PriorityMedicare D-SNP® (HMO)
Dual-eligible special needs plans (D-SNPs) are a type of Medicare Advantage plan designed to care for beneficiaries who have both Medicare and full Medicaid coverage. Priority Health offers PriorityMedicare D-SNP (HMO) as its dual-eligible plan option.
- Are eligible for and enrolled in Medicare Parts A and B, and;
- Are eligible for full Medicaid benefits, and;
- Live permanently within the Priority Health Medicare service area (all 68 counties in Michigan’s Lower Peninsula), and;
- Are 21 years of age or older
PriorityMedicare D-SNP plan benefits
PriorityMedicare D-SNP coordinates care and coverage between Medicaid and Original Medicare. When services are covered by both Medicare and Medicaid, the member’s cost-share will be $0. The plan also offers benefits beyond Medicaid and Original Medicare benefits, including:
- Routine vision, dental and hearing coverage
- Quarterly over-the-counter allowance
- SilverSneakers fitness benefit
As a type of Medicare Advantage plan, PriorityMedicare D-SNP shares the same formulary and authorization requirements as our other Medicare Advantage plans.
PriorityMedicare D-SNP network
PriorityMedicare D-SNP shares the same network as our other Medicare Advantage plans. As an HMO plan, it does not include coverage outside the Priority Health Medicare network except in urgent or emergent situations.
Provider billing requirements for dually-eligible members
PriorityMedicare D-SNP is Priority Health's dual-eligible special needs plan. Members with this plan are eligible for both Medicare and full Medicaid benefits and cannot legally be held liable for Medicare cost-sharing (i.e. copays, coinsurance or deductibles). If you provide services to PriorityMedicare D-SNP members, please review our billing guidelines for dually-eligible beneficiaries.
Model of Care training requirement for providers
All dual-eligible special needs plans have a Model of Care, which ensures the unique needs of each plan member are met. Health care providers play a key role in the PriorityMedicare D-SNP Model of Care.
The Centers for Medicare and Medicaid Services (CMS) requires all special needs plans (SNPs), like PriorityMedicare D-SNP, to provide initial and annual Model of Care training to providers who routinely see D-SNP members. All providers who see PriorityMedicare D-SNP members should take our Model of Care training. Training must be completed by Dec. 31 of each year.
PriorityMedicare D-SNP Model of Care training is available as an on-demand webinar and takes approximately 30 minutes to complete. Alternatively, some practices and provider groups who are part of an organization may receive Priority Health Model of Care training along with other annual training requirements. If you’re not sure which option applies to you, contact your provider performance specialist.