Priority Health Medicare Insurance Review

Pros Explained

• High-quality health plan: Priority Health is the highest-rated Medicare Advantage HMO-POS plan in Michigan.
• Coverage while traveling, including some plans which cover you overseas: Many Priority Health plans cover emergency medical care when you travel in the U.S. and, in some plans, around the world. Plans also include access to care anywhere in the U.S. at in-network prices.
• Household discount available: There is a 12% discount on premiums if multiple household members sign up for a Priority Health Medigap plan. Household members must live together but do not need to be related.
• Virtually all Michigan primary care doctors and hospitals participate: Nearly all Michigan primary care doctors and all hospitals accept Priority Health.

Cons Explained

• Available only in Michigan: Priority Health is a local plan that offers Medicare Advantage plans in 68 Lower Peninsula Michigan counties and Medigap plans across the state.
• No standalone prescription drug plans available: All Priority Health’s Medicare Advantage plans include prescription drug coverage, which may be a pro, but if you just need prescription coverage without other benefits, this is not the plan for you.

Available Plans

Medicare Advantage Plans

Priority Health offers HMO-POS, PPO, and Special Needs Medicare Advantage plans. As of 2021, Priority Health offers 221 HMO-POS plans and 319 PPO plans, all with prescription drug coverage. Most plans include $0 copayments for telehealth visits for primary, specialty, and mental health care. Costs and benefit levels vary for HMO-POS and PPO plans.

Priority Health offers Dual-Eligible Special Needs Plans (D-SNP) for people who qualify for both Medicare and Medicaid. D-SNP plans have few out-of-pocket costs, including no deductibles or copayments for hospital and doctor visits or on services like dental, vision, hearing, and telehealth. Members get assigned a care manager to help coordinate their care and benefits.

It offers its D-SNP members brain health and emotional support resources, over-the-counter allowances, transportation assistance, fitness benefits, and companion care through Papa, an in-home, on-demand assistance program.

Medicare Supplement Insurance (Medigap) Plans

Medicare Supplement Insurance plans, also called Medigap, cover some out-of-pocket costs for consumers that Original Medicare doesn’t. There are 10 different types of Medigap plans, each with set benefits and coverage. The benefits are the same within each plan type no matter the insurer, but costs and extra benefits vary by insurance company. 

Priority Health offers six Medigap plan types. They vary in how much they cover (set by Medicare, not Priority Health) and what they cost, but all include emergency care while traveling, hearing and vision discounts, and a 12% discount on monthly premiums if another person in your household is also enrolled in a Priority Health Medigap plan.

• Plan A: The lowest coverage Medigap option covers some of the costs Original Medicare doesn’t.
• Plan C: This plan covers more than Plan A covers, including some basic health care costs consumers face with just Original Medicare.
• Plan D: This plan helps pay almost all of the costs of basic Original Medicare benefits except for the Part B deductible and excess charges.
• Plan F: This plan covers the most of any of Priority Health’s Medigap options, including Medicare Part A and B deductibles, copayments for hospitalizations and skilled nursing facilities, and excess charges. Plans F and C are not available to people who became eligible for Medicare on or after January 1, 2020.
• Plan G: In addition to covering some of the costs not covered by basic Original Medicare, this plan covers Medicare Part A deductibles. 
• Plan N: This plan covers Part A deductibles and some of the other costs not covered by basic Original Medicare.

Extra Benefits 

Most Medicare plans offer extra benefits such as dental, vision, hearing, fitness, and other benefits. Priority Health’s HMO-POS and PPO plans include vision, dental, and hearing, as well as a range of physical and mental well-being programs and fitness benefits. Members also can buy enhanced dental and vision coverage. These plans include out-of-state access to providers at in-network rates, emergency medical care while traveling in the U.S. or, in some cases, overseas, and at-home check-ups. Some plans also include an over-the-counter allowance each quarter.

Customer Service

Prospective members: Call 833-489-5443, 9 a.m. to 4 p.m., Monday to Friday

Current members: Call 888-481-2070, 8 a.m. to 8 p.m., seven days a week

Members set up an online account for 24/7 access to claims and prescription history, and communication preferences. Current members can sign up for plan updates by text, email, or mail. Priority Health also offers an online cost estimator tool for members to preview their out-of-pocket costs of thousands of prescriptions and hundreds of procedures.

Customer Satisfaction 

The National Association of Insurance Commissioners (NAIC) calculates the ratio of complaints an insurance company receives compared to its share of premiums. Companies with complaint index scores less than 1.0 received fewer than expected complaints; a score greater than 1.0 means they received more complaints than expected based on their market share. Priority Health’s complaint index has been below 1.0 in 2019 (0.41), 2020 (0.77), and 2021 (0.54).

Third-Party Ratings

AM Best

AM Best, the credit rating agency that assesses insurance companies’ financial strength, gave its A (Excellent) Financial Strength Rating to Priority Health. AM Best noted its credit rating did not change as a result of a merger between Priority Health and Total Health Care, Inc., and stated that the merger was likely to strengthen Priority Health’s Medicaid business in Michigan.

NCQA

Most health plans are accredited through the National Committee for Quality Assurance (NCQA), which reviews and rates health plans. In the 2022 ratings, Priority Health’s plans scored between 4.0 and 4.5 stars out of 5. 

Medicare Star Ratings

One way to compare Medicare Advantage plans is by their Medicare Star Rating, issued by the Centers for Medicare and Medicaid Services (CMS). Based on a five-star rating system, Star Ratings reflect how well plans help members access care and how satisfied members are with the plan and its customer service. CMS also considers member complaints into the overall rating. Different plans under a corporate umbrella might be reviewed and rated separately. 

In the 2023 Star Ratings, four Priority Health plans were rated by CMS. averaging 4.0 out of 5.0 Stars.

Cost

Priority Health’s 2021 Medicare Advantage price ranges include both HMO-POS and PPO plans.

HMO-POS plans with prescription drug coverage:

• Monthly premiums range from $0 to $206.00, averaging $30.68; one-third of these plans have no monthly premium. 
• Deductibles range from $0 to $100, averaging $58.33; one-third have no deductible.  
• Annual out-of-pocket maximums for in-network services range from $4,500 to $5,500, averaging $4,967. 

PPO plans with prescription drug coverage:

• Monthly premiums range from $0 to $151.30, averaging $31.63; one-third of PPO plans have no premiums. 
• Deductibles range from $0 to $350, averaging $80; more than half (56%) have no deductible.  
• Annual out-of-pocket maximums for in-network services range from $3,500 to $6,000, averaging $4,857. 

Competition: Priority Health vs. UnitedHealthcare

Michigan has among the highest penetration of Medicare Advantage enrollments among Medicare beneficiaries. Among Medicare Advantage plans with the most enrollments in Michigan, UnitedHealthcare is a large national carrier with similar offerings. UnitedHealthcare and Priority Health score comparably on CSM quality ratings, as well as AM Best ratings.

UnitedHealthcare offers more supplemental plans, but Priority Health provides in-network pricing for providers nationwide, so members who travel get benefits outside of Michigan. Priority Health offers robust extra benefits, at least on par with the national carriers. In its favor, Priority Health has local corporate roots and in-person customer service at their walk-in centers. For local support, Priority Health wins.

Final Verdict

Priority Health Medicare insurance offers a choice between comprehensive Medicare Advantage plans with lots of extra benefits and supplemental Medigap plans. This local plan gives members access to care while traveling in the U.S., and some include overseas emergency coverage. A popular local brand, it works with most of the primary care doctors and hospitals in Michigan. Priority Health is a good choice for Michigan residents, especially those who spend part of the year elsewhere.

Frequently Asked Questions

Is Priority Medicare a Medicare Advantage Plan?

Yes, you can get Medicare Advantage with Priority Health Medicare insurance. Priority Health offers a variety of plans to choose from, including health maintenance organization point-of-service (HMO-POS) and preferred provider organization plans (PPO), plus Special Needs Medicare Advantage plans.

How Does the Billing Work Between Priority Health and Medicare?

Priority Health will process your claims automatically if you receive care from an in-network provider. Out-of-state providers should submit claims directly to Priority Health to receive reimbursement according to the Michigan Medicaid fee schedule for covered services.

How Much Will It Cost for Out-of-Network Priority Health Medicare?

As long as the out-of-network provider you see participates with Original Medicare or is part of the multiplan network, your care will be covered at in-network rates. Check whether your Priority Health plan has a deductible; if it does, you may need to pay for services until you meet your out-of-network deductible. If you have a Medigap plan from Priority Health, you can see any doctor you like if they accept Medicare.

Methodology

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners’ complaint index and AM Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.