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Priority Health Medicare Advantage with Part D

Priority Health Medicare Advantage with Part D oﬀers a broad, Michigan-based provider network, including Michigan Medicine providers. This plan works like a traditional HMO, but adds a point-of-service option, giving members the ﬂexibility to see out-of-network providers when needed. The Priority Health Medicare Advantage with Part D plan is a good ﬁt for those who prefer the coordinated care of an HMO, but want the reassurance of having an out-of-network option without the higher premiums of a Preferred Provider Organization (PPO).

This plan also includes integrated Medicare Part D prescription drug coverage, giving members comprehensive medical and pharmacy beneﬁts in one plan.

To be enrolled in the plan, you must be enrolled in both Medicare Part A and Medicare Part B, and continue paying any required Medicare Part B premiums.

In addition, based on your income and tax filing status, you may be required to pay a Medicare Part D premium, referred to as Income-Related Monthly Adjustment Amount (IRMAA). Please refer to the Part D IRMAA Brackets and Premiums Worksheet to understand your potential monthly costs.

Additional Information

Summary of Medical Benefits

In-Network Providers

No annual deductible
No out-of-pocket cost to you for preventive care
$10 copay for oﬃce visits for injury or illness
$10 copay for specialist visit
$10 copay for urgent care
$65 copay for emergency care (waived if admitted)
$10 copay for mental health, behavioral health and substance abuse services
No out-of-pocket cost to you for inpatient services
No out-of-pocket cost to you for outpatient surgery
$3,000 out-of-pocket maximum

Summary of Pharmacy Benefits

The comprehensive drug formulary is managed by Priority Health and is similar to the Prime Therapeutics formulary. Please review [Part D page] for detailed information.

No deductible
Prescription mail order service available with Birdi
$10 copay for Tier 1 and Tier 2 prescription drugs
$20 copay for Tier 3 prescription drugs
$75 copay for Tier 4 and Tier 5 prescription drugs
$2,400 out-of-pocket maximum for prescription drug coverage

The university has worked with Priority Health to align the Priority Health Medicare Advantage plan formulary as closely as possible to the U-M Prescription Drug Plan formulary. However, differences will exist, including but not limited to:

Which drugs are covered
Drug tier placement
Prior authorization or utilization management requirements
Pharmacy network participation

For complete information about benefits and coverage, including the Priority Health Medicare Advantage formulary, please refer to the plan documents.

Important Plan Details

Must live in Michigan’s Lower Peninsula.
If you Move out of a Managed Care Service Area you must complete the proper documentation.
You do not need a referral to see a specialist.
The plan must cover all services covered by Original/Traditional Medicare and follow Original/Traditional Medicare’s coverage rules.
Covers emergency services when traveling internationally.
Refer to priorityhealth.com/umich for information about how to receive services while traveling outside of the service area

Find a Participating Provider

Search the Priority Health web page to locate a participating provider or determine if your doctor accepts this plan.

Plan Documents

Plan documents will be added as they become available from Priority Health.

Priority Health Medicare Advantage with Part D 2027 Summary of Beneﬁts
Priority Health Medicare Advantage with Part D 2027 Formulary
View additional details regarding the plan and its features, such as Evidence of Coverage, Resource Guide, and more on the Priority Health microsite.

Plan Contact Information

priorityhealth.com/umic h

(888) 216-6090

Priority Health Insurance Company
1231 E. Beltline, NE
Grand Rapids, MI 49525-4501

Group number: 801346

Benefits Office

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