Applies to Medicare Advantage plans only. To check and see what plan you have, visit your member account.
All individual Priority Health Medicare Advantage plans include out-of-area travel benefit when you visit any Medicare-participating provider, in the U.S., outside the lower peninsula of Michigan. Plus, our partnership with MultiPlan makes accessing Medicare-participating providers even easier. You'll have access to out-of-area providers and help locating the right doctor while traveling, so you can get the care you need while outside the lower peninsula of Michigan.
Note: If you are a Priority Health Medicare employer group member and your member ID card says "Out-of-network coverage" you can still visit any Medicare-participating provider in the U.S., but you may be subject to a deductible, and you may pay more for services than if you used an in-network provider. Refer to your Evidence of Coverage for full plan details.
How to find a Medicare-participating provider
You can visit any Medicare-participating provider outside Michigan, plus, our partnership with MultiPlan makes it even easier to get care when you are out-of-area.
- To locate a MultiPlan Medicare Advantage provider, refer to the Medicare Out of State Provider filter on Find a Doctor.
- To find all Medicare-participating providers, including out-of-state providers, visit medicare.gov/care-compare
Tips for using your travel benefit
Prior to traveling:
- Pack your Priority Health member ID card and your Priority Health Travel Pass when seeking care while traveling outside the lower peninsula of Michigan. Your ID card serves as proof of your insurance through Priority Health and clarifies that you have coverage outside the lower peninsula of Michigan. Your Priority Health Travel Pass helps providers understand how to bill Priority Health for your service.
- Know before you go. If you regularly visit a provider outside the lower peninsula of Michigan, call and let them know that Priority Health covers services received outside the lower peninsula of Michigan. This will help ensure your provider bills Priority Health for your services instead of you.
During your medical service:
- At your appointment, show your provider your Priority Health member ID card and Priority Health Travel Pass and let them know Priority Health covers medical services received outside of Michigan. Ask them to bill Priority Health for your service.
What to expect after your medical visit:
- If you spoke to your provider and they agreed to accept your Priority Health insurance, they should bill Priority Health for the services you received.
FAQs
Q: I’ve called my outside-of-Michigan provider and they won’t accept Priority Health insurance. What should I do?
A: Your Priority Health insurance can be used at any out-of-state facility in the U.S. However, if your provider does not wish to accept your insurance, and you continue to see them, they will bill you. If this happens, send us a member reimbursem*nt form. If you choose to change your provider, you have options. Before traveling, look for a provider near your destination who accepts Priority Health insurance. Visit medicare.gov/care-compare to search for out-of-state providers.
Q: My out-of-state doctor is not part of the MultiPlan Medicare Advantage network, do I have to find a different doctor in the MultiPlan network?
A: No, our partnership with MultiPlan just enhances our out-of-state travel benefit. You are still able to see any Medicare-participating provider outside of Michigan for in-network costs.
Q: I'm at the doctor's office and my out-of-state provider won't accept Priority Health insurance. What should I do?
A: Your Priority Health insurance can be used at any outside of Michigan facility in the U.S. However, your provider may not be familiar with Priority Health if they are located outside of Michigan. Encourage your doctor to call the number for providers on the back of your member ID card if they require confirmation that they can bill Priority Health for your visit. Your provider can also visit priorityhealth.com/provider to learn more about Priority Health and our Medicare out-of-state coverage benefit. If your provider does not wish to call to confirm or accept your insurance, consider seeing a new provider. Otherwise, the provider can bill you and you can send us a member reimbursem*nt form.
Q: When do I need a prior authorization for my care? What do I do and what does my doctor need to do?
A: Reference chapter four of your Evidence of Coverage (EOC) to find out what services your plan covers and what services require a prior authorization or contact Priority Health at the number on the back of your member ID card. Access your EOC in your member account. If the medical service you need requires prior authorization, your provider should reference our provider manualand click authorizations. There, your provider will find instructions for requesting an authorization and applicable forms.
