11/04/2021

We’re excited to share 2022 updates for our commercial and Medicare products. Below you’ll find an at-a-glance view of the changes. For more detail, you can watch a recording of our October 14 Virtual Office Advisory Webinar.

2022 Commercial product updates

New Commercial plan

PriorityAllowance

In January 2022*, we’re introducing PriorityAllowance. This new product gives each member an allowance to make health care more affordable, promote good health and remove barriers to care. When the member has an allowance available, we pay the claim – including the member’s portion. *Available for small groups. PriorityAllowance will be available to large group employers in spring 2022.

How it works:

• Each member has an allowance to cover select copays such as primary care, specialty care, virtual care, urgent care, labs and retail health
• Priority Health administers the allowance and covers the entire amount up to the amount they have remaining in their allowance.

Provider experience:

• When the member has an allowance available, we pay the claim – including the member’s portion (their copay).
• To see if your patient has an allowance, call us or ask the patient to check their allowance in the Priority Health member app
• We’re working to include enhanced member benefit information in prism to indicate when a copay or partial payment is owed at the time of service. We’ll keep you updated on this progress.

Commercial benefit changes effective January 1

2022 preventive changes: These include dietician coverage and recommended updates from the United States Preventative Services Taskforce, updating age parameters for Hepatitis C screening, colon cancer screening and lung cancer screening. See the full Preventive Health Care Guidelines. 

Large group coverage amendments

Large groups now have two additional buy-up options. Expanded infertility provides coverage for assisted reproduction and artificial conception related to infertility at 50% after deductible for in-network/preferred and out of network/alternate benefits levels.

Hearing care covers one hearing exam at 100% before deductible for non-HSA patients and 100% after deductible for HSA plans, plus an allowance per aid every 36 contract months. The enhancements for 2022 include out of network coverage for POS and PPO plans, plus employer groups can select from a suite of per hearing aid allowance amounts of $500, $750, and $1,000.

2022 Individual (MyPriority) product updates

• We’ve updated the naming structure of the Telehealth PCP plan to add more description for members selecting this plan. Our shopping page will now label the plan “MyPriority Telehealth PCP – Virtual First” and will show as “MyPriority Telehealth PCP Silver 5500 (Doctor On Demand PCP selection required) on healthcare.gov.
• Doctor On Demand visit copays have been lowered to $10 for PCP, Behavioral Health and Urgent Care. All in-person visits follow the Specialist copay, referral required for in-person care.

2022 Medicare product updates

No new Medicare plans in 2022

In 2022, we’re enhancing the same plans your patients know and love. No new plans, no service area changes.

Medicare benefit updates effective January 1

• Post-discharge meal delivery: 28 home-delivered meals included at no cost on all plans after an inpatient, psychiatric or Skilled Nursing Facility stay. Following discharge, up to four times per year, Mom’s Meals will contact the patient to deliver two weeks of meals (2 meals per day for 14 days.)
• Insulin coverage in the “gap”: Eligible members in our $0 PriorityMedicare Key plan will pay no more than $35 in the coverage gap or initial coverage stage for a 30-day supply of select insulins. Insulin coverage in the “gap” is also available on our PriorityMedicare Value plan.
• Monthly produce allowance: Eligible members with certain chronic conditions and who meet eligibility requirements in our $0 PriorityMedicare Vital plan will now receive $10 per month loaded onto their OTC card to use at checkout at participating retailers (Walmart, Kroger and more).
• $0 anticoagulant labs: This will help patients on blood thinners, like Warfarin or Coumadin, stay on them and better manage their health.
• $0 palliative care physician visits: This will give your patients the freedom to talk to a provider about relieving the symptoms and stresses of advanced illness.
• Enhanced supplemental benefits available on all PriorityMedicare plans, including better dental, more vision coverage and improved hearing extras.

Prior authorizations no longer required for:

• Diabetic shoes and/or inserts
• Non-emergent ambulance services
• Radiofrequency catheter ablatio for cardiac arrhythmia
• Thyroidectomy 

Medicare D-SNP plan enhancements

• New benefit! Post-discharge meal delivery: 28 home-delivered meals included at no cost on all plans after an inpatient, psychiatric or Skilled Nursing Facility stay. Following discharge, up to four times per year, Mom’s Meals will contact the patient to deliver two weeks of meals (2 meals per day for 14 days.)
• New benefit! Transportation will be covered as a supplemental benefit, which includes 30 one-way trips (limited to 30 miles per one-way trip) per year to/from health-related locations, through the SafeRide network.
• New $0 Tier 1 Preferred Generic Copay: Part D prescription drug copays vary based on the member’s Low Income Subsidy (LIS) category.
• Personal Emergency Response (PERS): All D-SNP members can obtain a device without meeting eligibility criteria. The member’s care manager will coordinate PERS devices at the member’s request.

Looking for more information on all the member programs we offer for your patients? We’ve created a webpage for just that. Visit Member Programs to learn more.