PriorityMedicare Value (HMO-POS)

PriorityMedicare Value (HMO-POS) H2320-029 Plan Details
4 out of 5 stars

PriorityMedicare Value (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Priority Health.
Plan ID: H2320-029.

$72.00
Monthly Premium

PriorityMedicare Value (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Priority Health.
Plan ID: H2320-029.

PriorityMedicare Value (HMO-POS) H2320-029 Plan Details
4 out of 5 stars

PriorityMedicare Value (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Priority Health.
Plan ID: H2320-029.

$72.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $75
Out of Pocket Max In-Network: $4900
Out-of-Network: N/A
Initial Coverage Limit $4430
Catastrophic Coverage Limit $7,050
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00 to $5.00
POS (Out-of-Network):

Doctor Office Visit:
Coinsurance for Medicare Covered Primary Care Office Visit 40%
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $0.00 to $45.00
Prior Authorization may be required for Doctor Specialty Visit
Prior authorization required
POS (Out-of-Network):

Doctor Specialty Visit:
Coinsurance for Medicare Covered Physician Specialist Office Visit 40%
Inpatient Hospital Care
In-Network:

Acute Hospital Services:
$325.00 per day for days 1 to 5
$0.00 per day for days 6 to 90
Prior Authorization may be required for Acute Hospital Services
Prior authorization required
Out-of-Network:
Coinsurance for Acute Hospital Services per Stay 40%
Urgent Care
Copayment for Urgent Care $55.00
Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $55.00
Emergency Room Visit
Copayment for Emergency Care $90.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $90.00
Copayment for Worldwide Emergency Transportation $250.00
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $250.00

Air Ambulance:
Copayment for Air Ambulance Services $250.00
POS (Out-of-Network):

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $250.00
Copayment for Medicare Covered Ambulance Services - Air $250.00

Health Care Services and Medical Supplies

PriorityMedicare Value (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
POS (Out-of-Network):
Coinsurance for Medicare Covered Chiropractic Services 40%
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(Please see Evidence of Coverage)
POS (Out-of-Network):
Coinsurance for Medicare Covered Diabetic Supplies and Services 40%
Durable Medical Eqipment (DME)
In-Network:
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization may be required for Durable Medical Equipment
Prior authorization required
POS (Out-of-Network):
Coinsurance for Medicare Covered Durable Medical Equipment 30%
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 $225.00
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
Prior authorization required
POS (Out-of-Network):

Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests 40%
Coinsurance for Medicare Covered Lab Services 0% to 40%
Coinsurance for Medicare Covered Diagnostic Radiological Services 40%
Coinsurance for Medicare Covered Therapeutic Radiological Services 40%
Coinsurance for Medicare Covered Outpatient X-Ray Services 40%
Home Health Care
In-Network:
Copayment for Medicare-covered Home Health Services $0.00
Prior Authorization may be required for Home Health Services
Prior authorization required
POS (Out-of-Network):
Copayment for Medicare Covered Home Health $0.00
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$325.00 per day for days 1 to 5
$0.00 per day for days 6 to 90
Prior Authorization may be required for Psychiatric Hospital Services
Prior authorization required
Out-of-Network:
Coinsurance for Psychiatric Hospital Services per Stay 40%
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 40%
Coinsurance for Medicare Covered Group Sessions 40%
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $5.00 to $225.00
Prior Authorization may be required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $90.00

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $225.00
Prior Authorization may be required for Ambulatory Surgical Center Services
Prior authorization required
POS (Out-of-Network):

Outpatient Hospital and ASC Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 40%
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 40%
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 40%
Over-the-counter (OTC) Items
In-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $25.00 every three months
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
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 40%
Skilled Nursing Facility Care
In-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$188.00 per day for days 21 to 100
Prior Authorization may be required for Skilled Nursing Facility Services
Prior authorization required
Out-of-Network:
Coinsurance for Skilled Nursing Facility Services per Stay 40%

Dental Benefits

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

Coverage Cost
Dental Care
In-Network:

Preventive Dental:
Copayment for Oral Exams $0.00
  • Maximum 2 visits every year
Copayment for Prophylaxis (Cleaning) $0.00
  • Maximum 2 visits every year
Copayment for Dental X-Rays $0.00
  • Maximum 1 visit (Please see Evidence of Coverage for details)

Comprehensive Dental:
Copayment for Medicare-covered Benefits $5.00 to $225.00
Copayment for Periodontics $0.00
  • Maximum 2 visits every year
Prior Authorization may be required for Comprehensive Dental

POS (Out-of-Network):

Medicare Covered Dental Services:
Coinsurance for Medicare Covered Comprehensive Dental 40%
Prior authorization required

Vision Benefits

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

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $45.00
Copayment for Routine Eye Exams $0.00
  • Maximum 1 Routine Eye Exam every year
Copayment for Retinal imaging $0.00
  • Maximum 1 Retinal imaging every year

Eyewear:
Copayment for Medicare-Covered Benefits $0.00
Maximum Plan Allowance of $100.00 every year for all Non-Medicare covered eyewear

POS (Out-of-Network):

Medicare Covered Vision Services:
Coinsurance for Medicare Covered Eye Exams 40%
Coinsurance for Medicare Covered Eyewear 40%

Non-Medicare Covered Vision Services:
Routine Vision Services
Up to $50 reimbursement for one routine exam
Up to $20 reimbursement for retinal imaging
Up to $100 reimbursement for eyewear

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 $5.00 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
Up to two hearing aids through TruHearing at four levels of technology from 6 hearing aid manufacturers, available in over 100 models and a variety of styles and colors. Advanced and premium hearing aids are available in rechargeable style options for an additional $75 per aid. You must see a TruHearing provider to use this benefit. $295 includes many styles, aids that sit in or behind the ear, and colors in limited technology levels. These hearing aids have up to 9 channels, digital processing and feedback cancellation. $1,495 includes all styles, aids that sit in or behind the ear, including invisible in the canal and receiver in the canal, and colors in every technology level. These hearing aids have up to 20 channels, premium digital processing, automatic feedback cancellation and automatic speech enhancement. Hearing aid purchases include: •First year of follow-up provider visits • 3-year warranty for loss and damage • 60-day risk-free trial • 80 batteries per aid
POS (Out-of-Network):

Medicare Covered Hearing Services:
Coinsurance for Medicare Covered Hearing Exams 40%

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 shots
  • Hepatitis 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 40%

    Prescription Drug Costs and Coverage

    The PriorityMedicare Value (HMO-POS) plan offers the following prescription drug coverage, with an annual drug deductible of $75 (excludes Tiers 1 and 2) per year.

    Coverage
    Cost
    Coverage & Cost
    Annual Drug Deductible $75 (excludes Tiers 1 and 2)
    Preferred Generic
    • Preferred retail $2.00
    • Standard retail $7.00
    • Preferred mail order $2.00
    • Standard mail order $7.00
    Generic
    • Preferred retail $10.00
    • Standard retail $15.00
    • Preferred mail order $10.00
    • Standard mail order $15.00
    Annual Drug Deductible $75 (excludes Tiers 1 and 2)
    Preferred Generic
    • Preferred retail $4.00
    • Standard retail $14.00
    • Preferred mail order $4.00
    • Standard mail order $14.00
    Generic
    • Preferred retail $20.00
    • Standard retail $30.00
    • Preferred mail order $20.00
    • Standard mail order $30.00
    Annual Drug Deductible $75 (excludes Tiers 1 and 2)
    Preferred Generic
    • Preferred retail $6.00
    • Standard retail $21.00
    • Preferred mail order $0.00
    • Standard mail order $21.00
    Generic
    • Preferred retail $30.00
    • Standard retail $45.00
    • Preferred mail order $0.00
    • Standard mail order $45.00