepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
Yearly "Wellness" visit


POS (Out-of-Network):

Medicare-covered Zero Dollar Preventive Services:
Coinsurance for Medicare Covered Medicare-covered Preventive Services 50%