Priority Health - 2021 Commercial and Medicare Product Information

November 16, 2020

We’re excited to share 2021 product updates for our Commercial and Medicare products. The information below provides an at-a-glance view of changes. For more detailed product information, reference the attachments included with this email or view a recording of our Oct. 15 Virtual Office Advisory webinar, focused on product updates.

Our provider website will be updated with 2021 plan information prior to Jan. 1, 2021. We’ve also posted a news item with this information and supplemental material.

2021 Commercial product updates

New commercial plans in 2021

Priority Made Simple for large groups

Priority Made Simple is an HMO, POS and PPO* plan that offers all in-network coverage before deductible. Members will know the most they will pay for a doctor’s visit or procedure through clear “never-pay-more-than” copay amounts, allowing members to budget and seek the care they need without having to worry meeting their deductible or receiving unexpected bills. The plan has three easy to remember flat-dollar copay amounts for 1) primary care and mental health services 2) specialist, urgent care and emergency room visits 3) per day copay amount for inpatient and outpatient stays.

PriorityEngage for large groups

In March of 2021, we’re launching two new products called PriorityEngage and PriorityEngage Select for self-funded large groups. Both products are designed to help increase consumerism through a tiered benefit based on member behavior, such as shopping for select high-cost services. Under the new PriorityEngage Select benefit structure, members would receive a better benefit for any of the select services when they shop Priority Health’s Cost Estimator or connect with a concierge team to choose an at- or below-fair-market facility for the service.  In the PriorityEngage benefit structure,  members would receive a reduced benefit for any of the select services when they fail to shop Priority Health’s Cost Estimator or connect with a concierge team to choose an above fair-market facility for the service.


2021 commercial benefit changes effective Jan. 1

Virtual care and telehealth services - $0 for HDHP plans

High deductible health plans (HDHPs) will cover virtual care services in full ahead of deductible, through 2021 or through the end of the group’s 2021 plan year. Other telemedicine visits will be covered as they are today for HSA members, at the appropriate member cost-share after deductible. 


Retail care clinics: reasonable & customary (R&C)

HMO products will only cover in-network, contracted retail care clinics. POS and PPO products will cover in-network/contracted retail care clinics at the in-network benefit level, and out-of-network retail care clinics will be covered at the in-network level with R&C applying.


Spinal manipulation coverage added as standard benefit

Priority Health will now cover acute and maintenance spinal and osteopathic manipulations as a standard benefit. In addition to covering maintenance visits, we will also be pulling out spinal and osteopathic manipulation visits from the physical and occupational visit limits so spinal and osteopathic manipulation visits will now have 30 separate visits per contract year.



2021 Medicare product updates

New plans in 2021

PriorityMedicare Compass (PPO)

We’re introducing PriorityMedicare Compass (PPO), available in regions 3 and 4 and covering much of the northern counties in the power peninsula, which has a $0 combined medical deductible and $0 Rx deductible for generics (T1/T2), $0 PCP, $0 virtual visits and $25/Q OTC allowance.


PriorityMedicare Vital (PPO)

Our new PriorityMedicare Vital (PPO) plan is great for those on Original Medicare who want a hassle-free $0 premium plan that works like Original Medicare but offers a safety net and all the extras – vision, dental, hearing, fitness, OTC and drug coverage. Available in regions 1, 2 and 5, which includes the West and SE areas of Michigan.


PriorityMedicare Edge (PPO)

Our $0 premium PriorityMedicare Edge (PPO) plan launched this year in southeast Michigan, becoming the fastest growing PPO plan in the state. Due to it’s popularity, we’re expanding the plan to west and southwest Michigan in 2021. Additionally, we’ve made it even richer with a $0 PCP copay, $0 Rx deductible on all tiers, $0 labs and a $50/Q OTC allowance. Plus, it includes companion care with Papa.


2021 new Medicare benefits effective Jan. 1


In 2021, we’re adding a new supplemental benefit called BrainHQ. This tool is a personal gym for the brain, offering 29 online exercises that help with attention, brain speed, memory, people skills, navigation and intelligence. Members can register for an account by visiting


Insulin coverage in the “gap” (Part D Senior Savings Program)

In 2021, members in our PriorityMedicare Value plan will pay no more than $35 in the coverage gap or the initial coverage stage for select insulins. Members will pay a tier 2 copay ($10 at a preferred pharmacy) for Humalog and Humulin 100 unit/ml products and a $35 copay for Lantus & Toujeo. PriorityMedicare Value is available in all counties in the lower peninsula.

  • As a reminder, our Individual Medicare Advantage plan pharmacy benefits also include:
  • $0 deductible on Tiers 1 and 2 on all plans*
  • $0 mail-order on 90-day supply of Tiers 1 and 2 generic drugs on all plans*
  • Preferred pharmacy network*

*Not available on D-SNP


Virtual visits and additional telehealth:

Virtual care and telehealth services are covered at a $0 copay* for in-network virtual visits with PCPs, Specialists and now behavioral health providers (psychologists, psychiatrists, etc.). Members can schedule a visit with any in-network provider.

*Members on PriorityMedicare Vital will pay 20%.


Additional Medicare Advantage updates

Individuals with End State Renal Disease (ESRD) can now enroll in a Medicare Advantage plan

Effective January 2021, CMS will allow beneficiaries with ESRD to enroll in Medicare Advantage plans. All plans have a 20% coinsurance on dialysis and no prior authorization is required in 2021.


New supplemental benefits for Priority Health members


In 2021, we’ll continue to offer free virtual access to mental health support for members through myStrength. As of Jul. 1, 2020, we’ve expanded the offering to cover all 13 topic areas, including some specific to COVID-19. This digital tool includes a personalized plan for emotional support during challenging times. Users can create goals and habits, improve sleep and track health. There’s also a section for inspiration—all designed to keep users mentally strong. Activity topics include:

  • Strategies to manage heightened stress
  • Tips for parenting during challenging times
  • Ideas to manage social isolation
  • Simple ways to practice mindfulness