Are Priority Health Michigan Medicare plans the best value for your fixed income? In this article we’ll explore what Priority Health has to offer Medicare participants and if it’s the best plan for you!
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Table of Contents
An Introduction To Priority Health
Priority Health is the second largest insurer based in Michigan, only behind Blue Cross Blue Shield of Michigan. They offer Medicare Supplements, Medicare Advantage, and Part D Drug plans. Furthermore, they also offer Dental plans and group health insurance for businesses.
Priority Health has an A Excellent rating from AM Best. The shows that Priority Health is highly stable financially.
The company is headquartered in Grand Rapids, Michigan.
Priority Health Michigan Medicare Supplements
Priority Health Michigan Medicare Supplements include Plans D, F, G, and N. They offer both Guaranteed Issue and Fully underwritten plans:
- Guaranteed Issue/Medigap Open Enrollement: This type of underwriting supports no medical questions for the Medicare beneficiary. For guaranteed issue, the applicant can generally only sign up for Plans A, B, D, G, K, or L if your Medicare Part B effective date is after 1/1/2020. If it’s prior, switch out D and G for Plans C and F.
Medigap Open Enrollment, unless you qualify for a Special Enrollment Period, is the 7 month period starting 3 months prior to turning 65 to 3 months after turning 65. During this time, you can sign up for ANY Medicare Supplement plan without any underwriting questions.
Your Initial Open Enrollment is the best time to purchase a Medigap plan in Michigan.
- Fully Underwritten: In Michigan, anytime you want to switch Medicare Supplement plans outside of Open enrollment or a Special Enrollment Period, you need to pass medical underwriting. For many seniors, this can seem like a scary prospect because most people have some sort of health issue. However, underwriting criteria differs between insurance companies and you have nothing to lose in applying for coverage.
Priority Health Medicare Plan G
Priority Health Medicare Plan G is usually the most efficient Medigap plan for your premium dollar. Those with a Medicare Part B effective date of 1/1/2020 and beyond, the overall best Medicare Supplement plan is usually Plan G.
As you can see in the chart above. Plan G works essentially the same as Plan F (often considered the “Cadillac” of Medicare Supplements.) Plan F covers all Medicare approved coinsurance and deductibles.
The difference between Plan F and Priority Health Medicare Plan G is the Part B deductible. For 2020, the Part B deductible is $198 dollars. You can see below the difference in cost between Plan F and Plan G to see if there’s enough to support a better dollar value with Plan G.
Priority Health Michigan Medicare Supplement Rates
Below are sample rates for Priority Health Michigan Medicare Supplements in Grand Traverse County. As of the publishing date, the rates listed below are accurate. HOWEVER, plan rates can and often do increase due to inflation over time.
To get a free, instant quote based on your age, location, and smoking status, fill out the form to the right OR if mobile press “Get Quote” button above.
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Female Non-smoker 49686
|Age||Plan F||Plan G||Plan N|
Male Non-smoker 49686
|Age||Plan F||Plan G||Plan N|
Priority Health vs Blue Cross Blue Shield Of Michigan
Blue Cross Blue Shield of Michigan and Priority Health are the two largest insurers in Michigan.
They both offer Medicare Advantage and Medicare Supplement Plans throughout the state. Furthermore, they both have A Excellent rating from AM Best. Their rates tend to be consistent as well for Medicare Supplements and they offer both PPO and HMO plans for Medicare Advantage.
When comparing Priority Health vs Blue Cross Blue Shield, it’s less important concerning Medicare Supplements. Insurance companies have very minimal changes between Plan letters when it comes to Medigap plans that aren’t already standardized.
However, Blue Cross Blue Shield of Michigan has slightly lower Medigap plan rates.
However, for Medicare Advantage and Priority Health Part D plans it’s important to look at the network to ensure that your medications and doctors are in network.
Furthermore, for 2020 all individual Priority Health Medicare Advantage plans offer out of state coverage with any provider that accepts Medicare at in-network costs. This is a great benefit for snowbirds and people that travel out of state.
Priority Health Medicare Advantage Plans
Priority Health Medicare Part C, also known as Medicare Advantage, is the privately administered solution to Medicare. It’s required to offer the exact same basic services as Medicare.
Furthermore, Priority Health Medicare Advantage plans can offer secondary services that Medicare traditionally does not offer, such as vision and dental service, chiropractic services, gym memberships.
Unlike Original Medicare without a Medigap plan, Medicare Advantage has a maximum out of pocket amount annually. In the even of a catastrophic medical event, you know that what you’ll pay will be capped, then the Medicare Advantage plan pays 100%.
In return, Priority Health Medicare Advantage plans have networks and co-pays that you’re expected to pay whenever you use their services. In some plans, you’ll pay more out of pocket if you use a doctor or hospital that is out of network. In other types of plans, you can’t use a doctor or hospital outside of your network, unless it’s an emergency, without footing the whole bill.
Priority Health does offer the Silver Sneakers program on all Medicare Advantage plans.
Priority Health offers two basic plans: PPO’s and HMO’s
Priority Health Medicare Advantage PPO
Priority Health Medicare Advantage PPO’s are Preferred Provider Organizations. These plans offer the maximum amount of freedom to the user.
In PPO’s, the user can go to any doctor they wish, but will pay less with doctors that are “in-network.” Furthermore, they do not need referrals when going to a specialist from their family doctor.
Due to the increased services, these plans can cost more out of pocket, with premiums to the insurance company and paying more to “out of network” providers.
Priority Health Medicare HMO-POS
Priority Health Medicare Advantage HMO-POS plans tend to be more restrictive for the user, but are cheaper.
HMO-POS plans stand for Health Maintenance Organizations- Point of Service. Like traditional HMO’s, HMO-POS plans require you to select a primary care physician who coordinates your overall care.
Unlike standard HMO’s, you’re allowed to use doctors “out of network” at a higher costs. Furthermore, you generally do not need a referral. HOWEVER, there are two different deductibles that you’ll be responsible to pay. One for the “in-network” providers and one for the “out-of-network” providers
These deductibles are paid separately of each other, so you may pay two deductibles depending on who you need to see in a year.
Priority Health Medicare D-SNP
Priority Health Medicare D-SNP is a specialized Medicare Advantage plan for people that are eligible for both Medicare and full Medicaid benefits. It helps coordinate your health costs between Medicare and Medicaid and can offer additional benefits that most Medicare Advantage plans don’t offer.
To be eligible for a Priority Health Medicare D-SNP plan, you must meet the following requirements:
- Be enrolled in Medicare Parts A & B
- Be eligible for full Medicaid benefits
- Reside in a Priority Health Medicare service area
- Be over 21 years of age.
Which Is Best For You?
It’s really up to you. HMO-POS and PPO have a lot of flexibility, as long as you understand how they work.
If you want maximum freedom and are willing to pay for it, the PPO might be best.
If you’re not leaving your network very often HMO-POS can save you money in the long run.
The most important thing to recognize is that the lowest cost isn’t always the best. What’s most important is that your paying the least overall out of pocket. This is especially true if you have health issues or a medical emergency.
One last point:
Networks can be tricky in emergency or surgical situations. Your primary doctor, specialist, and hospital may all be in network, but the lab or surgeon may not be. While you can request an exception for these services, you may be responsible for services that do not accept your plan or pay more because it’s not in network.
Priority Health Medicare Part D
Here’s the thing about Priority Health Medicare Part D:
It’s confusing as heck.
Medicare Prescription Drug plans are a little bit of a pain. Companies have requirements, but how they meet those requirements is entirely up to the insurance company. The list of drugs and tiers that they cover are known as a formulary.
Since formularies can be so different between insurance companies and even plans, I’m not going to go into too much depth on them. However, there are some things I can tell you in regards to your other healthcare.
- Medicare Supplements do not have Medicare Part D attached to them. You will need to purchase a stand alone drug plan.
- Most common Medicare Advantage plans may or may not have a Part D plan. If they do, you must use that plan. If it doesn’t, you can’t sign up for a drug plan without dis-enrolling in your healthcare plan. Make sure your Medicare Advantage plan has a Part D.
- An insurance agent cannot ask you what drugs you are on. They can ask you if there are any drugs that you want to see are covered. Make sure your drugs are covered. If not, your doctor may need to switch your prescriptions to a covered drug.
What's The Verdict On Priority Health Michigan Medicare Plans?
Concerning Priority Health Michigan Medicare plans, you really need to look at the type of Medicare you want to work with.
If you want to go the Medicare Supplement route, I would not suggest Priority Health. They are not the best value of your premium dollar. You can easily save 30% or more using a less well know, but equally as strong plan.
As for Medicare Advantage, I would strongly consider them. Especially if your doctor’s are in network, you travel out of the area, and are interested in Silver Sneakers.