PriorityMedicare D-SNP (HMO D-SNP)
Available to residents of Alcona County, MI for 2026. Contract H8379, plan 001, segment 0.
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- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Alcona County
- Plan website
- Browse the PriorityMedicare D-SNP (HMO D-SNP) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $8.80 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $8.80? |
| Drug premium in CMS's quarterly plan file | $0.00The CMS Landscape file above lists $8.80 for the drug part; the two CMS files differ for this plan. |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | $545.00 |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $615.00Tier 1 and 2 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO D-SNP? |
| Special needs plan | Dual-eligible SNP |
| Contract / plan | H8379-001-0 |
| Offered by | Priority Health Medicare |
| Parent organization | Corewell Health |
| Formulary drugs | 3,310 |
| Formulary exception tier | 4? |
| Pharmacy search | www.priorityhealth.com/dsnp |
| Member services | (877)729-4124TTY 711 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H8379 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay(authorization required) |
| Other health care professional | 35% coinsurance |
| Additional telehealth services | $0 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay(referral required) |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 35% coinsurance(authorization required) |
| Lab services | 35% coinsurance(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | 35% coinsurance(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | 35% coinsurance(authorization required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | 30% coinsurance |
| Worldwide emergency coverage | $0 copay |
| Worldwide urgent care | $0 copay |
| Worldwide emergency transportation | $0 copay |
| Hospital care | |
| Inpatient hospital stay | $2,000 per stay(authorization required) |
| Outpatient hospital services | 0%–35% coinsurance(authorization required) |
| Outpatient observation | 35% coinsurance |
| Ambulatory surgical center | 35% coinsurance(authorization required) |
| Outpatient blood services | 35% coinsurance |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $218 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance |
| Rehabilitation | |
| Occupational therapy | 30% coinsurance |
| Physical therapy and speech-language therapy | 30% coinsurance |
| Cardiac rehabilitation | 30% coinsurance |
| Pulmonary rehabilitation | 30% coinsurance |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $2,000 per stay(authorization required) |
| Outpatient mental health, individual session | $0 copay |
| Outpatient mental health, group session | $0 copay |
| Psychiatrist, individual session | $0 copay |
| Psychiatrist, group session | $0 copay |
| Partial hospitalization | 30% coinsurance(authorization required) |
| Intensive outpatient program | 30% coinsurance |
| Outpatient substance use, individual session | $0 copay |
| Outpatient substance use, group session | $0 copay |
| Opioid treatment program | $0 copay |
| Ambulance and transportation | |
| Ground ambulance | 35% coinsurance(authorization required) |
| Air ambulance | 35% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 20% coinsurance |
| Diabetic therapeutic shoes or inserts | 20% coinsurance |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay |
| Routine chiropractic care | $0 copay(limits apply) |
| Acupuncture | $0 copay(limits apply) |
| Foot exams and treatment (Medicare-covered) | $0 copay |
| Routine foot care | $0 copay(limits apply) |
| Dental? | |
| Preventive dental plan limit | $1,500 plan limit every year |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay(limits apply) |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | $0 copay(limits apply) |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | $0 copay(limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Eyewear plan limit | $200 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Covered (allowance not stated) |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay |
| Health education | $0 copay |
| Nutritional / dietary benefit | $0 copay |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | $0 copay |
| Telemonitoring | $0 copay |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | $0 copay |
| Counseling services | Not covered |
| In-home safety assessment | $0 copay |
| Personal emergency response system (PERS) | $0 copay |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | $0 copay |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | $0 copay |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | 25% |
| Tier 4 | 25% |
| Tier 5 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 57 other MI counties
- Allegan
- Alpena
- Antrim
- Arenac
- Bay
- Benzie
- Charlevoix
- Cheboygan
- Clare
- Clinton
- Crawford
- Eaton
- Emmet
- Genesee
- Gladwin
- Grand Traverse
- Gratiot
- Hillsdale
- Huron
- Ingham
- Ionia
- Iosco
- Isabella
- Jackson
- Kalkaska
- Kent
- Lake
- Lapeer
- Leelanau
- Lenawee
- Livingston
- Manistee
- Mason
- Mecosta
- Midland
- Missaukee
- Monroe
- Montcalm
- Montmorency
- Muskegon
- Newaygo
- Oakland
- Oceana
- Ogemaw
- Osceola
- Oscoda
- Otsego
- Ottawa
- Presque Isle
- Roscommon
- Saginaw
- St. Clair
- Sanilac
- Shiawassee
- Tuscola
- Washtenaw
- Wexford
Benefits in plain text
PriorityMedicare D-SNP (HMO D-SNP) (H8379-001-0) is a 2026 HMO D-SNP Medicare Advantage plan offered by Priority Health Medicare, available to residents of Alcona County, MI.
The monthly premium is $8.80 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
The in-network deductible for health services is $545.00.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $615.00. Tier 1 and 2 exempt.
It is a special needs plan (Dual-eligible SNP).
The plan's formulary lists 3,310 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: 25%; tier 4: 25%; tier 5: 25%.
CMS gives the plan's contract (H8379) an overall rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.