PriorityMedicare Value (HMO-POS)
(4.5 / 5)
PriorityMedicare Value (HMO-POS) is a Medicare Advantage (Part C) Plan by Priority Health Medicare.
This page features plan details for 2024 PriorityMedicare Value (HMO-POS) H2320 – 029 – 1 available in Region 1.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
PriorityMedicare Value (HMO-POS) is offered in the following locations.
Plan Overview
PriorityMedicare Value (HMO-POS) offers the following coverage and cost-sharing.
| Insurer: | Priority Health Medicare |
| Health Plan Deductible: | $1,000 Out-of-network |
| MOOP: | $4,900 In-network |
| Drugs Covered: | Yes |
- This plan does not charge an annual deductible for all drugs. The $75.00 annual deductible only applies to drugs on certain tiers.
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Premium Breakdown
PriorityMedicare Value (HMO-POS) has a monthly premium of $12.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
| Part B | Part C | Part D | Part B Give Back | Total |
|---|
| $174.70 | $0.00 | $12.00 | $0.00 | $186.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
PriorityMedicare Value (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $75.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Enhanced Alternative |
| Additional Gap Coverage: |
| Formulary Link: | Formulary Link |
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
Initial Coverage Phase
After you pay your $75.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| 1 (Preferred Generic) | $2.00 copay | $7.00 copay | $2.00 copay | $7.00 copay |
| 2 (Generic) | $10.00 copay | $15.00 copay | $10.00 copay | $15.00 copay |
| 3 (Preferred Brand) | $42.00 copay | $47.00 copay | $42.00 copay | $47.00 copay |
| 4 (Non-Preferred Drug) | 50% | 50% | 50% | 50% |
| 5 (Specialty Tier) | 31% | 31% | 31% | 31% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| 1 (Preferred Generic) |
| 2 (Generic) |
| 3 (Preferred Brand) |
| 4 (Non-Preferred Drug) |
| 5 (Specialty Tier) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| 1 (Preferred Generic) | $0.00 copay | $21.00 copay | $0.00 copay | $21.00 copay |
| 2 (Generic) | $30.00 copay | $45.00 copay | $0.00 copay | $45.00 copay |
| 3 (Preferred Brand) | $126.00 copay | $141.00 copay | $105.00 copay | $141.00 copay |
| 4 (Non-Preferred Drug) | 50% | 50% | 50% | 50% |
| 5 (Specialty Tier) |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
| Tier | Cost |
|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.
Additional Benefits
PriorityMedicare Value (HMO-POS) also provides the following benefits.
Health plan deductible
Other health plan deductibles?
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Optional supplemental benefits
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
Outpatient hospital coverage
| out-of-network | 40% coinsurance per visit (Authorization is required.) (Referral is not required.) |
Doctor visits
| out-of-network Primary | 40% coinsurance per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | $0-45 copay per visit (Authorization is required.) (Referral is not required.) |
| out-of-network Specialist | 40% coinsurance per visit (Authorization is required.) (Referral is not required.) |
Preventive care
| out-of-network | 40% coinsurance (Authorization is not required.) (Referral is required.) |
Emergency care/Urgent care
| Urgent care | $55 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic procedures/lab services/imaging
| out-of-network Diagnostic tests and procedures | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Lab services | $0-10 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Lab services | 0-40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $225 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | 40% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | $35 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | 40% coinsurance (Authorization is required.) (Referral is not required.) |
Hearing
| out-of-network Hearing exam | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $295-1,495 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Preventive dental
| out-of-network Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Comprehensive dental
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Extractions | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Vision
| out-of-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Other | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Other | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | Not covered (Not applicable.) (Not applicable.) |
Rehabilitation services
| out-of-network Occupational therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
Ground ambulance
| out-of-network | $265 copay (Not applicable.) (Not applicable.) |
Transportation
Foot care (podiatry services)
| out-of-network Foot exams and treatment | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Medical equipment/supplies
| out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 30% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Prosthetics (e.g., braces, artificial limbs) | 30% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
| out-of-network Diabetes supplies | 40% coinsurance per item (Authorization is not required.) (Not applicable.) |
Wellness programs (e.g., fitness, nursing hotline)
Medicare Part B drugs
| out-of-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Inpatient hospital coverage
| out-of-network | 40% per stay (Authorization is required.) (Referral is not required.) |
Mental health services
| out-of-network Inpatient hospital – psychiatric | 40% per stay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $20 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $20 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $20 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $20 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | 40% coinsurance (Authorization is not required.) (Referral is not required.) |
Skilled Nursing Facility
| out-of-network | 40% per stay (Authorization is required.) (Referral is not required.) |
Package #1
Optional Benefits
Package #1
| Preventive dental: | Monthly Premium: | $38.00 |
| Preventive dental: | Deductible: | N/A |
| Comprehensive dental: | Monthly Premium: | $38.00 |
| Comprehensive dental: | Deductible: | N/A |
| Eyewear: | Monthly Premium: | $38.00 |
| Eyewear: | Deductible: | N/A |
Ready to sign up for PriorityMedicare Value (HMO-POS) ?
Get help from a licensed insurance agent.
8am – 11pm EST. 7 days a week
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