PriorityMedicare Thrive Plus (PPO) (PPO) 2025 Plan Details for Wayne County, Michigan Residents
PriorityMedicare Thrive Plus (PPO) (PPO) 2025 Plan Details for Wayne County, Michigan Residents
PriorityMedicare Thrive Plus (PPO) is a PPO Medicare Advantage plan, from Priority Health Medicare, {with_without_pdp} a prescription drug plan. It's CMS Plan ID is: H4875-018-5. It is not available in all areas. The list of locations where this plan is available can be found below.
According to CMS enrollment data (July, 2025), there are approximately 5,178 members enrolled in this plan.
PriorityMedicare Thrive Plus (PPO) (PPO) Overview
| CMS Fact | Landscape Value |
|---|---|
| Health Plan ID: | H4875-018-5 |
| CMS Overall Rating: | 0.0 out of 5 stars* |
| Medicare Advantage Plan Type: | PPO |
| Coverage Year: | CY2026 |
| Monthly Premium: | $49.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5600.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $100.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Wayne County, MI |
| Insured By: | Priority Health Medicare |
| Last Plan Content Update: |
Plan Availability by Location
Health Plan Out-of-Pocket Costs
Prescription Drug Costs & Benefits
PriorityMedicare Thrive Plus (PPO) includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $$41.60 |
|---|---|
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $$41.60 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $$8.80 |
| Low-Income Subsidy Premium: | $$32.80 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $100.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Priority Health Medicare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, PriorityMedicare Thrive Plus (PPO) may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $4.00 | $9.00 |
| Generic | $13.00 | $18.00 |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 40.00% | 45.00% |
| Specialty Tier | 33.00% | 33.00% |
| *Deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Need Help Enrolling?
| Website: | Priority Health Medicare Plan Page |
|---|---|
| Providers: | Priority Health Medicare Providers Page |
| Formulary: | Priority Health Medicare Formulary Page |
| Pharmacy: | Priority Health Medicare Pharmacy Page |
| New Member Health Plan Help: | (888)384-1695 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (888)384-1695 |
| New Member Part D TTY Users: | 711 |
Frequently Asked Questions
📘 What does Medicare plan code H4875 018 mean?
PriorityMedicare Thrive Plus (PPO) is a Medicare Advantage plan by Priority Health Medicare. The code H4875 is the CMS contract ID, whereas 018 is its plan ID.
- Plan Name: PriorityMedicare Thrive Plus (PPO)
- Plan Type: PPO
- Premium: $49.00/mo + your monthly Part B premium
- Out-of-Pocket Max: $5600.00 (in-network)
- Drug Coverage: {pdp_faq_summary}
- CMS Star Rating: 0.0 out of 5
- Contract Year: 2026
This information is based on official CMS data and is provided for educational purposes. Always review your plan’s official documents or contact the provider directly before making enrollment decisions.
📋 What type of plan is H4875 018?
This plan is a PPO — specifically, it's an PPO plan with a Medicare Advantage contract that's offered by Priority Health Medicare. It comes with defined provider network rules you should be aware of.
- Plan Marketing Name: PriorityMedicare Thrive Plus (PPO)
- Network Type: {plan_type_expanded}
- Referral Requirement: {referral_required_expanded}
- Prescription Coverage: {pdp_faq_summary}
Plan types like HMOs and PPOs determine whether you can go out-of-network or need referrals to see specialists.
📦 What benefits are included in H4875 018?
This plan covers all Medicare Part A and Part B services. Depending on the plan, it may also include valuable extras like dental, vision, and hearing benefits.
- Medical Services: Hospital, doctor visits, preventive care
- Prescription Drugs: Enhanced, $100.00 deductible
- Dental: {dental_benefit}
- Vision: {vision_benefit}
- Hearing: {hearing_benefit}
Benefit availability may vary by location and plan version. Confirm specific details in your plan's Evidence of Coverage (EOC).