Medicare Advantage plan benefits

Medicare Advantage plans are offered by private insurance companies like Priority Health.

See a summary of benefits for the Priority Health Medicare Advantage plans:

Original Medicare Part A and Part B benefits

  • Initial preventive physical examination (IPPE), also known as the "Welcome to Medicare" visit, is a preventive E&M service that includes 7 components; note that clinical lab tests and preventive services that are currently covered and paid for by Medicare Part B must be billed separately from the IPPE. See IPPE info on cms.gov.
  • Annual wellness visit, including personalized prevention plan services:
    See AWP info on cms.gov.
  • Abdominal aortic aneurysm ultrasound screening (one-time) for eligible beneficiaries: See MLN SE0711 on cms.gov.

Additional services covered by Priority Health Medicare plans

  • Admission to skilled nursing facilities without having to be in the hospital 3 days prior to admission. See details.
  • Preventative and comprehensive dental services, with enhanced dental coverage also available.
  • Routine vision services, with enhanced vision coverage also available.
  • Routine hearing services.
  • Comprehensive physical is covered once per calendar year if billing guidelines are followed.
  • In-home safety assessments and post-discharge medication reconciliation.
  • Medication Therapy Management visits with pharmacists. See details.
  • Nutritional education for members with medical conditions. Physician recommendation is required. See details.
  • Unlimited medical hospital days.
  • Physical wellness programs, including membership with One Pass® (mental fitness, gym memberships and digital fitness options, depending on plan)
  • Mental wellness tools with Teladoc Health Mental Health®.
  • Out-of-state health coverage.
  • Worldwide emergency and urgent care coverage.
  • A personal emergency response system, available to all PriorityMedicare D-SNP members and to all other members enrolled in the Enhanced Disease Management program
  • Non-emergency transportation, available on select plans.
  • Over-the-counter and wellness allowances available on select plans.
  • Galleri multi-cancer early detection test provided by GRAIL available on select plans. 

Provider benefit briefs

For more information about some of the additional services listed above and other extra benefits we provide our Medicare members, view and download these provider benefit briefs. These briefs include benefit descriptions, vendor partner information, information on where services related to the benefit may be performed, authorization requirements, short guides to accessing and using the benefit, coverage criteria, FAQs and more. 

Note: these benefit briefs are intended for providers only. If your patients come to you with questions about their benefits, they should be directed to the Medicare member information section of our site to find information about their plan, including extra benefits. They can also contact member support through their online member portal or by calling the number on the back of their Priority Health member ID card. 

Member information

Go to the Priority Health Medicare member web section for plan summaries (copayments & benefits overviews) and formulary information.

Health risk appraisals (HRAs) and high-risk members

Within 90 days of enrollment, Priority Health Medicare Advantage plan members are mailed a health risk appraisal survey to complete. This is a Medicare requirement for all Part C plans. Members who are identified as high-risk according to the health risk appraisal information as well as all PriorityMedicare D-SNP members, are assigned to a Priority Health nurse care manager. The care manager coordinates services for the member and develops a care plan for him/her in consultation with the member's primary care physician's office.