Your PriorityMedicare D-SNP plan information

Your 2025 plan documents

Find out what our PriorityMedicare^SM Dual Eligible Special Needs Plan (D-SNP) (HMO) offers you. Review your benefits in the chart below or by downloading your coverage documents.

Your coverage documents provide detailed explanations about how your plan works.

• 2025 Evidence of Coverage
  The Evidence of Coverage is the legal, detailed description of your benefits and costs. It also explains your rights and rules you need to follow when using your coverage for medical care and prescription drugs.
• 2025 Annual Notice of Change
  For existing members who have a 2024 Priority Health Medicare Advantage plan, the Annual Notice of Change outlines the year-over-year changes to the plan, including basic benefits and embedded extras.
• 2025 PriorityMedicare D-SNP formulary

2025 PriorityMedicare D-SNP coverage summary

This chart shows what the PriorityMedicare D-SNP offers to our members. If you have Medicaid, you will owe the $0 cost-share we indicate below in each benefit. If you lose Medicaid eligibility, your cost-share will vary depending on the service you receive.

Deductible
The amount you'll pay for most covered medical services, in-network, before you start paying only copayments or coinsurance and Priority Health pays the balance.	$0

D-SNPs do not include a deductible.

Out-of-pocket maximum

This is the most you pay during a calendar year for in-network services before Priority Health begins to pay 100% of the allowed amount. This limit includes copayments and coinsurance payments. It does not include Part D drug costs. If you are receiving full Medicaid benefits, you are not responsible for paying any out-of-pocket costs toward the maximum out-of-pocket amount for covered Part A and Part B services.

$9,350

Inpatient hospital care
Unlimited days	$0 copay per day

No limit to the number of days covered by the plan each hospital stay.

Authorization rules may apply.

Doctor office visits
Each primary care doctor visit	$0 copay
Each specialist visit	$0 copay

Authorization rules may apply for certain specialist visits.

Emergency and urgent care
Each emergency room visit	$0 copay
Each urgent care visit	$0 copay

Get emergency or urgent care services wherever you are in the United States or all over the world.

Lab services
Medicare-covered lab services	$0 copay

Preventive care
Annual physical exam and preventive services covered under Original Medicare	$0 copay

See a list of preventive services.

Dental services (by Delta Dental®)
Two oral exams and two cleanings per year (regular or periodontal maintenance) One brush biopsy, one fluoride treatment and one set of bitewing x-rays each year Periapical radiographs as needed All other radiographs (full-mouth series or panoramic x-rays) every 24 months $1,500 annual maximum on all covered dental services	$0 copay

Routine vision (by EyeMed)
One routine exam (including refraction) & one retinal imaging per year	$0 copay
Each year	$200 for eyewear

Routine hearing (by TruHearing)
Per hearing exam	$0 copay
Per hearing aid exam each year. $0 for Advanced Aids, per ear, every two years.	$0 copay

Virtual care
Per visit	$0 copay

Also referred to as "evisits" or "telehealth," virtual care is a cost-effective and convenient way to visit with a health care professional via phone or video for non-emergencies.

Prescription drug benefits

Curious about which pharmacies are in your network? Learn more.

Part D prescription drug deductible
Deductible	$0

This deductible applies to the cost of all drugs on the plan's list of approved drugs, or "formulary." Download the formulary to see approved drugs or view the digital Approved Drug List.

All tiers
All drugs	$0

Member must receive Extra Help (LIS) to receive this benefit.

Transportation services
Up to 30 one-way trips every year to or from health related locations. Trips are limited to 100 miles, members may also be reimbursed for mileage, up to 100 miles each way.	$0

Additional benefits

Diabetes management
Supplies and services	$0

Includes diabetes monitoring supplies, self-management training, and shoes or inserts.

Authorization rules may apply.

Home health care
Per visit	$0

Authorization rules may apply.

PriorityFlex allowance
Per quarter (no rollover)	$222

Use your PriorityFlex benefit to purchase over-the-counter (OTC) items, healthy food and produce, pest control services, and select utilities.

Learn more about how to use your PriorityFlex benefit.

Caregiver Support through Carallel

Unlimited caregiver support through caregiver advocates that can assist with:

• Health insurance
• Emotional support
• Stress management
• Housing and transportation
• Financial and legal guidance

Learn more about Caregiver Support.

One Pass^®

Digital fitness membership that includes live and on-demand workouts and a home fitness kit (1 per year).

Learn more about One Pass.