Your 2020 PriorityMedicare (D-SNP) plan information

Find out what our 2020 PriorityMedicare Dual Eligible Special Needs (D-SNP)SM (HMO) plan offers you. Review your benefits in the chart below or by downloading any of your coverage documents.

Your 2020 plan documents

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

2020 PriorityMedicare D-SNP coverage summary

This chart shows what our 2020 PriorityMedicare D-SNP plan offers members.

In-network benefits

Deductible

$0
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.
D-SNP plans do not include a deductible.

Out-of-pocket maximum

$0
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.
D-SNP plans do not include a maximum out-of-pocket amount.

Inpatient hospital care

$0 copay per day
Unlimited days

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

Authorization rules may apply.

Doctor office visits

$0 copay
Each primary care doctor visit
$0 copay
Each specialist visit

Authorization rules may apply for certain specialist visits.

Emergency and urgent care

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

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

Lab services

$0 copay
Medicare-covered lab services

Diagnostic tests and procedures

$0 copay
Medicare-covered diagnostic procedures and tests

Authorization rules may apply.

Outpatient x-rays

$0 copay
Medicare-covered outpatient x-rays

Diagnostic radiology services

$0 copay
Medicare-covered diagnostic radiology services

Diagnostic radiology includes services such as MRIs and CT scans. 

Authorization rules may apply.

Radiation therapy

$0 copay
Medicare-covered radiation therapy services, such as cancer treatment.

Preventive care

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

See a list of preventive services.

Preventive dental services

$0 copay
2 oral exams and 2 cleanings per year
$0 copay
1 set of bitewing X-rays per year

 

Routine vision (by EyeMed)

$0 copay
1 routine exam (including refraction) & 1 retinal imaging per year
$200 eyewear allowance
Each year

Routine hearing (by TruHearing)

$0 copay
Per hearing exam
$0 copay
Per hearing aid exam each year. $0 for Advanced Aids, one per ear, per year.

Virtual care

$0 copay
Per visit

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

Have questions on drug coverage? Learn more. And, get familiar with what pharmacies are in your network.

Part D prescription drug 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 Approved Drug List on this website.

Tier 1

$0, $1.30 or $3.60 per prescription
Generic drugs
$0, $3.90 or $8.95 per prescription
All other drugs
The amount depends on your LIS level.

Transportation services


Transportation services are not covered by Medicare but they are covered by Medicaid. Contact your care manager to learn more.

 

Additional benefits

Diabetes management

$0
Supplies and services

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

Authorization rules may apply.

Home health care

$0
Per visit

Authorization rules may apply.

Over-the-counter (OTC) allowance

$145 allowance
Per quarter

Over-the-counter items are drugs and health related products that do not need a prescription such as: allergy medication, eye drops, cough drops, nasal spray, vitamins and more. Items can be purchased in participating stores (Walmart, CVS, Kroger and more). Or, over the phone or online at walmart.com, with free 2-day shipping. After signing up for this benefit, you’ll receive a separate OTC card in the mail.

SilverSneakers® (fitness)

$0
Gym memberships at participating SilverSneakers locations.

Includes access to online educational programs and SilverSneakers On-Demand™ workout videos. You can also download the SilverSneakers® GO™ fitness app for additional workout ideas. Learn more at www.silversneakers.com.