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Medicare Advantage · Local PPO · 2027

PriorityMedicare Thrive Plus (PPO)

Priority Health Medicare H4875-018-0014.0 CMS rating for 2027
Is it offered where you live?

No referral needed to see a specialist

At a glance: $66 monthly premium and $0 primary care visits.

Monthly premium
$66
Part B premium separate
Yearly limit
$6,600
Most you’d pay for in-network care
Hearing
$399–$899
Copay per hearing aid
Doctor visits
$0
Primary care · specialists $40

Check this plan for you

Add your doctors and prescriptions to see how they work with this plan.

Your doctors
Not checked yetSee if they’re in this plan’s network
Your prescriptions
Not checked yetSee your drug tier and monthly cost
Extra benefits
4 includedHearing · Vision · Dental · Fitness

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TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

Costs and copays

Deductibles, yearly limit, visits, hospital stays and drug tiers
DeductiblesMedical · $225 for drugs
$0
Yearly limitIn-network care, not counting drugs
$6,600
Yearly limit, in and out of networkCombined, not counting drugs
$6,600
Primary doctorPer visit
$0
SpecialistPer visit · no referral needed
$40
Hospital stayNo limit on covered hospital days
Days 1-7: $375/day, Days 8-90: $0/day
Inpatient mental healthHospital stay
Days 1-6: $290/day, Days 7-90: $0/day
Outpatient surgeryPer procedure
$375
Emergency roomPer visit
$130
Urgent carePer visit
$50
Tier 1 · Preferred Generic30-day supply at a retail pharmacy
$1
Tier 2 · Generic30-day supply at a retail pharmacy
$7
Tier 3 · Preferred Brand30-day supply at a retail pharmacy, after deductible
22%
Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy, after deductible
31%
Tier 5 · Specialty30-day supply at a retail pharmacy, after deductible
30%

Our take

Where this plan shines, and what to know

Where this plan shines

  • See your primary doctor for $0.
  • No separate medical deductible.
  • Highly rated by CMS (4 stars).

Things to know before you enroll

  • This plan’s out-of-pocket maximum is above the national median.
  • Limited coverage while traveling outside the plan’s service area.

Similar plans

Other Medicare Advantage plans offered in Michigan

Common questions

6 answers about this plan

What does PriorityMedicare Thrive Plus (PPO) (Local PPO) cover?

PriorityMedicare Thrive Plus (PPO) (Local PPO) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 5 formulary tiers. Published supplemental benefits include dental (Routine dental benefit), vision ($100/yr eyewear allowance), hearing ($399–$899 copay per hearing aid), and fitness ($0 fitness benefit). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does PriorityMedicare Thrive Plus (PPO) (Local PPO) cost in 2027?

The published 2027 monthly plan premium for PriorityMedicare Thrive Plus (PPO) (Local PPO) is $66. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $225. The in-network medical out-of-pocket maximum is $6,600; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $40. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with PriorityMedicare Thrive Plus (PPO) (Local PPO)?

CMS lists PriorityMedicare Thrive Plus (PPO) (Local PPO) as a Local PPO plan. The plan record says specialist referrals are not required. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Does PriorityMedicare Thrive Plus (PPO) (Local PPO) cover my prescriptions?

PriorityMedicare Thrive Plus (PPO) (Local PPO) has 5 published formulary tiers in the current plan record. Published preferred-pharmacy 30-day retail costs include Tier 1 at $1, Tier 2 at $7, Tier 3 at 22%, Tier 4 at 31%, and Tier 5 at 30%. The listed Part D deductible is $225. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.

Check your prescriptions

What dental, vision, and hearing benefits does PriorityMedicare Thrive Plus (PPO) (Local PPO) include?

The current plan record for PriorityMedicare Thrive Plus (PPO) (Local PPO) lists dental (Routine dental benefit), vision ($100/yr eyewear allowance), and hearing ($399–$899 copay per hearing aid). Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

When can I enroll in PriorityMedicare Thrive Plus (PPO) (Local PPO)?

PriorityMedicare Thrive Plus (PPO) (Local PPO) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

Plan documents

How to get this plan’s documents

Talk to a licensed agent

Talk with a licensed advisor

A licensed agent can review this plan and other plans in your area that fit your needs.

TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

PriorityMedicare Thrive Plus H4875-018 (PPO) — 2027 Costs & Benefits