2027 Medicare Advantage plan

PriorityMedicare Dual Premier (HMO D-SNP): 2027 benefits and costs

Priority Health Medicare HMO D-SNP Special Needs Plan

CMS plan ID: H8379-003-2 · Plan year: 2027

PriorityMedicare Dual Premier (HMO D-SNP) is a 2027 Medicare Advantage plan offered by Priority Health Medicare. It is listed in Michigan.

2027 plan costs at a glance

Monthly plan premium$6.30

Drug deductible$700.00

In-network medical out-of-pocket maximum$9,850.00

Costs shown are before Medicaid or Extra Help; your costs depend on your eligibility and assistance.

Organization: Priority Health Medicare
Plan organization: PRIORITY HEALTH CHOICE, INC.
Parent company: Corewell Health
Plan type: HMO D-SNP
Part C premium: $0.00
Part D premium: $6.30
Prescription drug coverage: Yes
Special Needs Plan type: Dual-Eligible
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: $480.00
Applies to certain in-network Medicare-covered services.
In-network medical maximum: $9,850.00

Who can join this Special Needs Plan?

This plan is for people who qualify for both Medicare and Medicaid. The plan must confirm the required Medicaid eligibility level. Your costs can depend on your assistance level.

Plan eligibility type: Dual-Eligible

2027 benefit summary

Doctor visits and medical care

Plan-level deductibles may still apply when a service-specific deductible is listed as No.

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0 Service-specific deductible No
Specialist visit	$0 Service-specific deductible No	Approval required Yes Referral required No
Telehealth	$0 Service-specific deductible No	Approval required No Referral required No
Emergency care	$115.00 copay
Urgent care	30% coinsurance
Home health	$0 Service-specific deductible No	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$0 Service-specific deductible No	Approval required No Referral required No
Other health professionals	35% coinsurance Service-specific deductible No	Approval required No Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$2,000.00 copay per stay	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$2,000.00 copay per stay	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $218.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	0% to 35% coinsurance Service-specific deductible No
Hospital observation services	35% coinsurance Service-specific deductible No
Ambulatory surgical center	35% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	35% coinsurance Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	35% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	35% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	35% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
X-rays	35% coinsurance Service-specific deductible No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	30% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	30% coinsurance Service-specific deductible No	Approval required No Referral required No
Substance use treatment, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Substance use treatment, group sessions	$0 Service-specific deductible No	Approval required No Referral required No
Opioid treatment program	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, group sessions	$0 Service-specific deductible No	Approval required No Referral required No
Psychiatry, individual sessions	$0 Service-specific deductible No	Approval required No Referral required No
Psychiatry, group sessions	$0 Service-specific deductible No	Approval required No Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	30% coinsurance Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	30% coinsurance Service-specific deductible No	Approval required No Referral required No
Cardiac rehabilitation	30% coinsurance Service-specific deductible No	Approval required No Referral required No
Intensive cardiac rehabilitation	30% coinsurance Service-specific deductible No	Approval required No Referral required No
Pulmonary rehabilitation	30% coinsurance Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	30% coinsurance Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	35% coinsurance Service-specific deductible No	Approval required Yes
Air ambulance	35% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic monitors	20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	0% to 35% coinsurance

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$0 Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Supplemental acupunctureAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

SSBCI

One shared limit covers the listed services, not a separate allowance for each service.

Full allowance details are not summarized here.

Benefits for qualifying members

SSBCI Flex

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Overweight, obesity, and metabolic syndrome; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Post-organ transplantation; Immunodeficiency and Immunosuppressive disorders; Conditions associated with cognitive impairment; Conditions with functional challenges; Chronic conditions that impair vision, hearing (deafness), taste, touch, and smell; Conditions that require continued therapy services in order for individuals to maintain or retain functioning; Other 1; Other 2; Other 3
Qualifying conditions: chronic hypertension
Qualifying conditions: Osteoporosis
Qualifying conditions: Chronic low back pain
Included services: Food and produce; Additional meal benefits; Pest control; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Some package benefits are exempt from the deductible: Yes
Services exempt from the deductible: Food and produce; Additional meal benefits; Pest control; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Package limit: $0.00
How often this limit applies: Every month
How benefits are provided: Catalogue Purchase; Debit Card; Reimbursement
Services sharing the package limit: Food and produce; Additional meal benefits; Pest control; Support for daily living; Other 1 Non-Primarily Health Related Benefit

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$0.00	$0.00	Not listed
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	25%	25%	25%
Tier 4Non-Preferred Drug	25%	25%	25%
Tier 5Specialty Tier	25%	Not listed	Not listed

Standard retail: initial-coverage cost per prescription fill (continued: 100 days)
Drug tier	100 days
Tier 1Preferred Generic	$0.00

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	90 days
Tier 1Preferred Generic	$0.00	$0.00	Not listed
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	25%	25%	25%
Tier 4Non-Preferred Drug	25%	25%	25%
Tier 5Specialty Tier	25%	Not listed	Not listed

Standard mail order: initial-coverage cost per prescription fill (continued: 100 days)
Drug tier	100 days
Tier 1Preferred Generic	$0.00

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	25%
Tier 4Non-Preferred Drug	25%
Tier 5Specialty Tier	25%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	25%
Tier 4Non-Preferred Drug	25%
Tier 5Specialty Tier	25%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.