We can help you lower retiree costs

Page last updated on: 4/10/25

Priority Health's employer group Medicare Advantage coverage offers you innovative and cost-saving retiree health plan solutions. These plans can help lower your overall health care costs because of the benefits and programs we offer our members.

Standard plans available: Essential, Basic, Enhanced or Elevate

Our plans:

  • Cover members wherever they are, even if they travel out of state
  • Allow non-Medicare spouses to remain covered by your regular group plan
  • Can be implemented off-cycle (which lowers your average age at renewal)
  • Give members access to our excellent Priority Health Medicare physician and pharmacy networks
  • May include a free gym membership
  • Provide prescription drug coverage with no deductible

Compare benefit options for standard Medicare plans

A list of the benefits available in the employer group PriorityMedicare standard plans. Contact your group Medicare representative or your independent agent for more information. Amounts shown are in-network only.

Benefit

PriorityMedicare
Essential (HMO-POS)

PriorityMedicare
Basic (HMO-POS)

PriorityMedicare Enhanced
(HMO-POS)

PriorityMedicare
Elevate (PPO)

Out-of-pocket maximum

$6,700

$5,500

$4,000

$2,000 in-network & out-of-network (combined)

Deductible

$425

$300

$50

$250 in-network & out-of-network (combined)

Inpatient hospital care

$100 copayment per day (days 1-5)

$50 copayment per day (days 1-5)

$0 copayment

$0 copayment

Office visit: primary care

$20 copayment*

$15 copayment*

$10 copayment*

$10 copayment*

Office visit: specialists

$30 copayment*

$25 copayment*

$20 copayment*

$20 copayment*

Diagnostic tests,
x-rays, lab services and radiology services

  • $30 copayment for x-rays

  • $20 copayment for diagnostic test, therapeutic radiology and lab services

  • $175 for imaging services

  • $25 copayment for x-rays

  • $15 copayment for diagnostic test, therapeutic radiology and lab services

  • $150 for imaging services

  • $10 copayment for x-rays

  • $10 copayment for diagnostic test, therapeutic radiology and lab services

  • $100 for imaging services

  • $25 copayment for x-rays

  • $10 copayment for diagnostic test, therapeutic radiology and lab services

  • $100 for imaging services

Ambulance services

$125 copayment*

$100 copayment*

$100 copayment*

$100 copayment*

Urgently needed care1

$50 copayment*

$45 copayment*

$40 copayment*

$40 copayment*

Worldwide emergency care1

$65 copayment*

$65 copayment*

$65 copayment*

$80 copayment*

Preventive services2

$0 copayment*

$0 copayment*

$0 copayment*

$0 copayment*

Annual wellness and preventive physical exam

$0 copayment*

$0 copayment*

$0 copayment*

$0 copayment*

Durable medical equipment

20% coinsurance

20% coinsurance

20% coinsurance

20% coinsurance

Vision
services3

$30 copayment* for diagnostic vision exams

  • $25 copayment* for diagnostic vision exams

  • $25 copayment* for one non-Medicare covered routine eye exam 

  • $60 eyewear allowance every year*

  • $20 copayment* for diagnostic vision exams

  • $20 copayment* for one non-Medicare covered routine eye exam 

  • $200 eyewear allowance every year*

  • $20 copayment* for diagnostic vision exams

  • $0 copayment* for one non-Medicare covered routine eye exam

  • $200 eyewear allowance every year*

Hearing
services

$20 copayment* for diagnostic hearing exams

  • $0 copayment* for diagnostic hearing exams

  • $0 copayment* for one non-Medicare covered routine hearing exam

  • $200 for hearing aids every three years*

  • $0 copayment* for diagnostic hearing exams

  • $0 copayment* for one non-Medicare covered routine hearing exam

  • $500 for hearing aids every three years*

  • $20 copayment* for diagnostic hearing exams

  • $0 copayment* for one non-Medicare covered routine hearing exam

  • $500 for hearing aids every three years*

Fitness membership (included with this plan through One Pass®)

n/a

$0 copayment*

$0 copayment*

$0 copayment*

Part D prescription drugs
(retail: 30-day supply)
-initial coverage stage (until your total out-of-pocket drug costs reach $2,000)

  • $0 deductible

  • Tier 1: Preferred generic: $15 copayment

  • Tier 2: Generic: $15 copayment

  • Tier 3: Preferred brand: 25% coinsurance

  • Tier 4: Non-preferred drug: 25% coinsurance

  • Tier 5: Specialty: 25% coinsurance

  • $0 deductible

  • Tier 1: Preferred generic: $15 copayment

  • Tier 2: Generic: $15 copayment

  • Tier 3: Preferred brand: 25% coinsurance

  • Tier 4: Non-preferred drug: 25% coinsurance

  • Tier 5: Specialty: 25% coinsurance

  • $0 deductible

  • Tier 1: Preferred generic: $10 copayment

  • Tier 2: Generic: $10 copayment

  • Tier 3: Preferred brand: 25% coinsurance

  • Tier 4: Non-preferred drug: 25% coinsurance

  • Tier 5: Specialty: 25% coinsurance

  • $0 deductible

  • Tier 1: Preferred 
    generic: $3 copayment

  • Tier 2: Generic: $8 copayment

  • Tier 3: Preferred brand: 25% coinsurance

  • Tier 4: Non-preferred drug: 25% coinsurance

Tier 5: Specialty: 25% coinsurance

*Deductible does not apply.

1$0 copayment if admitted to the hospital within 24 hours(s) for the same condition.

2Preventive services include: Welcome to Medicare exam, abdominal aortic aneurysm screening, bone mass measurement. breast cancer screening (Mammogram), cardiovascular screening, cervical and vaginal cancer screening, colorectal cancer screening, depression screening, diabetes screening, Hepatitis C screening, HIV screening, immunizations (pneumonia, Influenza, Hepatitis B), lung cancer screening with LCDT, medical nutrition therapy, Medicare diabetes prevention program (MDPP), obesity screening, prostate cancer screening, screening to reduce alcohol misuse, sexually transmitted infections screening, smoking and tobacco cessation.

3For each Medicare-covered exam to diagnose and treat diseases and condition of the eye. $0 copayment for annual glaucoma screening for people at risk. $0 copayment for one pair of Medicare-covered eyeglasses or contact lenses after cataract surgery.

The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan.

See the Priority Health Medicare website for more information about provider networks and approved drug lists.

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